Intersex people pee the same way everyone else does: urine leaves the bladder through the urethra and exits the body. The basic plumbing works the same regardless of whether someone has an intersex variation. What can differ is where the urethral opening is located on the body or, in rarer cases, how the bladder and urethra developed. Most intersex people urinate without any difficulty at all, and many never even know they have an intersex trait.
Why the Process Is Usually the Same
Urination depends on three things: a functioning bladder, a urethra to carry urine out, and nerves that signal when the bladder is full. Intersex variations mostly affect how the external genitals look or how the reproductive organs developed. They don’t typically change the urinary system itself. A person whose genitals look different from what’s considered typical still has a bladder that fills, muscles that relax, and a urethra that drains, just like anyone else.
“Intersex” is an umbrella term covering dozens of different conditions. Some involve hormone differences, some involve chromosomes, and some involve the physical structure of the genitals. Only a handful of these variations affect urinary anatomy in any meaningful way.
When the Urethral Opening Is in a Different Spot
One of the most common intersex-adjacent variations is hypospadias, where the urethral opening is not at the tip of the penis. According to the CDC, the opening can appear anywhere from just below the head of the penis to the point where the penis meets the scrotum. Hypospadias is relatively common, affecting roughly 1 in every 200 births with a penis.
A person with hypospadias still urinates through the urethra. The difference is the angle and direction of the urine stream, which can vary depending on where the opening sits. In milder cases (near the tip), many people never notice a functional issue. In more significant cases, where the opening is along the shaft or closer to the scrotum, the stream may spray or aim downward, which can make standing urination messy or impractical. Some people with these variations simply sit to pee, which works perfectly well.
There’s also a much rarer variation called epispadias, where the urethral opening is on the top surface of the penis rather than the underside. This can affect both the direction of the stream and, in some cases, bladder control, depending on how the surrounding muscles developed.
Variations That Affect the Bladder
A small number of intersex conditions involve more significant differences in the urinary tract. One example is cloacal exstrophy, a rare condition where the bladder doesn’t form into its normal hollow shape and instead develops as a flat, open plate. In these cases, the bladder can’t fill or empty properly on its own. Spina bifida, which often accompanies this condition, can also affect the nerves that control the bladder.
People born with these variations typically need surgery early in life to reconstruct the bladder and close the abdominal wall. Additional surgeries during childhood are common as the body grows. The long-term goals of treatment focus on protecting the kidneys, reducing urinary infections, and helping the person develop reliable strategies for urination. Some individuals achieve full continence, while others may use catheters (thin tubes inserted into the urethra to drain the bladder) as a normal part of their routine. This isn’t painful once it becomes familiar, and many people who catheterize describe it as no more burdensome than wearing glasses.
The Role of Surgery
Some intersex people undergo genital surgery in childhood, either to address a functional concern or, more controversially, for cosmetic reasons. These surgeries can sometimes affect urination, for better or worse. Reconstructive procedures that reposition the urethra generally aim to create a more typical urine stream, but they carry risks like any surgery.
A study of children with congenital adrenal hyperplasia (a condition where higher androgen levels cause the genitals to develop with more typically masculine features in people with XX chromosomes) found that after reconstructive surgery, all patients over age three were fully toilet-trained without incontinence. About 15% experienced recurrent urinary tract infections during follow-up, and roughly 7.5% needed an additional surgery to address complications. These numbers reflect outcomes from specialized centers using modern techniques; results can vary.
It’s worth noting that many intersex adults and advocacy organizations have raised concerns about performing surgery on infants who can’t consent, particularly when the surgery is cosmetic rather than medically necessary. Urinary function is generally considered a valid medical reason for intervention, while reshaping genitals to look more typical is increasingly viewed as something the individual should decide for themselves when they’re older.
What Day-to-Day Life Looks Like
For the vast majority of intersex people, urination is completely unremarkable. Many intersex variations, like differences in sex chromosomes or internal reproductive anatomy, have zero effect on how someone pees. Even among those with visible genital differences, most find a comfortable method without medical intervention.
Some intersex people with atypical urethral placement choose to sit while urinating. Others use the restroom standing up without issue. People who need catheterization develop a quick routine that takes a couple of minutes. The practical reality is far less dramatic than many people imagine when they first encounter the topic. Bodies are adaptable, and there are only so many ways urine needs to get from point A to point B.