Geographies of the secret: Navigating medical, activist, and intimate spaces in intersex research in Chile

This article examines how medical secrecy, family silence, and nascent activism produce distinct spatial-cultural regimes that shape health outcomes, care pathways, and health inequities for intersex people in Chile. It contributes a spatial-analytic framework to medical anthropology debates on clinical secrecy, contested diagnostic nomenclature, and epistemic injustice in healthcare. Multi-sited reflexive ethnography was conducted in Chile between October 2020 and December 2023, primarily in Santiago. The study draws on 30 semi-structured interviews-14 with intersex individuals (aged 19-45), of whom one additionally provided a life history interview; 5 specialist physicians, 7 parents/guardians, 2 academic researchers, 1 government official, and 1 international activist-supplemented by approximately 340 h of participant observation across virtual, institutional, domestic, and café-based settings. Analysis followed a constructivist grounded theory approach. Medical institutions, families, and activist organizations produce distinct 'geographies of secrecy' that render intersex bodies selectively visible and impose specific health consequences: clinical spaces generate epistemic injustice through information hoarding and paternalistic consent practices; family spaces enforce silence that isolates individuals from diagnosis, community, and healthcare; activist spaces offer collective recognition while simultaneously producing new exclusions. The concept of 'calibrated disclosure' captures how intersex people strategically manage visibility across spatial contexts with direct implications for healthcare access and wellbeing. The article introduces 'embodied accountability' as a methodological principle for reflexive research with small, geographically concentrated marginalized communities. Findings highlight the need for healthcare systems to address not only clinical protocols but the spatial-institutional conditions that produce epistemic injustice and impede informed consent for intersex people.