Pilipili derives from Akkadian, an extinct East Semitic language spoken in ancient Mesopotamia (Akkad, Assyria, and Babylonia). It refers to a gender nonconforming individual who undergoes a significant transformation at the hands of the deity Inanna, (Ishtar in Assyria).

It involved a purification ceremony that marked significant transitions in identity, gender, or social status, acknowledging those who did not conform to binary roles and instead held distinct social or spiritual positions. The ritual formally recognised their new identity within the community and was marked by also renaming the individual.