This number may be slightly exaggerated according to other sources. According to the Intersex Society of North America (2008), approximately one in every 1,500 children is born with no clear sex or born with characteristics of both sexes. The birth of hermaphroditic or intersex children is not altogether uncommon. Gender differences are 'differences in the roles and behavior of males and females that are prescribed by the culture.' However whether the person in question accepts that gender assignment that they have been given based upon their physical body is gender identity or 'a person's acceptance of the roles and behaviors that society associates with the biological categories of male and female.' An hermaphroditic person is one who does not belong to one sex or the other and consequent interference from other people can affect that person's gender as well. In her book The Developing Person (2009), psychologist Kathleen Stassen explains the difference between gender and sex. sex and the question of nurture over nurture in which factor determines how a child will create their identity in a world of obstacles. Annabel artistically describes the conflicting ideas of gender vs. Therefore, the only way that the person is labeled with regard to these categories is by the gender imposition of his or her mother and father who are clearly physically and sociologically male and female.

A young person is born without a clear distinction over what his or her physical sex is and thus the physical cannot determine if the begin is man or woman. This distinction is the subject of the novel Annabel by Kathleen Winter. There is a clear delineation between gender and sex.

Gender is the sociological difference that society places on male and female based on attributes that have been historically applied to one sex over the other.

Sex is the physical difference between men and women. Sociologists have made it clear that these are, in fact, two very different concepts. Many people use the terms gender and sex interchangeably.