伝統的な性別の二元論に反対する者は、イナンナの信仰に深く関わっていた<ref>Leick, 2013, pages157–158</ref>。シュメール時代には、イナンナの神殿でガラ(gala)と呼ばれる神官たちが働き、哀歌や嘆きを奏でたという<ref>Leick, 2013, page285</ref>。ガラになった男性は女性の名を名乗ることもあり、その歌はシュメール語のエメ・サル(''eme-sal'')という方言で詠まれた。この方言は、文学作品では通常、女性の登場人物が話すためのものである。シュメールの諺には、ガラが男性とアナルセックスをすることに定評があったことを示唆するものもあるようだ<ref>Roscoe, Murray, 1997, page65</ref>。アッカド時代、イシュタルの神殿で女装して戦いの踊りを披露したイシュタルの召使がクーガルやアシンヌである<ref>Roscoe, Murray, 1997, pages65–66</ref>。アッカド語のことわざの中には、彼らが同性愛の性癖を持っていた可能性を示唆するものがいくつかあるようだ<ref>Roscoe, Murray, 1997, pages65–66</ref>。メソポタミアに関する著作で知られる人類学者グウェンドリン・レイクは、これらの人物を現代のインドのヒジュラになぞらえている<ref>Leick, 2013, pages158–163</ref>。アッカド語の讃美歌には、イシュタルが男性を女性に変えるという表現がある<ref>Roscoe, Murray, 1997, page66</ref><ref>Brandão, 2019, p63</ref>。
紀元前20世紀後半、イナンナ信仰は、王がドゥムジに扮し、女神に扮したイナンナの大神官と儀式的に性交することで自らの正統性を確立する「聖なる結婚」の儀式があると広く信じられていた<ref>Kramer, 1970</ref><ref>Nemet-Nejat, 1998, page196</ref><ref>Brandão, 2019, p56</ref><ref>Pryke, 2017, pages128–129</ref>。
Throughout the latter half of the twentieth century, it was widely believed that the cult of Inanna involved a "[[hieros gamos|sacred marriage]]" ritual, in which a king would establish his legitimacy by taking on the role of Dumuzid and engaging in ritual sexual intercourse with the high priestess of Inanna, who took on the role of the goddess.{{sfn|Kramer|1970}}{{sfn|Nemet-Nejat|1998|page=196}}{{Sfn|Brandão|2019|p=56}}{{sfn|Pryke|2017|pages=128–129}} This view, however, has been challenged and scholars continue to debate whether the sacred marriage described in literary texts involved any kind of physical ritual enactment at all and, if so, whether this ritual enactment involved actual intercourse or merely the symbolic representation of intercourse.{{sfn|George|2006|page=6}}{{sfn|Pryke|2017|pages=128–129}} The scholar of the ancient Near East Louise M. Pryke states that most scholars now maintain, if the sacred marriage was a ritual that was actually acted out, then it involved only symbolic intercourse.{{sfn|Pryke|2017|page=129}}
The cult of Ishtar was long thought to have involved [[sacred prostitution]],{{sfnm|1a1=Day|1y=2004|1pp=15–17|2a1=Marcovich|2y=1996|2p=49|3a1=Guirand|3y=1968|3p=58|4a1=Nemet-Nejat|4y=1998|4p=193}} but this is now rejected among many scholars.{{sfnm|1a1=Assante|1y=2003|1pp=14–47|2a1=Day|2y=2004|2pp=2–21|3a1=Sweet|3y=1994|3pp=85–104|4a1=Pryke|4y=2017|4p=61}} [[Hierodules]] known as ''ishtaritum'' are reported to have worked in Ishtar's temples,{{sfn|Marcovich|1996|page=49}} but it is unclear if such priestesses actually performed any [[sex act]]s{{sfn|Day|2004|pages=2–21}} and several modern scholars have argued that they did not.{{sfn|Sweet|1994|pages=85–104}}{{sfn|Assante|2003|pages=14–47}} Women across the ancient Near East worshipped Ishtar by dedicating to her cakes baked in ashes (known as ''kamān tumri'').{{sfn|Ackerman|2006|pages=116–117}} A dedication of this type is described in an Akkadian hymn.{{sfn|Ackerman|2006|page=115}} Several clay cake molds discovered at Mari are shaped like naked women with large hips clutching their breasts.{{sfn|Ackerman|2006|page=115}} Some scholars have suggested that the cakes made from these molds were intended as representations of Ishtar herself.{{sfn|Ackerman|2006|pages=115–116}}