Sex and Gender are Different:
Sexual Identity and Gender Identity are Different
Milton Diamond, Ph.D.
University of Hawaii, John A. Burns School of Medicine
Department of Anatomy and Reproductive Biology
Pacific Center for Sex and Society

Clinical Child Psychology & Psychiatry -
Special Issue In Press for July 2002

Special Editors:
Bernadette Wren, Portman Clinic
Fiona Tasker, University of London

Sex and Gender are Different:
Sexual Identity and Gender Identity are Different

Abstract:
This paper attempts to enhance understanding and communication about different sexual issues. It starts by offering definitions to common terms like sex, gender, gender identity, and sexual identity. Alternate ways to discuss one's sexual attractions are also presented. Terms are defined or redefined and examples given of their preferred use in different clinical situations including those associated with children. Adherence to the usage advocated here is proposed as helpful in theory formulation and discussion as well as in clinical practice. When reference is made to individuals of various sexual-minority groups such as transsexual or intersexual persons, the distinctions offered are particularly advocated.
Key Words:
Sexual Identity, Gender Identity, Sexual Orientation
Transsexuality, Intersexuality, Transvestite, Transgender, ambiguous genitalia
Introduction: Sex and Gender:

For the last several decades the term gender has come into common usage particularly as a synonym for sex. The term has proved useful in many ways although distinctions between the two words, sex and gender, when one might be more appropriate than the other, has not been firmly established. In most instances, particularly in casual conversation, the words gender and sex are used interchangeably and it seems to make little difference. If there is room for doubt the context generally makes the meaning clear. However, in scientific, medical, legal or political and even religious discourse the discrepant use of the terms can lead to confusion and a lack of understanding.
Here is a quote from a recent report (Schmidt 2001): "the findings [of a second gene related to sex determination] offer new hope for parents whose babies are born with this [ambiguous genital] condition - as well as valuable information to help physicians more accurately and quickly diagnose the newborn's gender." Knowing the genetics of a child's sex in cases with ambiguous genitalia is not always helpful in knowing what a child's genitals would look like and certainly rarely helpful in predicting a child's gender. The term sex is related to anatomical structure, the term gender is related to an imposed or adopted social and psychological condition. Explaining the difference to anguished parents and confused physicians occupies a good part of my time. Both parents and many professionals assume that knowing sex infers gender but this is not always the case.
Maintenance of clear conceptual distinctions between the two words sex and gender and associated concepts is particularly helpful for the psychological understanding of identity. This paper attempts to show that, in certain contexts --particularly those involving transsexuality and intersexuality but in other instances as well-- it is most useful to recognize and encourage the distinction.
The term sex, since classical times, has been used to designate matters related to biology and medicine when male, female or bisexual were in context. Thus animals, including humans, are categorized dependent upon whether they either produce gametes as, or similar to, spermatozoa (males) or ova (females), or have parts of the reproductive system appropriate to the development of and delivery or reception of such gametes. Among non-human animals bisexuality covers those cases where both male and female reproductive components are present.1 Among animals the term bisexuality, unless specifically so-stated, usually refers to anatomy and not to sexual