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Transvertism: a disorder of the sense of self.

Transvestism is not simply a sexual disorder, but is best understood as primarily a disorder of the sense of self. A descriptive background of transvestism is provided through a review of developmental history, clinical course, presonality structure, and family history. The predominant transvestic fantasies and their modes of enactment are described. The disorder of the sence of self that gives rise to transvestic behavior is identified as a split in the ego into incompatible male and female gender identities. The split is attributed to an early identification with the mother as a defense against unresolved separation anxiety engendered during the separation-individuation phase of infantile development. The effect of this split upon the sense of reality, object relations, and adaptation to stress in transvestism are examined for a psychodynamic point of view.

Adaptation, Psychological↗

Gender dysphoria and cross-dressing in people with intellectual disability: a literature review.

In clinical practice, we have come across people with intellectual disability who have gender dysphoria and cross-dress. Here, we review the literature on this subject and present an illustrative case example. We searched databases, followed-up references from relevant articles, and contacted colleagues in the field. We found nine papers with case examples and one survey. Gender identity problems certainly occur in people with intellectual disabilities, and developmental perspectives are important in assessing and treating them. In some cases autistic spectrum disorder was co-morbid, for individuals with and those without intellectual disability. Aggression was also common. Documented treatments were primarily psychological and social and did not include hormones and sex reassignment surgery. Capacity to consent is a factor that determines treatment.

Female↗

Hypnosis in human sexuality problems.

This is a general overview of the use of hypnosis in five aspects of human sexuality where problems or pathology may move patients to seek therapy. These are gender identity, sexual orientation, sexual preferences, sexual functioning and sexual mores. The article emphasizes two main hypnotic techniques that respect the patient's existential experiences regarding his/her own sexuality. The use of hypnosis proposed here is patient-centered, permissive and utilizing the patient's imagery and other inner resources. Several clinical vignettes illustrate the theoretical points with the intention of giving the reader an opportunity for identification with these cases.

Gender Identity↗

Gender-disturbed males.

Adolescent and adult cross-dressing or "transvestism" is the most common antecedent behavioral pattern among those who request sex reassignment surgery. Transvestites are actually a diverse group of men who differ in their gender identities, orientation, and intention. They do, however, have in common a soothing image of themselves as women. Because of this, whether cross-dressing occurs among masculine or feminine males or heterosexuals, homosexuals, bisexuals, or asexuals, or among those with paraphilia, the behavior should be considered the expression of their consciously felt femininity. The confusing differences among cross-dressing males may be explained by their diversity along three dimensions: 1) the ambition for heterosexual intercourse; 2) the natural history of their sexual arousal to female clothing; 3) their current capacity to integrate their masculine and feminine strivings into separate compartments. When cross-dressers give up all vestiges of male gender role behaviors and successfully live and work full time as women, the appropriate descriptive term for them becomes "transsexual."

Adaptation, Psychological↗

Clinical, hormonal, behavioral, and genetic characteristics of androgen insensitivity syndrome in a Brazilian cohort: five novel mutations in the androgen receptor gene.

Androgen insensitivity syndrome (AIS) is caused by mutations in the androgen receptor gene and is associated with a variety of phenotypes in 46,XY individuals, ranging from phenotypic women [complete form (CAIS)] to men with minor degrees of undervirilization or infertility [partial form (PAIS)]. We studied 32 subjects with male pseudohermaphroditism from 20 families (9 CAIS, 11 PAIS) with the following criteria for AIS: 46,XY karyotype, normal male basal and human chorionic gonadotropin-stimulated levels of serum testosterone and steroid precursors, gynecomastia at puberty, and, in prepubertal patients, a family history suggestive of X-linked inheritance. The entire coding region of the androgen receptor gene was analyzed, and mutations were found in all families with CAIS and in eight of 11 families with PAIS. Fifteen different mutations were identified, including five (S119X, T602P, L768V, I898F, and P904V) that have not been described previously. Detailed clinical and hormonal features were compared with genotype in 25 subjects with AIS and confirmed by mutational analysis. LH hormone levels and the LH x testosterone product were high in all postpubertal subjects with AIS. All subjects with PAIS maintained at postpubertal age the gender identity and social sex that was assigned to them in infancy, in contrast to other forms of pseudohermaphroditism.

Adolescent↗

The adolescent. Athletics and development.

An appreciation of adolescent growth and development is essential to the understanding of problems faced by the adolescent athlete. Early adolescence (ages 10-15 years) can be characterized as the body period. Physical growth is genetically determined and can be influenced by disease, injury, and nutrition. Early maturers are subject to adult expectations which may lead to either failure or excessive acclaim. Middle adolescence (ages 15-18 years) is the sexuality period, with special emphasis on gender identity. Friendships are critical, and athletics can be a focal point for showing love and affection without social fear. Late adolescence (ages 18-22 years) is the separation period. Young people with athletic skills leave home to face greater athletic and academic pressure and competition in college. Adjustment to this final adolescent period is achieved through learning to lose as well as win with grace and dignity.

Adolescent↗

Children in lesbian and single-parent households: psychosexual and psychiatric appraisal.

Thirty-seven school-age children reared in 27 lesbian households were compared with 38 school-age children reared in 27 heterosexual single-parent households, with respect to their psychosexual development and their emotions, behaviour and relationships. Systematic standardized interviews with the mothers and with the children, together with parent and teacher questionnaires, were used to make the psychosexual and psychiatric appraisal. The two groups did not differ in terms of their gender identity, sex role behaviour or sexual orientation. Also, they did not differ on most measures of emotions, behaviour and relationships--although there was some indication of more frequent psychiatric problems in the single-parent group. It was concluded that rearing in a lesbian household per se did not lead to atypical psychosexual development or constitute a psychiatric risk factor.

Adolescent↗

Effects of prenatal sex hormones on gender-related behavior.

Gender identity depends largely on postnatal environmental influences, while sex-dimorphic behavior and temperamental sex differences appear to be modified by prenatal sex hormones. A role of the prenatal endocrine milieu in the development of erotic partner preference, as in hetero-, homo-, or bisexual orientation, or of cognitive sex differences has not been conclusively demonstrated.

Adolescent↗

Matched pair of siblings concordant for 46,XY hermaphroditism with female sex assignment, and discordant for erotosexual outcome.

The two siblings in this comparison constitute a matched pair on the basis of concordance not only for prenatal history and diagnosis but also for assigned sex as girls, and for spontaneous hormonal puberty that was not feminizing, but masculinizing. They were further concordant in being surgically and hormonally feminized, with their own informed consent, early in adolescence. Subsequently, they became discordant, for the younger one has lived continuously as a woman, with a feminine gender-identity/role (G-I/R) socially and erotosexually, whereas the older one became self-reassigned to live as a man with a masculine G-I/R socially and erotosexually, hormonally supported on testosterone replacement therapy. Flattening of the chest was readily accomplished by plastic surgery, but phalloplasty was not attempted, primarily because of the technical obstacles and, to a lesser extent, the cost.

Adolescent↗

Beyond dualism: leading out of oppression.

PURPOSE: To reexamine our beliefs about our gender identity in order to identify new possibilities for leading in nursing. SOURCES OF INFORMATION: Leadership is complex. This article is the result of a lengthy iterative process of exploring the empowerment, image, leadership, feminist, and oppression literature. All of this was distilled in the context of the author's experience as a nurse and nurse leader. CONCLUSIONS: Moving beyond dualism creates new possibilities for leading nurses out of oppression.

Attitude of Health Personnel↗

Andy. A boy who thought he needed to be a girl.

In presenting the case of Andy, I hope to demonstrate the complicated multi-determined functions of feminine identifications and strivings in a boy with a diagnosable gender identity disorder. My patient's fantasies of wishing and needing to be a girl were not just the result of the influence of parental behavior and attitudes. Equipmental problems resulting from inborn factors and interferences with optimal development due to ongoing interaction with his environment were major contributing influences. Andy's experience of his body and his psychological elaboration of certain childhood events as well as his sexual and aggressive fantasies strongly influenced his feminine desires.

Child↗

Sexual activity and temperament in Polish transsexuals.

Two groups of 23 female-to-male and 14 male-to-female transsexuals were compared to a representative sample of Polish controls along following dimensions: (i) temperamental features including reactivity and mobility of nervous processes, as measured by Strelau's Temperament Inventory; and (ii) patterns of sexual activity, measured with Dulko's Questionnaire for Measurement of Transsexualism. Transsexuals were found to resemble respective controls on temperamental dimensions according to their sense of gender identity and not their somatic sex. Male-to-female transsexuals were more similar to control females than to control males and the reverse was true for female-to-male subjects. With respect to forms of sexual activity, transsexuals, particularly the female-to-male, were found to have a relatively versatile erotic life. Both groups experienced more dreams with erotic content than respective controls. However, they also manifested fewer successes at satisfying their erotic needs.

Adolescent↗

Women and children at risk: a feminist perspective on child abuse.

Viewing child abuse through the prism of woman battering reveals that both problems originate in conflicts over gender identity and male authority. Data indicate that men, not women, typically commit serious child abuse. A study of the mothers of child abuse victims shows that battering is the most common context for child abuse, that the battering male is the typical child abuser, that the battered mothers have no distinctive pathology in their backgrounds, and that clinicians respond punitively to the battered mothers. The child abuse establishment assigns responsibility for abuse to mothers regardless of who assaults the child, and responds punitively to women, withholding vital resources and often removing the child to foster care, if women are battered or otherwise fail to meet expectations of "good mothering." The combination of male control, misleading psychological knowledge about women's propensity for "bonding," and sanctions used to enforce gender stereotypes of motherhood combine to increase the entrapment and inequality from which battering and child abuse originate, a process termed "patriarchal mothering." The best way to prevent child abuse is through "female empowerment."

Child↗

Oedipal themes in latency. Analysis of the "farmer's daughter" joke.

A sample of "farmer's daughter" jokes, gathered from archives, personal informants, and published collections, is examined in relation to the developmental progress of the latency-age boys who most often tell them. The joke texts are divided into three categories-oedipal triumph, castration, and feminization-each of which represents a different regressive fantasy. Through these fantasied scenarios, the joke teller can safely work through some of the anxieties he experiences as a result of the recent repression of the oedipal conflict. Common themes of latency fantasies such as separation from the family, confusion of gender identity, and incestuous desires are all present in the texts. Repetition of the farmer's daughter joke not only motivates the child's individual psychological progress but also reinforces his or her awareness of taboos and socially appropriate behavior. Because the parental injunctions are internalized to help consolidate superego formation at the onset of latency and the child must now displace incestuous urges with manifestations of conscience, the retesting of values through joke telling is important during this developmental period.

Adolescent↗

Hispanic women and AIDS: gendered risk factors and clinical implications.

Current theory and research indicate that Hispanic women's increased risk for AIDS is due to sociocultural and psychological factors that are influenced by gender. Hispanic women's low social status limits their ability to negotiate safer sex behaviors for AIDS prevention. Female gender identity, based upon the desire for interpersonal attachment, places Hispanic women at risk for AIDS through a fear of abandonment by male sexual partners who perceive safer sex behaviors as unmasculine. Male sexual partners' beliefs, practices, and behaviors, such as bisexuality and the practice of anal intercourse, increase Hispanic women's AIDS risk. The experience of involuntary sexual encounters and the lack of power to determine sexual behaviors and practices within these encounters also place Hispanic women at risk for AIDS.

Acquired Immunodeficiency Syndrome↗

The paraconscious.

A new concept, the paraconscious, is presented as the third complementary member of the conscious/unconscious paradigm. A form of cognition dating from early intrauterine existence to sometime in the first year of life, the nature of the paraconscious is determined by the incompleteness of developing cognitive structures, giving rise to a form of knowing that does not allow for the generation of voluntarily retrievable mental representations. The paraconscious provides a conceptual framework for the understanding of "conflict-free" psychic development, thereby linking such apparently disparate phenomena as Stoller's core gender identity and primary transsexualism, Bruch's primary anorexia nervosa, night terrors, and ubiquitous convictions such as the belief in telephathy and the survival of death by human consciousness. It has profound implications for the treatment (or nontreatment in the case of primary male transsexualism) of significant psychiatric syndromes and raises crucial questions about the nature of learning during the earliest moments of our cognitive existence, about the nonlinguistic transmission of information and about the origin of certain widely held beliefs.

Adult↗

Two types of fetishism.

This study attempted to differentiate two clinical types of fetishism-fetishism proper and tranvestism-and to determine if tranvestites are truly fetishistic. The transvestites were further divided into gender-conforming and gender-noncomforming groups according to their score on a gender identity scale. These groups were compared using a self-report scale measuring fetishistic interests, and a set of questionnaire items regarding their childhood history, parental characteristics, and their emotional closeness with their parents. In addition, the penile responses of a subset of fetishists and tranvestites were recorded while they were presented with visual depictions of female and male public regions and potentially fetishistic objects (nylon stockings, female and male shoes, panties, male underwear, female and male feet). The fetishists proper and the transvestite subgroups did not differ from each other in terms of self-reported fetishistic interest or childhood and family histories. Moreover, there were no differences between these groups in their penile response to the potentially fetishistic stimulus they were most aroused by, relative to the depictions of the pubic region of their preferred gender. These results suggest that transvestites are in fact fetishistic, and that they are difficult to distinguish from fetishists proper.

Adult↗

[Psychosexual aspects of intersex syndromes].

Disorders of somatosexual development that lead to ambiguous genitalia occur in one from 3,000-5,000 newborns. Parents and health care professionals are confronted with a number of crucial questions: to what sex should the child be assigned, what is the appropriate treatment in terms of hormonal and surgical interventions, when and how should these take place, and what impact do they have on the development of gender identity (GI), psychosexual well-being and fertility? This paper reviews the etiology, treatment and outcome in terms of GI and sexual health for the following syndromes: congenital adrenal hyperplasia (CAH), complete and partial androgen insensitivity (cAIS, pAIS), and pure and mixed gonadal dysgenesis (pGD, mGD). Emphasis is focussed on the current discussion involving the timing and extent of genital surgery. Finally, a procedure is introduced that covers the sexual-medical needs of patients, parents and health care professionals.

Adrenal Hyperplasia, Congenital↗