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PubMed2006

[Importance of ethical and psychological features in the intersex management].

The treatment of intersex disorders has passed through different historical periods. The most important was the age of surgery, during which the dominant concept was that at birth the brain would be adaptable, psychosexually neutral and gender identity the result of educational and social processes. Thus, the preferred and systematic treatment was towards female assignment because from the surgical point of view it was technically more feasible the construction of a vagina than a penis with future normal function. During the 90s various other aspects began to be considered, mainly ethical questions. It became evident the importance of prenatal exposition to androgens, the various environmental and cultural factors related to sexuality and more recently the recognition of the brain as an endocrine organ. It is now quite clear the existence of a wide spectrum of sexual identities as well as the different ways individuals conduct their social sexual behavior. Surgical procedures are still discussed, especially with the purpose to determine the best moment to be performed and in the context of some ethical aspects involved. Today the moment is more complex. The work is done with families by multidisciplinary teams in order to offer a more adequate psychosocial orientation to intersex patients, but all the steps on how to achieve those aims are not known yet.

Consensus↗
PubMed1990

Social assessment of transsexuals who apply for sex reassignment therapy.

A social worker member of the gender identity team of a Psychiatry Department is responsible for the social assessment of the transsexual who applies for sex reassignment surgery. This paper synthesizes the dynamics and processes in conducting the social assessment for eight male-to-female transsexuals from 1986 to April 1988. Role theory was used as the underlying theoretical framework for the assessment. Social criteria for the eligibility of the surgery are delineated. Three cases demonstrate how the social worker used these criteria for the assessment, the difficulties in the process and ways of resolving them.

Adult↗
PubMed1978

Sex role concepts of two- and three-year-olds.

An instrument was developed to assess beliefs about males and females in very young children. Use of the instrument with 72 2- and 3-year-old subjects indicated that children as young as 2 years of age possess substantial knowledge of sex role stereotypes prevailing in the adult culture. Knowledge of sex role stereotypes was highly correlated (.85) with comprehension of gender identity as an irreversible characteristic. Subjects who indicated actual or ideal identity with the opposite sex, however, showed a level of stereotyping no greater than chance. While there were no differences in amount of stereotyping as a function of subjects' age or sex, an analysis of the content of subjects' stereotypes revealed that boys' and girls' beliefs were only partially overlapping. In particular, girls tended to ascribe positive characteristics to their own sex and negative characteristics to males, while boys did the reverse. Explanations for these findings in terms of self-valuation processes were suggested.

Affect↗
PubMed1998

Children of Armageddon. Common developmental threats in high-conflict divorcing families.

This article traces how parental vulnerability to the feelings of humiliation and loss (inherent in highly conflicted divorce and custody litigation) distorts parenting capacities and parent-child relationships in distinctive ways, putting children at risk for specific kinds of developmental difficulties. Pre-oedipal children often fail to achieve a complete separation from their primary caretakers. Oedipal children, already struggling with separation issues, manifest sexualized anxiety and discomfort with gender identity. By latency, these children present as fragmented within themselves and in relationships with others. Each stage-specific response is discussed and illustrated. It is argued that mental health and legal professionals can use this in-depth understanding of child responses to help parents reframe their disputing agendas in terms of the child's developmental concerns and preoccupations to produce custody settlements that are more protective of the child's best interests.

Adolescent↗
PubMed2000

[Climacteric--medicalization, minimalization or normalization?].

Women's experiences and ideas about the climacteric are not in accord with the biomedical model, in which the climacteric and the menopause are characterized as being a risk factor for various diseases and a cause of "estrogen deficiency", a hormonal disease which is assumed to persist during the rest of life. The biomedical model may lead to medicalization and pathologizing, increasing the subordination of women and making them dependent on the health care system. Women who use hormonal therapy during the climacteric have many characteristics differentiating them from women who do not use such therapy. Thus, epidemiological studies will be difficult to interpret with respect to the long term effects of hormonal therapy. It is argued that the consultation for women of middle-age should be characterized by a holistic view of the woman taking account of her gender identity, life conditions and life situation. Such a view should focus on the woman's own ideas as to diagnostic procedures, treatment and solutions. In view of the lack of knowledge about the pros and cons of hormonal therapy, women themselves should make the decision, and such decisions should be encouraged. Also, the efforts directed towards women's compliance to hormonal therapy can be questioned. Women's climacteric symptoms should neither be medicalized, pathologized or minimized.

Adult↗
PubMed2000

Transsexualism in female monozygotic twins: a case report.

OBJECTIVE: A case report is presented of a gender identity disorder involving a pair of female monozygotic twins who requested sex reassignment. As far as we know, this case is the first in psychiatric literature and supports a genetic aetiology of this disorder. CLINICAL PICTURE: The patients were two 18-year-old female monozygotic twins who had showed symptoms of transsexualism since early childhood. They had no other physical or psychiatric disorder except borderline mental functioning. TREATMENT: The patients were referred for sex reassignment. OUTCOME: They were lost to follow up after initial evaluation. CONCLUSION: In addition to other possible (yet not confirmed) causes of transsexualism, a genetic basis for this disorder is suggested by this case.

Adolescent↗
PubMed1981

Female-to-male transsexuals and their partners.

This paper reviews briefly the literature on gender disorders, that is transsexualism in females. Forty-one female-to-male transsexuals and twenty-one female partners of these patients were evaluated in the Gender Identity Clinic at the Clarke Institute of Psychiatry. The authors report on the type of behaviour patterns with particular reference to the kind of relationship the patients form with their partners. These seem to be stable, long-term relationships, though both the transsexual and his partner have had considerable sexual experience prior to forming this relationship. Contrary to what other workers report, these transsexuals wish to parent children and indeed frequently chose partners who already had children. The authors speculate on the reasons why a normal biological female would choose a "penis-less man" as a partner and form a long-term enduring relationship with him.

Adolescent↗
PubMed1991

Body image, sexuality and the psychotic core.

The mental representation of the body--that is, the body image--is a basic element of the person's relationship to himself as well as to reality. From a developmental point of view the body image only becomes finally integrated to form the basis of the person's sexual and gender identity at the end of adolescence. This final body image can contain distortions compared to the person's real body (as viewed by others) and thus can represent a break with some aspects of external reality. In this paper I use material from the analyses of two patients, one adult and one adolescent, to show the compelling quality of the need to maintain a specific body image, and how it becomes related to their sexuality. I also discuss how, when the body image is one that is distorted, it forms a psychotic core to the personality in that it must affect the person's relationship to external reality.

Adolescent↗
PubMed1999

Congenital hypogonadotropic hypogonadism and micropenis: effect of testosterone treatment on adult penile size why sex reversal is not indicated.

Micropenis is commonly due to fetal testosterone deficiency. The clinical management of this form of micropenis has been contentious, with disagreement about the capacity of testosterone treatment to induce a functionally adequate adult penis. As a consequence, some clinicians recommend sex reversal of affected male infants. We studied 8 male subjects with micropenis secondary to congenital pituitary gonadotropin deficiency from infancy or childhood to maturity (ages 18 to 27 years). Four patients were treated with testosterone before 2 years of age (group I) and four between age 6 and 13 years (group II). At presentation, the mean penile length in group I was 1.1 cm (-4 SD; range, 0.5 to 1.5 cm) and in group II it was 2.7 cm (-3.4 SD; range, 1.5 to 3.5 cm). All patients received one or more courses of 3 intramuscular injections of testosterone enanthate (25 or 50 mg) at 4-week intervals in infancy or childhood. At the age of puberty the dose was gradually increased to 200 mg monthly and later to an adult replacement regimen. As adults, both group I and II had attained a mean final penile length of 10.3 cm 2.7 cm with a range of 8 to 14 cm (mean adult stretched penile length for Caucasians is 12.4 2.7 cm). Six of 8 men were sexually active, and all reported normal male gender identity and psychosocial behavior. We conclude that 1 or 2 short courses of testosterone therapy in infancy and childhood augment penile size into the normal range for age in boys with micropenis secondary to fetal testosterone deficiency; replacement therapy at the age of puberty results in an adult size penis within 2 SD of the mean. We found no clinical, psychologic, or physiologic indications to support conversion of affected male infants to girls. Further, the results of this study do not support the notion, derived from data in the rat, that testosterone treatment in infancy or childhood impairs penile growth in adolescence and compromises adult penile length.

Adolescent↗
PubMed1976

Differences in psychological sex, adjustment, and familial influences among homosexual and nonhomosexual populations.

The present study investigated differences in psychological sex, present and past adjustment, and parental influences among homosexual cross-dressers, homosexual non-cross-dressers, applicants for sex change surgery, and heterosexuals. The homosexual non-cross dresser and heterosexual groups were found to have the most masculine gender role, with the sex change group having the most feminine gender identity. The two homosexual groups were most accepting of homosexuality, with the sex change group having the least acceptance of homosexuality. Support was not found for the prediction that the sex change group would have the worst present and past adjustment followed by the homosexual cross-dressers with the poorest past adjustment. As predicted, however, fathers were perceived as more nurturant in the heterosexual group than among the remaining three groups. These findings suggest that variations in sexual-life-style can be understood as manifestations of different combinations of the components of psychological sex and that a nurturant father is important in the development of a heterosexual life-style.

Adaptation, Psychological↗
PubMed2005

Early history of the concept of autogynephilia.

Since the beginning of the last century, clinical observers have described the propensity of certain males to be erotically aroused by the thought or image of themselves as women. Because there was no specific term to denote this phenomenon, clinicians' references to it were generally oblique or periphrastic. The closest available word was transvestism. The definition of transvestism accepted by the end of the twentieth century, however, did not just fail to capture the wide range of erotically arousing cross-gender behaviors and fantasies in which women's garments per seplay a small role or none at all; it actually directed attention away from them. The absence of an adequate terminology became acute in the writer's research on the taxonomy of gender identity disorders in biological males. This had suggested that heterosexual, asexual, and bisexual transsexuals are more similar to each other-and to transvestites-than any of them is to the homosexual type, and that the common feature in transvestites and the three types of non-homosexual transsexuals is a history of erotic arousal in association with the thought or image of themselves as women. At the same time, the writer was becoming aware of male patients who are sexually aroused only by the idea of having a woman's body and not at all by the idea of wearing women's clothes. To fill this terminological and conceptual gap, the writer introduced the term autogynephilia(love of oneself as a woman).

Europe↗
PubMed2005

The basis of gender assignment in disorders of somatosexual differentiation.

Sex assignment of patients with disorders of somatosexual differentiation is a controversial topic. The aim is to enable the patient to develop a stable gender identity during childhood, adolescence and adulthood. Enormous advances have recently been made in our knowledge of the molecular mechanisms of sexual differentiation and it is understood that long-term outcome may depend on the underlying diagnosis. There is increasing evidence that genital development is dependent on the action of androgenic steroids; moreover, both androgens and oestrogens may have an impact on other developing organs including neuronal structures such as the brain. Long-term outcome studies on the various intersexuality disorders are desperately needed in order to establish a basis for evidence-based medicine regarding sex assignment and treatment options. Premature decisions leading to irreversible interventions before an accurate diagnosis has been established must be avoided.

Disorders of Sex Development↗
PubMed1980

On fathering (the nature and functions of the father role). Part II: Conceptualization of fathering.

The scientific study of fathering has been somewhat neglected, perhaps because the father role is hardly constant even within a particular culture and is subject to very great fluctuations indeed from culture to culture. In that respect the study of fathering is much more difficult than the study of mothering. Work often subsumed under the heading of "attachment theory" has shown that the mother-infant and mother-child relationships have some cross-cultural constancy and may even be described as a bio-social "given". Four methods of data collection are described and reviewed: studies of adults partially or fully deprived of adequate fathering during their childhoods; direct studies of father-infant and father-child interaction; "in-depth" psychoanalytic studies of individual psychopathology in relation to that individual's relationship to a father; and introspection and personal observation. Each of these four avenues of data collection offers certain advantages as well as certain disadvantages which are reviewed with examples from available literature. In studying the importance of the father role there is a tendency to study the importance of fathering to children, ignoring that fathering is clearly important to the psychological development and further growth of the father. That there is a psychopathology of the process of fatherhood seems obvious on reflection, and data bearing on that psychopathology are reviewed. The importance of fathering to infants and children can be reviewed according to the three areas of psychic activity: primary creativity, the basic fault, and the Oedipus conflict. In the area of primary creativity we can study the importance of fathering to infants in terms of fantasied fathers and part-time fathers, and the prenatal role of father as mother facilitator. In the area of the basic fault (two-person psychology) we can study the postnatal role of father as mother facilitator, the role of father as mother-surrogate, the pre-oedipal role of father in the determination of gender identity, the role of father in "healing by second intent", and the importance of father in separation-individuation. In the area of the Oedipus conflict (three-person psychology) we can study the role of father in the infant's resolution of the oedipus complex and the development of superego, the importance of father as a role model for post-oedipal identification, the relation of father-absence to anti-social behaviour, the role of father in fostering cognitive and general development and growth, and the role of father in the further formation of adult personality. This two-part concludes with a review of the importance of improved understanding of the father role in clinical work.

Adolescent↗
PubMedDate not supplied

The role of gender-related processes in the development of sex differences in self-evaluation and depression.

This paper examines gender socialization processes during childhood that may contribute to a higher incidence of depression or depressive symptoms in females than in males. It is argued that because of the actions of socialization agents and the impact of gender stereotypes on a child's construction of gender identity, girls may exhibit higher levels of self-evaluative concerns that increase vulnerability to depression. Indeed, a review of the literature on sex differences in self-evaluation suggests that girls may be more susceptible than boys to self-evaluative concerns, particularly as reflected in lower expectations for future success, more maladaptive causal attributions for success or failure outcomes, and negative behavioral and evaluative reactions to failure. Moreover, an examination of the literature on sex differences in depressive symptoms leads to questions about previous conclusions that girls do not exhibit higher levels of depressive symptoms prior to adolescence. Finally, we present some recent original data that support the contention that sex differences in vulnerability to depression may be evident prior to adolescence.

Adolescent↗
PubMed2005

Handedness, functional cerebral hemispheric lateralization, and cognition in male-to-female transsexuals receiving cross-sex hormone treatment.

This study examined the impact of sex hormones on functional cerebral hemispheric lateralization and cognition in a group of male-to-female transsexuals receiving cross-sex hormone therapy compared to eugonadal men with a male gender identity. Cerebral lateralization was measured with a handedness questionnaire and a visual-split-field paradigm and cognitive tests sensitive to sex hormone exposure (identical pictures, 3-D mental rotation, building memory) were also administered. Endocrine measures on the day of participation for transsexual and control subjects included total testosterone, free testosterone, estradiol, gonadotropins, and sex hormone binding globulin concentrations. Compared to controls, male-to-female transsexuals had elevated estradiol and sex hormone binding globulin concentrations and suppressed testosterone concentrations. Transsexual subjects showed a trend toward less exclusive right-handedness than controls. No group differences were observed on the visual-split-field or cognitive tasks. No direct associations were observed between endocrine measures and the laterality measures and cognitive performance. Previous observations of female-typical patterns in cerebral lateralization and cognitive performance in male-to-female transsexuals were not found in the current study.

Adult↗
PubMed2002

Fraternal birth order and birth weight in probably prehomosexual feminine boys.

The purpose of this study was to confirm a previous finding that homosexual males with older brothers weigh less at birth than do heterosexual males with older brothers. The subjects comprised 250 feminine boys referred to a child psychiatry service because of extreme cross-gender wishes or behavior and assumed, on the basis of previous research, to be prehomosexual, plus 739 control boys and 261 control girls referred to the same service for reasons unrelated to sexual orientation or gender identity disorder and assumed, from base-rate probabilities, to be preheterosexual. The feminine boys with two or more older brothers weighed 385 g less at birth than did the control boys with two or more older brothers (P = 0.005). In contrast, the feminine and control boys with fewer than two older brothers did not differ in birth weight. This finding suggests that the mechanism by which older brothers increase the odds of homosexuality in later-born males operates prior to the individual's birth. We hypothesize that this mechanism may be immunologic, that antimale antibodies produced by human mothers in response to immunization by male fetuses could decrease the birth weight of subsequent male fetuses as well as increase their odds of homosexuality.

Antibodies↗
PubMedDate not supplied

[Troubling femininity. On the topic of adolescence].

Adolescence is of cardinal importance for gender identity, a period of self-differentiation in which sexual identity is finally and fully established. The author proceeds from a somato-psychic relation model taking shape between mother and daughter at birth and based on unconscious projections on the part of the mother. The model centres around the contrast between the body as envelope and as (empty) cavity. In the course of adolescence, in which femininity, sexuality and motherhood are supposed to manifest themselves and unite in the female body, girls are faced with the difficult task of relinquishing the idea of their body as a cavity and identifying with the idea of physical containment. With reference to the case of a bulimic adolescent and more general remarks on anorexia, the author traces the difficulties encountered on the arduous path to the appropriation of femininity, which, if strayed from, can lead to the brink of death.

Adolescent↗
PubMed1976

Freud's views on early female sexuality in the light of direct child observation.

Freud's writings on early female sexuality are reviewed in order to demonstrate which of his central assumptions are supported and which have been corrected by the direct observation of young children. The study of the emergence of core gender identity in little girls is a key to the modification of Freud's statements on the onset of and crucial factors in the development of femininity. Cognitive functions, learning experiences, and language are believed to be more important than Freud stressed, and penis envy and feelings of inferiority are relegated to a less universal and less necessary place in the onset of femininity. The role of the father is given different emphasis. Direct observation clarifies many aspects of masturbation or early genital self-stimulation in the young female: its onset; its feminine rather than masculine character; its early vicissitudes; its importance relative to other behavior; the impact of the discovery of anatomical difference; one special way it is affected by parental attitude; and how it contrasts with comparable behavior in the young male. Observation refutes Freud's often quoted statement that masturbation is further removed from the nature of women than of men.

Child↗