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Introduction <p>Students with innate variations of sex characteristics (IVSC; also known as intersex variations) encounter significant challenges within health and physical education (HPE) in school settings negatively impacting their educational outcomes. The scarcity of comprehensive synthesis of existing empirical literature underscores the urgent need for focused inquiry to inform IVSC-inclusive HPE education policies, curricula, and practices. This scoping review maps the experiences and outcomes of students with IVSC in the learning are of HPE.</p> Methods <p>In alignment with the PRISMA-ScR framework and JBI guidelines, this review drew on Arksey and O’Malley’s five-stage framework. Nine electronic databases were used with literature searched on 16 January, 2025. Included empirical studies were written in English, full-text accessible online, with no geographical or date limitations, and relevant to the research question. Chartered data was meta-synthesised first using a modified socio-ecological framework, and further synthesised inductively using reflexive thematic analysis within the three levels.</p> Results <p>21 studies were included in the final synthesis with 15 using qualitative methodologies, five being cross-sectional, and one using mixed-methods design, across a range of nations, including Australia, China, Europe, New Zealand, North and South America, South Africa, and the Pacific. Of the included studies, 13 were peer-reviewed, with a majority quality appraisal score above 75%, and eight were grey literature, published from 2009 to 2024. Findings were meta-synthesised across three levels of barriers and further synthesised inductively through reflexive thematic analysis. Structural barriers included sub-themes of curriculum invisibility, limited staff training, and impeding environmental conditions, whilst interpersonal barriers included sub-themes of exclusionary language, discriminatory remarks, stigmatised attitudes and bullying behaviours. Individual barriers highlighted sub-themes of self-isolation, feelings of shame, medicalised body image, and low self-confidence.</p> Conclusions <p>The findings underscore how students with IVSC encounter poly-layered and ongoing challenges in accessing safe and inclusive HPE within school settings. These challenges substantially contribute to adverse mental health outcomes among students with IVSC and have long-term implications for their educational engagement and achievement, inconsistent with human rights and anti-discrimination legislation.</p> Policy Implications <p>This review highlights the critical need for robust empirical data on the experiences of students with within HPE globally, including protective factors. Such evidence is essential in evaluating the current landscape and progress toward creating HPE and school environments that are inclusive, affirming and safe, for students with IVSC, and informing policy reform that advance their health and human rights in educational settings.</p>

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The Experiences and Outcomes of Students with Innate Variations of Sex Characteristics in Health and Physical Education: A Scoping Review and Meta-Synthesis of Empirical Literature

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月18日

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  • Christine Monjal,
  • Annette Brömdal,
  • Agli Zavros-Orr,
  • lisahunter,
  • Kirstine Hand

摘要

Introduction

Students with innate variations of sex characteristics (IVSC; also known as intersex variations) encounter significant challenges within health and physical education (HPE) in school settings negatively impacting their educational outcomes. The scarcity of comprehensive synthesis of existing empirical literature underscores the urgent need for focused inquiry to inform IVSC-inclusive HPE education policies, curricula, and practices. This scoping review maps the experiences and outcomes of students with IVSC in the learning are of HPE.

Methods

In alignment with the PRISMA-ScR framework and JBI guidelines, this review drew on Arksey and O’Malley’s five-stage framework. Nine electronic databases were used with literature searched on 16 January, 2025. Included empirical studies were written in English, full-text accessible online, with no geographical or date limitations, and relevant to the research question. Chartered data was meta-synthesised first using a modified socio-ecological framework, and further synthesised inductively using reflexive thematic analysis within the three levels.

Results

21 studies were included in the final synthesis with 15 using qualitative methodologies, five being cross-sectional, and one using mixed-methods design, across a range of nations, including Australia, China, Europe, New Zealand, North and South America, South Africa, and the Pacific. Of the included studies, 13 were peer-reviewed, with a majority quality appraisal score above 75%, and eight were grey literature, published from 2009 to 2024. Findings were meta-synthesised across three levels of barriers and further synthesised inductively through reflexive thematic analysis. Structural barriers included sub-themes of curriculum invisibility, limited staff training, and impeding environmental conditions, whilst interpersonal barriers included sub-themes of exclusionary language, discriminatory remarks, stigmatised attitudes and bullying behaviours. Individual barriers highlighted sub-themes of self-isolation, feelings of shame, medicalised body image, and low self-confidence.

Conclusions

The findings underscore how students with IVSC encounter poly-layered and ongoing challenges in accessing safe and inclusive HPE within school settings. These challenges substantially contribute to adverse mental health outcomes among students with IVSC and have long-term implications for their educational engagement and achievement, inconsistent with human rights and anti-discrimination legislation.

Policy Implications

This review highlights the critical need for robust empirical data on the experiences of students with within HPE globally, including protective factors. Such evidence is essential in evaluating the current landscape and progress toward creating HPE and school environments that are inclusive, affirming and safe, for students with IVSC, and informing policy reform that advance their health and human rights in educational settings.