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PubMed1983

Femininity, masculinity, and sexual orientation: some cross-cultural comparisons.

Predominantly homosexual males from Australia (n = 163), Sweden (n = 176) and Finland (n = 149) were compared on the Bem Sex-Role Inventory and on various measures of partner preference in order to establish the relationship between degree of homosexuality in terms of Kinsey Scale position and gender identity. Results suggest that while there is no relationship between femininity and degree of homosexuality, masculinity is inversely related depending on the degree of sex role stereotyping and anti-homosexual attitudes of the society the subjects live in. Such findings suggest that deviant gender identity is a function not of homosexuality as such but of societal attitudes which may reinforce a homosexual role.

Adult↗
PubMed1994

[Gender identification disorders from the clinical perspective. A contribution from psychiatric practice].

Referring to the recent debate on how to describe and classify "transsexual phenomena" according to psychopathological and diagnostic criteria and the necessary definition of standards of care, this investigation is intended as a clinically oriented contribution to the study of gender identity disorders. Beside a literature review to outline the different theoretical positions, several case reports are presented to illustrate and analyze the variety and complexity of conditions which are underlying or concomitant to the desire for a sex change. This study focuses on the need for more careful diagnostic considerations and scrupulous follow-up of patients presenting with the conviction of wrong sex assignment. Although it seems reasonable to "detotalize" transsexualism, the authors plead for the adherence to a clinically oriented approach to this issue. They disagree with arguments to abandon a "nosomorphic view" or with notions that regard transsexualism as a "minority which has been pathologized". In order to match demands properly and to give adequate advice it appears necessary to improve general knowledge and specific therapeutic competence in the field of gender identity disorders.

Adult↗
PubMed2005

[Sex/Gender research -- introduction and anesthesiological aspects].

On the one hand gender studies are based on the differentiation of biological (sex) and social (gender) identities. Above all, gender studies in public health research are seen as an biological, psychological and social entity. To understand the complexity linked to the term "gender" in medicine, different perspectives are required. Apart from the uncertainty, which may occur by the changing perspective on gender, it also holds the option for innovation in anesthesiology, too. The goal of gender based medicine is an optimized, individual adjusted medical care. Precondition to realize this aim is the understanding of the genesis, the consolidation, and the elimination of gender biases in all fields of research, publications and education. The transfer of methods and guidelines for gender sensitive research, adapted from the public health research, allows an access to detect the meaning of gender specifics and gender differences, to verify its clinical relevance and to exercise the results in clinical daily work. With gender sensitive methods desiderata should be reduced, and methodological standards for gender sensitive medical/clinical research can be developed and implemented into medical education. In the light of knowledge about sex specific differences in pharmacokinetic and pharmacodynamic as well as undesired drug interactions, basic research may help to overcome the gender gap and to individualize and optimize the anesthesiological approach as well. A main problem in implementing gender studies into medicine is the limitation of sex sensitive biomedical significance. Nevertheless, the already existing measures in public health should be evaluated and modified for clinical practice. The current review is to be read as an introduction into different aspects of gender studies in medicine, in order to extend the understanding of its importance for anesthesiology, too. It shows that the relevance transcends still existing studies based on biomedical gender diversities.

Adult↗
PubMed2006

Visually mediated species and neighbour recognition in fiddler crabs (Uca mjoebergi and Uca capricornis).

Mating signals are often directed at numerous senses and provide information about species identity, gender, receptiveness, individual identity and mate quality. Given the diversity of colourful body patterns in invertebrates, surprisingly few studies have examined the role of these visual signals in mate recognition. Here, we demonstrate the use of claw coloration as a species recognition signal in a fiddler crab (Uca mjoebergi). Furthermore, we show that distinct carapace colour patterns in Uca capricornis enable males to discriminate between their female neighbours and unfamiliar females. This is the first empirical evidence of the social importance of colour markings in fiddler crabs and the first example of visually mediated species and neighbour recognition in invertebrates other than insects.

Animals↗
PubMed2005

Primary care needs of patients who have undergone gender reassignment.

PURPOSE: The purpose of this article is to inform nurse practitioners (NPs) about the primary care needs of patients who have undergone gender reassignment, either by hormone therapy alone or in conjunction with surgery. DATA SOURCES: Data sources used were mainly from a review of the literature about gender identity disorder and gender reassignment. Information was also gathered from several leading surgeons on gender reassignment surgical procedures and subsequent clinical considerations. CONCLUSIONS: There is very little written on the primary care clinical ramifications of transsexual patients and how clinicians can adapt their approaches to healthcare delivery to accommodate their special situations. IMPLICATIONS FOR PRACTICE: Implications for practice include how an NP can adapt clinical practice approaches to provide for patients who have undergone gender reassignment. Changes that occur in the transsexual process may warrant noncustomary primary healthcare screening and examination.

Female↗
PubMed2002

Complete virilization in congenital adrenal hyperplasia: clinical course, medical management and disease-related complications.

OBJECTIVE: In girls with congenital adrenal hyperplasia (CAH), genital ambiguity usually leads to a rapid neonatal diagnosis. Rarely, CAH causes complete virilization and male sex assignment with a delayed diagnosis. After being confronted with very specific problems in two of such patients, we collected data of patients with CAH and complete virilization in a nationwide study to delineate specific problems of these rare patients in order to improve their management. DESIGN AND PATIENTS: Through the German Working Group of Paediatric Endocrinology (Arbeitsgemeinschaft Pädiatrische Endokrinologie, APE), questionnaires were sent to all members caring for patients with CAH and complete virilization in their endocrine clinics. Data from 16 patients from 10 paediatric endocrine centres were assessed by questionnaire. RESULTS: The following problems have been encountered. (1) Sex assignment/gender identity: initially all patients had a male sex assignment. Six patients were diagnosed during the first month of life. Five were reassigned to female sex immediately, one at the age of 19 months. Except in one girl demonstrating some tomboyish behaviour, gender role behaviour in these patients did not differ from unaffected girls. Ten patients were diagnosed late at 3.4--7 years of age. In seven patients with a late diagnosis, male sex assignment was maintained; one of them expressed some concerns about living as a male. In three patients late sex reversal was performed, gender identity is very poor in one and new sex assignment is currently under consideration. (2) SURGERY: irrespective of the sex assigned, all patients had between one and three surgical procedures, including clitoris reduction and (repeated) vaginoplasties in patients with female sex assignment. Hysterectomy and ovarectomy were performed in patients with male sex assignment. (3) Short stature: patients with a late diagnosis of CAH had extremely advanced bone ages of +6.3 to +9.5 years, leading to severely reduced final height of 137 to 150 cm in adult patients. Patients tended to follow height percentiles of genetic females. One pubertal patient was suicidal due to short stature. (4) Central precocious puberty (CPP): prolonged exposition to adrenal androgens led to CPP in one patient. He was treated with GnRH analogues until gonadectomy. CONCLUSIONS: Patients with CAH and complete virilization have a high risk of being diagnosed late. There are major problems and uncertainties of the patients' families and the treating physicians concerning gender assignment. Gender identity is disturbed in some patients. In addition, multiple surgical procedures are necessary and short stature as well as central precocious puberty might be important to avoid late sequelae. While some surgical interventions are probably unavoidable, most of these issues could be resolved with an early diagnosis. Thus, especially for these patients, a neonatal screening programme for CAH would be of paramount importance.

Adolescent↗
PubMed2000

Female-to-male transsexual with 47,XXX karyotype.

BACKGROUND: There are few reports describing chromosomal abnormalities in transsexuals. In rare cases, transsexualism and sexual chromosomal multiplicity coexist. Six cases of male-to-female transsexuals with 47,XYY chromosomal pattern have been previously reported. We have not encountered any female transsexual cases with 47,XXX karyotype in the literature. METHODS: A 21-year-old female patient came to our outpatient department with depressive symptoms and suicidal thoughts. On psychiatric interview, she reported that she had feelings of discomfort with her gender identity and had desired to be male since her childhood. Then, we performed cytogenetic investigation using blood culture and G chromosome banding. RESULTS: Histology and DNA histograms of the patient revealed a chromosomal pattern of 47,XXX. CONCLUSIONS: We conclude that sexual chromosomal abnormalities in some transsexuals may cause a vulnerability to development of a gender identity disorder.

Adult↗
PubMed2002

Psychological consequences.

Sex assignment of children born with ambiguous genitalia is a difficult and responsible decision based on limited empirical evidence regarding future development of gender identity/role, sexual orientation, and sexual functioning. Sex of assignment and rearing has appeared to be a prognosticator of future gender identity, usually better than the other criteria of sex (chromosomes, gonadal tissue, prenatal and postnatal hormonal profiles). The decision to assign a sex is guided by the prognosis of the "optimal" sex for the newborn, of which the elements are an overall sex-appropriate appearance with a stable gender identity; good sexual function, preferably combined with reproductive function if attainable; minimal medical procedures; and a reasonably happy life given the limitations. The limited follow-up studies indicate that this is a reasonable policy, although a limited number of subjects will experience gender dysphoria later in life and will cross over to the other sex. This is more often the case in subjects assigned to the female sex with considerable prenatal or postnatal androgen exposure. Children in this predicament must receive guidance well into adulthood. It may be difficult to engage in sexual relations when the anatomy of the genitalia (often operated upon) is not fully normal.

Androgens↗
PubMed1984

The mid-life male sex-change applicant: a multiclinic survey.

Directors of coordinators of a cross-section of North American Gender Identity Clinics provided descriptive information on 1,637 sex-change applicants and psychosocial, psychosexual, and psychiatric data on 21 middle-aged male candidates. To determine the age relatedness of the findings, the mid-life male candidates were then compared on selected characteristics with a random sample of younger biological males seeking sexual reassignment at the Vanderbilt Gender Identity Clinic. The results are consistent with previous findings highlighting the factors at mid-life that intensify the male transsexual's desire for sexual transformation. Viewing the aging gender dysphoria patient's surgical request from a developmental perspective promotes appreciation of his predicament and informed consideration of his treatment options.

Adult↗
PubMed1991

Development of male gender identity/role and a sexual orientation towards women in a 46,XY subject with an incomplete form of the androgen insensitivity syndrome.

Transsexualism and homosexuality have been theorized to originate in the male from insufficient androgenization of the brain. For verification of this hypothesis clinical science must rely on subjects with an abnormal prenatal/perinatal endocrine history. A case of a 33-year-old 46,XY subject with an incomplete form of androgen insensitivity syndrome (AIS) is presented. In adulthood the only genital sign of masculinization is a clitoris of 4 cm; the vagina is normal size. The diagnosis AIS was verified by androgen receptor studies. At birth there was confusion as to the sex of the newborn. Originally, the subject was assigned to the male sex, but this decision was reversed 5 days after birth and the subject was reared as a girl. At age 30 the subject applied for gender reassignment treatment to the male sex. Upon psychological evaluation the gender identity was unambiguously male and the sexual orientation was exclusively towards women. The estrogen feedback effect on LH, regarded by some as a marker of the sexual differentiation of the neuroendocrinium was negative before orchiectomy but positive after orchiectomy. Our observation demonstrates that in 46,XY subjects a male gender identity and a sexual orientation towards women can develop with a strikingly lower-than-normal level of biological action of androgens.

Androgen-Insensitivity Syndrome↗
PubMed1996

Prospective prediction of husband marital aggression within newlywed couples.

This study prospectively examined a social interactional model of husband marital aggression. Young couples were assessed at the time of their 1st marriage with respect to marital conflict styles, alcohol consumption, hostility, gender identity, perceived power inequity, and history of family violence. Couples were reassessed at their 1-year anniversary, and information concerning marital aggression was collected. Most of the constructs were prospectively related to husband aggression, but these relationships were largely mediated through marital conflict styles and husband alcohol consumption, which in turn were influenced by husband's hostility, gender identity, and perceived power inequity.

Adult↗
PubMed1977

Gender-specific variances in sexual fantasy.

Six sexual fantasy categories were derived by inductive content analysis, based upon the starting criterion that fantasy is a dynamic and interactional event. Detailed narrative descriptions of sexual fantasy in three conditions, including 'Daydream,' 'masturbatory,' and "During Sex Relations' were obtained from 48 male and 45 female volunteer graduate students. Detailed narrative descriptions of sexual fantasies were collected by administration of sexual fantasy questionnaires. While the intention was to empirically derive sexual fantasy categories which could be used for personality assessment of gender identity, the hypothesis predicted gender-specific variances in fantasy productions according to derived fantasy categories. Results indicated that significantly more females than males fantasized themselves as recipients of sexual activity from fantasized sexual objects, while males fantasized the sexual object as recipients of sexual activity. Marginal tendencies toward reversal of this gender pattern occurred in the 'Mastubatory' condition for males, and in the 'Daydream' sexual fantasy condition for females.

Adolescent↗
PubMed1978

Quality of life and factors affecting the response to hysterectomy .

Hysterectomy is the most commonly performed major surgery in the United States. A hysterectomy does not produce significant psychopathology in a psychologically mature woman. Yet a mourning process occurs as a woman reintegrates her gender identity. Organic pathology, age, socioeconomic class, types of significant relationships, meaning given menses, coitus, childbearing, children, and vocational and avocational involvements are variables affecting every woman's attitudes toward, decision to have, and reactions to a hysterectomy. Each woman's characteristic coping pattern in a personally threatening situation is apparent during her hospitalization. In the process of reorganizing her gender identity, other interests (vocational and avocational) and intimate interpersonal relationships will assume new significance. The most frequent psychopathological reaction is depression. A woman's potential for depression is increased with malignancy, predisposing personality features, a history of depressive responses to stress, and concurrent marital disruption. Data support a higher incidence of depression in posthysterectomy than in other postsurgical female patients.

Adjustment Disorders↗
PubMed1995

Hormones and psychosexual differentiation.

The male phenotype arises from the optimal concordance of chromosomal, gonadal and hormonal sex. Hormonal sex depends directly on the type of gonads that have been formed, and is linked both to the production of hormones and to their optimal effect on target tissues. The present review underlines the fact that psychosexual orientation in the male is also related to factors linked to sex hormones. Many of the experimental and clinical data available militate against the long-held belief that the development of role and gender identity in man is predominantly determined by environmental factors. This study points out the importance of hormonal factors at the CNS level. The most common abnormalities of sexual orientation are homosexuality and transsexualism. Despite their relatively high frequency in the general population, research into possible biological influences in these abnormalities is very scant. The authors of the present paper have reviewed the literature data yielded by biological and hormonal studies on homosexuality and transsexualism. These data seem to support the hypothesis that androgens may be deficient in the CNS of male homosexuals. Morphological or functional (neurotransmitter) anomalies in androgen actions at the CNS level could also favor radical dissociation between psychological sex and gonadal, hormonal and phenotypic sex in transsexualism. In conclusion, the present review seems to indicate that hormonal factors (gonadal and adrenal hormones, hormone receptors, transduction mechanism of the hormonal signal, neurosteroids, neurotransmitters etc.) play a determining role in the formation of gender identity.

Adult↗
PubMed1999

Transsexualism: a review of etiology, diagnosis and treatment.

Transsexualism is considered to be the extreme end of the spectrum of gender identity disorders characterized by, among other things, a pursuit of sex reassignment surgery (SRS). The origins of transsexualism are still largely unclear. A first indication of anatomic brain differences between transsexuals and nontranssexuals has been found. Also, certain parental (rearing) factors seem to be associated with transsexualism. Some contradictory findings regarding etiology, psychopathology and success of SRS seem to be related to the fact that certain subtypes of transsexuals follow different developmental routes. The observations that psychotherapy is not helpful in altering a crystallized cross-gender identity and that certain transsexuals do not show severe psychopathology has led clinicians to adopt sex reassignment as a treatment option. In many countries, transsexuals are now treated according to the Standards of Care of the Harry Benjamin International Gender Dysphoria Association, a professional organization in the field of transsexualism. Research on postoperative functioning of transsexuals does not allow for unequivocal conclusions, but there is little doubt that sex reassignment substantially alleviates the suffering of transsexuals. However, SRS is no panacea. Psychotherapy may be needed to help transsexuals in adapting to the new situation or in dealing with issues that could not be addressed before treatment.

Adaptation, Psychological↗
PubMed2000

Utility of the MMPI-2 in assessing gender dysphoric patients.

We compared MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of 2 groups of adult biological men requesting sex reassignment surgery; 1 group was diagnosed with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) transsexualism and the other with gender identity disorder of adolescence and adulthood, nontranssexual type (GIDAANT). Although the mean profiles for the transsexual group did not demonstrate any psychopathology, the GIDAANT group showed moderate psychopathology. A cluster analysis indicated that 85% of the transsexual group showed low psychopathology and 47% of the GIDAANT group showed severe psychopathology. Neither the MMPI-2 results nor the DSM-III-R clinical evaluation support the conclusion of many authors that transsexualism is associated with severe personality disorder; rather, the data indicate that transsexualism and other gender identity disorders without persistent wish for sex reassignment differ significantly in degree of psychopathology.

Adult↗
PubMed2004

How are sociosexuality, sex drive, and lifetime number of sexual partners related?

In two studies (ns = 277 and 221), the authors examined the relationships among sex drive, sociosexuality, lifetime number of sex partners, and gender identity. They found that sex drive is highly and positively correlated with sociosexual orientation, and that both sex drive and sociosexual orientation are positively correlated with lifetime number of sex partners. However, partial correlations revealed that sociosexual orientation is an independent predictor of lifetime number of sex partners, whereas sex drive is not. The authors were also able to replicate and extend Mikach and Bailey's (1999) finding that gender identity is related to women's lifetime number of sex partners. More masculine women had more sex partners and had a less restricted sociosexual orientation than did less masculine women; less masculine men had a higher sex drive than did more masculine men. The findings are discussed with regard to theory and research on sex drive and sociosexuality.

Adolescent↗
PubMed1999

Psychopathological aspects of cryptorchidism in children and adolescents.

In the male sexual and aggressive drives are mostly centered on the penis, whose real or fantasied features strongly affect the way children and adolescents build up their own personal and gender identity. In some clinical conditions a shift of genital centrality from penis to testicles is evident. The most frequent is abnormality in the descent of testicles, especially cryptorchidism, characterized by an arrested descent of one or two testicles that remain in the abdomen. The aim of this paper is to define mechanisms by which cryptorchidism increases psychological vulnerability. Time of diagnosis and treatment, restoration of genital integrity, personality stability and familial interactions are considered as elements affecting psychopathological outcome. Behavioral and psychological features in children and adolescents with cryptorchidism are reviewed. A case report of an adolescent with unilateral cryptorchidism is reported and discussed, as an example of pubertal distortion in bodily and gender identity.

Adolescent↗