Respecting variations in embodiment as well as gender: Beyond the presumed 'binary' of sex

Although societies and health care systems are increasingly recognizing gender outside traditional binary categories, the notion persists of two, and only two sexes, 'naturally' aligned between chromosomes and phenotypic body. Yet there are more than a dozen documented genetic or phenotypic variations that do not completely fit the two simplistic categories, and together, they may comprise 1%-2% of the population worldwide. In this commentary, I consider how adherence to binary notions of sex has created and maintained social and health care structures that perpetuate health care inequities, and may well violate our nursing codes of ethics. I provide some current examples in law and health care systems that create difficulties for people with variations in sex development. I describe our responsibility to challenge the societally promoted but scientifically inaccurate perspective of sex as a binary. I conclude by briefly suggesting a few implications for action within nursing research, nursing education, nursing practice, and in advocacy as a profession.