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PubMed1989

[Sex reassignment surgery in a trans-sexual].

Trans-sexualism is a psychiatric disorder characterized by the conviction that one's gender identity does not conform to one's biological sex. The current Diagnostic and Statistical Manual of Mental Disorders gives 5 diagnostic criteria for trans-sexualism which most health care professionals accept. Although many trans-sexuals derive some gratification from assuming roles appropriate to their desired gender, a substantial number are convinced that only sexual transformation can bring meaningful relief of their feelings of despair. Approximately 2/3 of trans-sexuals who undergo sex reassignment procedures are improved at follow-up. A relatively advanced age and secondary trans-sexualism (transvestites and effeminate homosexuals) are risk factors for poor prognosis in those requesting sex reassignment. In recent decades the demand for sex reassignment has increased, as have the number and variety of psychological, hormonal and surgical treatments proposed. The operative procedures currently employed for sex reassignment give reasonably good esthetic and functional results, and in 1986 the Israel Ministry of Health permitted its government hospitals to perform them. A 23-year-old male trans-sexual is reported who underwent successful surgery for sex change and now, 1 year later, is satisfied with the result.

Adult↗
PubMed1989

[Comments on female homosexuality].

The author explores to what extent the first gender-identical love between mother and daughter shapes female self representation and becomes influential for later homosexual relations among women. Literary examples and case vignettes illustrate the connection.

Female↗
PubMed2006

Sexual identity formation and AIDS prevention: an exploratory study of non-gay-identified Puerto Rican MSM from working class neighborhoods.

As a subgroup of men who have sex with men (MSM), non-gay-identified (NGI) behaviorally bisexual Latino MSM are associated with heightened probabilities of HIV transmission, yet they have eluded HIV/AIDS interventionists. This exploratory study of Puerto Rican MSM drug users employed multi-session qualitative interviews to examine early life experiences related to gender identity and sexual orientation, and the place of risky drug and sexual behaviors in the process of sexual identity formation. NGI participants experienced sexual debut between ages 13 and 20, and most were recruited to prostitution as young teens by NGI age mates who were also members of drug use networks. Participants emphasized their role as insertive sexual partners and that they maintained relationships with pasivo biological males. It is feasible to recruit NGI MSM through primary male sexual partners and drug use networks. HIV/AIDS prevention based on awareness of developmental histories holds promise for intervening before NGI youth engage in male prostitution or injection drug use.

Adolescent↗
PubMed1987

"I want to be a daddy!": meanings of masculine identifications in girls.

This paper suggests revisions in our understanding of feminine identity formation, the girl's negative oedipus complex, and masculine identifications in girls. Analytic material from the cases of three girls is used to explore the various origins and intrapsychic functions of masculine identifications at each phase of the girl's development. Accounts of feminine development based on such concepts as castration shock, primary femininity, primary identification with mother, or core gender identity are seen as oversimplified. Feminine and masculine identifications are neither primary nor secondary, but the product of a long line of development, of ongoing conflict resolution, and of defensive transformations.

Child↗
PubMed2004

[Sex differentiation of central nervous system--brain of man and woman].

Sex differentiation of human brain is mostly dependent on the prenatal exposure to androgen(testosterone). Congenital aromatase deficiency does not disturb male brain development in men. This is quite different from experimental evidence from rodents whose brains need intraneuronal aromatization from androgen to estrogen to induce sex differentiation. There is evidence for male-female differences in brain structures. Some of them(INHA-3) appear to be related with sexual orientation. The other(BNST) might participate in forming gender-identity. In addition, sexually dimorphic features are recognized in some cognitive activities. The possible involvement of genetic factors in human brain sex differentiation is also discussed.

Androgens↗
PubMed1982

Male and female transsexualism: the Danish experience with 37 patients.

Since the first sex-reassignment operation in Denmark at the Rigshospitalet in 1951, a total of 37 patients, 29 males and 8 females, have had sex-modifying surgery and a change in legal status. In our experience a basic insecure gender identity is a predominant trait in transsexuals, dating back to earliest childhood. This insecurity and a concomitant anxiety are overcome differently by the two transsexual sexes. In male transsexualism, the most outstanding characteristic is a narcissistic withdrawal to a condition marked by submission and pseudofeminity. Anxiety and insecurity are basic to the gender dysphoria but are subdued by means of fantasy escape and gratification in aestheticized ego-ideals with suppression of aggressive and sexual feelings. This results in the often observed pseudofeminity in the male transsexual. A core group of transsexual males are marked by a persistent pseudofeminine narcissism. They have stable ego strength, are agenital in sexual attitude, and have an intact sense of reality. This group is expected to remain so after sex reassignment. The transsexual female assumes a narcissistic, phallic attitude displaying outer activities and caricatured masculine manners in an attempt to subdue her insecurity. Examples are given of the characteristic splitting of these persons' phenomenological ego-experiences and how different their reality testing is from that of psychotic persons with a desire for sex change. Transsexual females are much more sexually active than transsexual males. We find a closer connection between female homosexuality and transsexualism than between male homosexuality and transsexualism.

Adult↗
PubMed2004

[Decision-making process about sex assignment in the neonate with ambiguous genitalia].

Although diagnoses and etiologies of underlying disorders of sexual differentiation can be carefully delineated through biochemical, imagine, and chromosomal analyses, the decision-making process about sex assignment in the newborn with ambiguous genitalia is in a state of controversy. The conventional way for the approach to these neonates consists of 4 principles; 1) Urgency of diagnosis and sex assignment, so that early surgical reconstruction could obviate the fear of the parents with each diaper change. 2) Adequacy of the phallus as a male. 3) Fertility, especially 46XX female are sex assigned female because of potential fertility. 4) Cosmetic appearance of the reconstructed genitalia based on the recognition that external female genitalia are generally easier to construct than male. Contrary to these conventional methods, some researchers insist on flexibility in the clinical approach to provide the best possible outcome. It is getting apparent that the quantity, timing, and duration of androgen exposure will play a role in determining the degree of masculinization of the brain, which may potentially decide gender identity before 18 months of age or even in utero, and may influence the psychosexual development of the child. Flexibility in decision-making will allow for options not to remove any tissues including gonads and internal sex organs, or to reconstruct the genitalia until he or she is sure of the gender. This new approach must be proved in the future.

Adolescent↗
PubMed1986

Sexological theory, H-Y antigen, chromosomes, gonads, and cyclicity: two syndromes compared.

The androgen-insensitivity syndrome (AIS) and Rokitansky syndrome (RS) are clinically similar except for H-Y antigen, chromosomal sex, gonadal sex, and the cyclicity of sex hormonal functioning. Nine AIS women and nine RS women could not be distinguished systematically on any of the following variables: romantic and genitoerotic imagery/ideation; sensory channels of erotic arousal; gender orientation; satisfaction with feminine status; self-rating of sexual frequency and interest; masturbation experience; orgasm experience; attitude toward marriage; and attitude toward infant and child care. These findings indicate that neither H-Y antigen status, chromosomal sex, nor hormonal cyclicity directly determines the differentiation of gender-identity/role (G-I/R) as male, female, or ambiguous. By implication, these findings are relevant to heterosexual/homosexual theory.

Adolescent↗
PubMed1999

Gender, adolescence and the management of diabetes.

Health professionals view adolescence as a difficult time in which to manage diabetes. Adherence to treatment may be a problem, and there is also an expectation that young people should become independent in self-care. Drawing on data from a qualitative study which interviewed teenagers with diabetes and their mothers, this paper focuses on the ways in which gender and adolescence interact to affect how young people live with diabetes. Key themes explored include: the gendered meanings of diabetes; gendered management strategies; gendered dependencies; and adherence to treatment regimes. Gender was found to have a major impact on how young people managed diabetes. Gender also impacted on the involvement of mothers, with the mothers of sons much more likely to be involved in helping their sons than the mothers of daughters. In discussing some of the implications for health policy, it is suggested that in their ways of managing diabetes, young people should be seen as acting rationally within the confines of their gendered identities. Therefore, a uniform policy which promotes the independence of young people may not always be an appropriate way of working with young people or their families.

Adolescent↗
PubMed1979

Early intervention for female sexual identity disturbance: self-monitoring of play behavior.

This study is the first experimental demonstration of sex-typed play behavior change in a young girl with sexual identity disturbance. The 8-year-old child was treated with a self-monitoring procedure combined with a behavioral prompting technique that was gradually faded out. Self-monitoring in the clinic resulted in a high, stable rate of appropriate sex-typed play, and this effect generalized to a different set of sex-typed toys over time. The treatment effects did not generalize to the home environment. The self-regulation intervention was subsequently adapted to the home setting, resulting in a replication of the treatment effects across settings. After the removal of the self-monitoring interventions, a high level of feminine sex-typed play persisted. Pretreatment, posttreatment, and follow-up psychological testing demonstrated a reversal of a pronounced cross-gender identity to a normal female sexual identity.

Aggression↗
PubMed1990

Projective test findings for boys with gender disturbance: Draw-A-Person Test, IT scale, and Make-A-Picture Story Test.

With 66 boys, aged 3 yr. to 17 yr. who were referred for potential gender-identity disorder, this study examined intrapsychic manifestations as reflected in their projections to the Draw-A-Person Test, the Brown IT Scale for Children, and the Shneidman Make-A-Picture Story Test. Without access to these projective test findings, an independent clinical psychologist provided a diagnostic rating on the severity of gender disturbance on a five-point diagnostic rating scale, based on clinical interviews of the child and his parents and a systematic behavioral assessment based on previously published normative standardization data. For each of the three projective measures, significant correlations were found between the clinician ratings on severity of gender disturbance and the test findings in the feminine direction (D-A-P, r = .44; IT Scale, r = .64; M-A-P-S, r = .35). These results validated the use of intrapsychic phenomena of fantasy and self-perception as measured by these projective tests for the diagnosis of gender disturbance in male children and adolescents.

Adolescent↗
PubMed1992

Effects of recalled childhood gender nonconformity on adult genitoerotic role and AIDS exposure. HNRC Group.

The connections between childhood gender nonconformity (assessed by the Freund Feminine Gender Identity Scale, or FGI) and adult genitoerotic role (assessed by a sex history) were examined. The core sample was a group of 106 men who had sex with other men before 1980 and who are currently enrolled in two longitudinal studies of AIDS. Although other workers have cautioned against assuming a priori that childhood gender role is inherently related to adult preferences for particular sexual acts, our data suggest that there is at least a statistical association between these two concepts. In particular, the FGI (and many of its factors and items) are significantly associated with preferences for receptive anal intercourse and, less clearly, with oral-anal contact--but not with oral-genital intercourse or insertive and intercourse. Suggestions for AIDS prevention and safe-sex awareness are made on the basis of these findings. The data also suggest that in sex research involving homosexual men, the correct genitoerotic role distinction is not insertive vs. receptive behaviors, or even insertive vs. receptive and intercourse, but receptive anal intercourse vs. all other behaviors.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Psychosexual development in genetic males assigned female: the cloacal exstrophy experience.

Genetic males who have cloacal exstrophy, a rare, severe pelvic field defect that leads to aphallia, traditionally have been socially, legally, and surgically sex-assigned female at birth and reared female, despite a male karyotype and a typical male prenatal hormonal milieu. Psychosexual development in such children previously has been unknown. Studies of 29 children revealed that despite the absence of the typical postnatal and pubertal androgen surges and the presence of female genitalia, all female-assigned subjects displayed a marked male-typical shift in psychosocial and psychosexual development. Nearly half of them have declared themselves male. Psychosexual development, including gender identity, in genetic and hormonal male neonates seems to be influenced heavily by prenatal androgen exposure. The clinical practice of surgical sex assignment at birth requires re-evaluation.

Bladder Exstrophy↗
PubMed2003

Young adults' reactions to gay and lesbian peers who became suicidal following "coming out" to their parents.

Rates of nonfatal suicidal behavior among gay and lesbian youth surpass those recorded among their heterosexual peers. A frequently cited precipitant of gay and lesbian nonfatal suicidal behavior is the turmoil associated with coming out to one's family. This study investigated young adults' attitudes toward peers who engaged in suicidal behavior after coming out and being rejected by their parents, and compared them with attitudes toward persons who had become suicidal in response to other stressors (a physical illness, a relationship loss, or an academic failure). Our goal was to explore whether young persons hold beliefs that may encourage lesbian and gay suicidal behavior. We found that gays and lesbians who engaged in suicidal behavior following coming out were not viewed in particularly forgiving or empathic ways, as was the case for persons who became suicidal following an incurable illness. All suicidal persons were perceived as relatively feminine. At the same time, suicidal males were rated as more masculine if they engaged in suicidal behavior because of an academic failure or a physical illness, while suicidal females were viewed as more masculine only if their suicidal behavior followed an academic failure. Finally, we found that both respondent sex and respondent gender-identity influenced evaluations of suicidal persons. Building on these findings, future research should explore attitudes toward the permissibility of a suicidal decision by lesbian and gay persons.

Adolescent↗
PubMed1986

Differences between human figure drawings of child molesters and control groups.

The present research attempted to identify differences between human figure drawings of adult and juvenile child molesters and adult and juvenile control groups, based on ratings obtained for various psychodiagnostic signs (N = 75). Eleven reliable signs were identified. Results of significance tests on each of the 11 signs revealed that adult molesters drew the female larger than the male. Also, molesters as a group produced drawings of poorer gender differentiation than did the controls as a group and drew the male figures with blank or missing eyes. The overall quality of the molesters' drawings was rated as significantly poorer than that of the control's drawings. Results of a factor analysis for the 11 signs revealed, for the molesters, a first factor of overall quality with a component of gender identity confusion, a second factor of figure-size only, a third factor of fingers only, and a fourth factor of hidden eyes/hidden hands.

Adolescent↗
PubMed2001

OCD and transvestism: is there a relationship?

OBJECTIVE: There have been reports of obsessive-compulsive disorder (OCD) patients with comorbid paraphilias. In this paper, two cases of comorbidity between OCD and transvestism are reported with the aim of discussing possible explanations for this association. METHOD: Longitudinal case studies of two patients with OCD and tranvestism according to the DSM-IV were assessed using semi-structured interviews. RESULTS: Both patients presented with OCD and comorbid transvestism with different clinical features and treatment response. The case whose cross-dressing was more egodystonic responded better to treatment. CONCLUSION: It is possible that some cases of transvestism are OCD-related while others are more related to a gender identity disorder. A dimensional approach focusing on common phenomenological and neurobiological substrates is suggested as particularly useful for clinical management and future research of both disorders.

Adult↗
PubMed1999

[Problematic puberty?].

This paper shows how involvement in problem behaviour among 13- and 14-year-olds varies according to level of pubertal development. Furthermore, it explores whether psychosocial factors such as characteristics of the peer network (deviance and gang membership), parental behaviour (supervision, care, and parents' frequency of alcohol intoxication) and masculine gender identity mediate this relationship. The data stem from a nation-wide representative survey of the general youth population in Norway (n = 3,139, response rate 97%). The prevalence of problem behaviour (i.e. shoplifting, truancy, vandalism etc.) increased with increasing levels of physical maturation for both sexes. The association was strongest among boys, however. Further analyses revealed that this gender difference could be attributed to the fact that early mature boys, to a greater extent than early mature girls, associate with deviant peers.

Adolescent↗
PubMed1987

Psychosexual outcome of assigned females and males with 46,XX virilizing congenital adrenal hyperplasia.

Seven genotypic female (46,XX) patients with congenital adrenal hyperplasia, four reared as girls and three reared as boys were evaluated at 16-26 years of age with psychological interviews and testing. A small penis in the three young men produced a practical and psychological barrier that severely injured their personality. In spite of some degree of pre-adolescent tomboyism and a somewhat injured body image, the girls adjusted to their feminine gender identity. It is concluded that in cases of both early and late diagnosis, the genotypic female sex should be preferred.

Adaptation, Psychological↗