According to Lang, female assigned at birth two-spirits usually have sexual relations or marriages with only females. Two-spirits might have relationships with people of either sex. According to Will Roscoe, male and female two-spirits have been "documented in over 130 North America tribes, in every region of the continent". The presence of male two-spirits existed before European contact, and "was a fundamental institution among most tribal peoples". Two-spirit is a modern umbrella term used by some indigenous North Americans for Gender variant individuals in their communities.
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