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Gender verification emerged as an issue in sporting competition 30 years ago when the International Olympic Committee (IOC) first began testing the ‘sex’ of athletes in the Olympic games. The IOC was responding to concerns that some athletes from then Communist countries of Eastern Europe were actually men masquerading as women.

The very first tests, which were invasive and controversial gynaecological examinations, were conducted in 1966. Then came the sex chromotin test at the Mexico Olympic Games which relied on the biological fact that all the cells of most female mammals contain two X chromosomes, while cells from males have one X and one Y chromosome.

Officials who test athletes take a sample of cells from the inside of the cheek, in a process known as the buccal smear test, then examine them under a microscope for the presence of these chromosomes. Until 1991, each woman competing internationally needed a gender verification card which contained a photograph and statement that she had passed the chromosome sex test used by the IOC.

While the notion of a sex test to find men disguised as women may seem a reasonable idea, the trouble is that it misses some hereditary disorders whereby women may have chromosomal abnormalities that cause them to ‘fail’ a test, while men with chromosomal abnormalities could theoretically ‘pass’ the test.

If a female athlete ‘fails’ a test, she undergoes a physiological examination. A negative test can cause incredible distress to women whose gender is suddenly called into question and there are many documented cases where women’s lives have undergone massive change because of sudden public scrutiny.

One such woman was Polish sprinter Eva Klobukowska who, at the European Championships in Budapest in 1966, passed a gynaecological examination. One year later, after the introduction of sex chromatin testing, she was found to have one chromosome too many to be declared a woman for the purposes of athletic competition. Despite having a rare XXY condition that gave her no advantage over other athletes, she was forced to return her Olympic and other medals and retired from competition surrounded by controversy.

Until 1990, the International Amateur Athletic Federation had relied on the buccal smear test, but following repeated discrepancies in test results, the federation abandoned the process and returned to physical examinations. These examinations became general health checks of both male and female athletes, a component of which for females was a physical examination for gender. They were to be conducted by national federations and any athletes holding an International Amateur Athletic Federation femininity certificate would not be exempt from further examinations (although no athlete would be tested more than once a year). Athletics Australia and other federations chose to advise their athletes that tests would be conducted by a doctor of the athlete’s choice should a random test be needed.

This new approach created problems including disquiet about the need for an intrusive examination, questions about those selected to conduct the examination and the difficulty for individuals who have attributes of both sexes. In 1992, the IOC decided to introduce more sophisticated tests which looked even more closely at the genetic make-up of the Y chromosome. Called the polymerase chain reaction test, this still did not eliminate all the issues surrounding the accuracy of the test. At the 1996 Atlanta Olympic Games, officials again reverted to the buccal smear test. About one in 400 females in Atlanta tested male, but all were cleared by subsequent physical examinations.

In late 1999, the IOC Medical Commission reviewed its medical code and agreed to change the requirement for gender verification tests from mandatory for all female athletes, to random.