The terms sex and gender are often used interchangeably, but these terms have different contexts and meanings. Gender is socially constructed and operates as a way to identify and categorize certain behavioral, cultural, and psychological traits as belonging to specific groups of people. Sex is a biological construct that refers to the structural, functional and behavioral characteristics of living beings determined by sex chromosomes. Although the sexual system is often described as a binary of male and female, in reality there is a spectrum of anatomical and chromosomal variation found in the human population including intersex as well as genitalia considered ambiguous at birth. In addition, sexual anatomy has a long history of surgical intervention such a circumcision, vasectomy, tubal ligation and more recently, sex reassignment surgery. Sexual anatomy has typically been described using only heterocentric language and binary sexual identity, with an assumption that sex only occurs between a cis-gendered man and woman, for the purpose of reproduction, making it one of the least inclusive and representative topics found in anatomy textbooks. In this chapter, we attempt to present anatomy and physiology in ways that incorporate more lived experiences, rather than only what exists at the binary extremes.