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PubMed1988

The LH surge in humans: its mechanism and sex difference.

There is a sex difference in the response to an estrogen challenge test in humans, but, unlike with rats, this sex difference is not permanently imprinted in the central nervous system. Estrogen is not only the important ovarian signal to trigger off the LH surge, but it also probably plays an important role in activating the positive estrogen feedback mechanism in humans. For an LH surge to occur, amplification of the hypothalamic signal (enhanced secretion of GnRH) as well as sensitization of the pituitary responsiveness to GnRH are required. It is unlikely that androgens per se are responsible for suppressing the positive estrogen feedback in humans and the possible role of another gonadal factor other than androgens remains speculative. The LH surge is a neuroendocrine phenomenon involved primarily in the process of ovulation and it is not correlated to sexual identity and orientation. Furthermore, how the hypothalamic-pituitary axis (HPA) responds to the estrogen challenge can be accounted for purely by its exposure to a different steroid milieu without reference to gender identity or sexual orientation of the subject.

Estrogens↗
PubMed1989

Gender differences in identity development: issues of process, domain and timing.

Adolescence has been designated as the first time in one's life span when the identity concerns of developing one's values, beliefs, and goals become salient (Erikson, 1968). Theorists and empiricists have suggested that males and females may address the identity task differently. In three separate studies conducted with early to late adolescents, gender comparisons were made regarding: (I) the process by which their identities are formed; (2) the domains in which they might define themselves; and (3) the time in which this task might be initiated. It was found that both genders used the identity statuses (process) comparably, except for foreclosure which characterized males significantly more than females. Both genders used the identity process similarly in the domains of vocational choice, religious beliefs, and sex-role orientation. Males were significantly more likely to be foreclosed and females, diffuse, in the area of political ideology. Females were significantly more likely to be in moratorium or identity achieved with regard to family roles. In two of the three studies, no timing differences were found. The findings from a third study may reflect a greater complexity of the identity task for some female high school seniors as they confront intrapersonal and interpersonal goals simultaneously.

Adolescent↗
PubMed2002

Health care reform in New Zealand: the diversity of gender experience.

Women are a heterogeneous group with varying experiences and needs of health care systems. It is important that we recognise not only differences between women, but also that individual women may have different, even contradictory, health care issues and needs. These may vary according to women's different roles, identities, contexts, and resources (financial, social, etc.). This paper explores situated ideas about identity, gender, and place and how these relate to perceptions of accessibility of health care services in the context of New Zealand's restructured health care system.

Delivery of Health Care↗
PubMed2002

Management of 46, XY partial gonadal dysgenesis--revisited.

46, XY partial gonadal dysgenesis is a rare condition characterized by a varying degree of testicular dysgenesis, ambiguous genitalia, and usually absence of regression of Müllerian structures. The management of patients with these disorders warrants revisiting, owing to recent molecular biological findings and to reports on the long-term outcome of individuals with ambiguous genitalia. We report on a patient with 46, XY chromosomes, presence of the "sex-determining region of Y chromosome" (SRY) gene, scrotal gonads, fallopain tubes, uterus, vagina, and ambiguous genitalia with a penisoid, perineal hypospadia and sinus urogenitalis. Gonadal biopsy revealed virtually normal testicular tissue in both gonads. Removal of the gonads during surgery for a cystic adnex tumor revealed clear signs of partial gonadal dysgenesis. The decision to raise the child as a male was made by parents and physicians caring for the patient. Administration of testosterone, removal of the uterus and adnexes, in addition to repair of the hypospadia permitted an almost normal penis to be formed with normal male micturition. In the management of affected patients it has to be considered that establishing the diagnosis may be extremely tricky, even with the use of gonadal biopsies. The decision on sex assignment may be even more difficult, since future gender identity, limitations of genital reconstructive surgery and the potential for development of gonadal tumors have to be taken into consideration. While in the past, female sex assignment was commonly recommended for such patients, raising them in a male gender role is now considered. Parents should be involved in the decision that is ultimately based on extensive analysis of the individual case.

Child, Preschool↗
PubMed2001

A psychoanalytic reading of Peter Høeg's novel Miss Smilla's Feeling for Snow.

The author presents a psychoanalytic reading of the Danish author Peter Høeg's masterpiece 'Miss Smilla's Feeling for Snow', focusing on the special linguistic style of the novel. Further, the author puts forward an interpretation of the heroine, seeing her as a literary example of female bisexuality. Investigating the heroine's fate, the author discusses Miss Smilla's phallic defence and identity. The narrative technique in Høeg's novel is analysed through Lacan's concepts of the Real, the Imaginary and the Symbolic. The main figure is interpreted as an imaginary example of female bisexuality. Miss Smilla has neither an unambiguous gender identity nor ethnicity. The heroine is pictured in a conflict between two cultures: the Greenlandish and the western European, and her bisexuality both reflects this and is part of it. The author proposes to interpret a significant memory from Smilla's early childhood as an example of a castration phantasy, which retroactively gives new significance to the little girl's pre-oedipal frustration.

Bisexuality↗
PubMedDate not supplied

Is there a gender difference of somatostatin-receptor density in the human brain?

Animal experiments and observations in human brains have convincingly shown that sexual differentiation not only concerns the genitalia but also the brain. This has been investigated also in the light of a possible explanation of a presumed biological aetiology of transsexuality. The volume of the central subdivision of the bed nucleus of the stria terminalis, a brain area that is essential for sexual behaviour, has been reported to be larger in men than in women. Additionally, the number of somatostatin expressing neurons in this region was shown to be higher in men than in women. As neuronal production of somatostatin is involved the idea is striking whether somatostatin-receptor density in the cortex of cerebral hemispheres might be related to gender identity. We investigated in vivo the density of somatostatin-receptors in selected regions of the human brain in both sexes by means of receptor scintigraphy. Basal ganglia tracer uptake of 111-In-Pentreotide was equally low in both genders at 0,80% +/ 0,26 (related to tracer uptake of the whole brain layer). Temporal cortex accumulated at 2,9% +/ 1,1 in men and at 2,3% +/ 0,76 in women. Frontal brain region had an uptake of 3,0% +/ 1,4 in male and of 2,5% +/ 1,3 in female. This shows a tendency in males for relatively augmented uptake indicating higher somatostatin receptor density in temporal and frontal cerebral cortex.

Adult↗
PubMedDate not supplied

Experiences of long-term tranquillizer use: a psychodynamic perspective.

The aim of the article is to analyse narrative descriptions and experiences of long-term tranquillizer use. The analysis is based on a Danish in-depth study of 50 informants with a self-diagnosed dependency on tranquillizers. The theoretical analysis is dependent on psychodynamic reasoning. Further, the psychodynamic perspective is integrated within a multi-dimensional model that considers biological, cognitive, identity, gender and social learning factors. The analysis reveals the possibility of achieving a detailed understanding of the dynamic processes involved in the development of long-term tranquillizer use. Important themes frequently mentioned in the clients' descriptions are traumatic childhood experiences, identity problems, life crises in adulthood and difficulties in stopping taking psychotropic drugs.

Adult↗
PubMed2001

Gender reassignment surgery and the gynecological patient(1).

With the increasing number of open transsexuals in the population and the advances in reconstructive surgical techniques, gender reassignment surgery has been increasing since the 1960s. Secondary to the increase in patients undergoing gender reassignment surgery, the practicing gynecologist is more likely to encounter a transsexual patient. A 49-year-old, nulligravid, white female presented to the gynecology clinic for her annual gynecological exam. Her past surgical history was significant for male to female gender reassignment surgery in 1991. Her hormonal medications included levothyroxine and estrogen. She described a strong family history of breast cancer for which she was being followed in our institutional Breast Watch Clinic. On physical examination, findings were notable for surgically constructed female external genitalia and a neovagina. The rectal exam was normal and failed to demonstrate any prostate pathology. It is important for the experienced gynecologist to be familiar with transsexualism, the reconstructive surgery involved, the surgical complications, and gender identity support groups and clinics available to these patients. Transsexuals should be treated to the extent possible like other female gynecological patients, while care is taken not to overlook underlying or preexisting medical conditions, including conditions unique to the prior and new genders.

Journal Article↗
PubMed2002

Gender gaps, gender traps: sexual identity and vulnerability to sexually transmitted diseases among women in Vietnam.

We conducted a qualitative study to explore the pathways by which traditional gender roles may ultimately affect Vietnamese women's interpretation of sexually transmitted disease (STD) symptoms and health-seeking strategies. Data on gender roles, perceptions of types of sexual relationships, perceptions of persons with STDs, and STD patient experiences were gathered through in-depth interviews and focus groups with 18 men and 18 women in the general population of northern Vietnam. A framework integrating Andersen's behavioral model of health services use and Zurayk's multi-layered model was used to conceptualize women's health-seeking behavior for STD symptoms. Both men and women noted clear gender differences in sexual roles and expectations. According to participants, a woman's primary roles in northern Vietnam are socially constructed as that of a wife and mother-and in these roles, she is expected to behave in a faithful and obedient manner vis à vis her husband. It emerged that men's marital and sexual roles are less clearly defined by traditional norms and are more permissive in their tolerance of premarital and extramarital sex. For women, however, these activities are socially condemned. Finally, since STDs are associated with sexual promiscuity, both men and women expressed anxiety about telling their partners about an STD; women's expressions were characterized more by fear of social and physical consequences, whereas men expressed embarrassment. Community level interventions that work towards disassociating STDs from traditional social norms may enable Vietnamese women to report possible STD symptoms and promote diagnosis and care for STDs.

Adult↗
PubMed2001

The sexual games of the body politic: fantasy and state violence in Northern Ireland.

This article analyzes the practice of strip searching women political prisoners in Northern Ireland as a violent technology of control aimed at breaking the political identity of prisoners. Focusing on a controversial case of a mass strip search carried out in 1992, the article examines the phantasmatic investements pervading this seemingly rational technology of control. Using a psychoanalytic notion of fantasy against the backdrop of a Foucaultian theory of power, this article argues that strip searches constitute a gendered form of political domination driven by, and performed within, a phantasmatic scenario of sexual violence. In this scenario both the political and gender identities of prisoners are re-inscribed with the power of a state acting as a male body politic. The article argues that the phantasmatic support of rational technologies of control betrays the contingent and shifting character of domination as well as its ambiguous effects.

Anecdotes as Topic↗
PubMed1998

Sexual differentiation: from genes to gender.

A person's sex can be considered across various levels. To illustrate, genes, hormones, and genitalia can all be considered physical markers of a person's sex. In addition to physical markers, behaviors such as gender role, gender identity and sexual orientation can be perceived as stereotypically male or female. The purpose of this review is to summarize current knowledge of sexual differentiation which emphasizes genetic and hormonal mechanisms that result in male and female development of gonads and genitalia. Finally, consideration is given to associations between genetic sex, gonadal sex, and hormonal sex with gender.

Animals↗
PubMedDate not supplied

[Intersection between gender and socioeconomic status in medical sciences career choice].

OBJECTIVE: Analyze the relationship between gender identity and socioeconomic level associated with career choice among undergraduate students selecting the area of health sciences. MATERIAL AND METHODS: Our sample was comprised of first year medical nutrition, dentistry and nursing students (n=637) admitted to the Universidad Autonoma Metropolitana - Xochimilco. A self administered questionnaire was used. The dependent variable was career choice. Independent variables included socioeconomic status, gender norms in student's homes, and gender stereotype internalization. RESULTS: More female nursing students came from low socioeconomic strata, while medical students had a higher socioeconomic status. Among males, more nursing and medical students belonged to a higher socioeconomicstrata. Nutrition and dentistry students belonged to a medium strata. In comparison with males from high socioeconomic strata more male participants reported that household chores were divided among men and women. For women, as the socioeconomic level increased, the participation of men and women also increased. In the indicators of internalization of gender stereotypes, nursing students had the highest rates in the submission scale, but the lowest for masculinity and machismo. As the socioeconomic strata increased, the characteristics of masculinity and machismo also increased. CONCLUSIONS: The present results seem to indicate that among women of low socioeconomic strata more traditional gender stereotypes prevail which lead them to seek career choices considered femenine. Among men, there is a clear relationship between career choice, socioeconomic level and internalization of gender stereotypes.

Career Choice↗
PubMedDate not supplied

The psychopathology inventory for mentally retarded adults: factor structure and comparisons between subjects with or without dual diagnosis.

Whether the Psychopathology Inventory for Mentally Retarded Adults (PIMRA) could detect specific psychopathological disorders was investigated in 652 subjects with different levels of mental retardation living in the community or in residential facilities. An exploratory factor analysis was carried out to check the scale organization of PIMRA. The Anxiety, Adjustment Disorder, Somatoform Disorder, and Soundness Scales were confirmed by 4 corresponding factors; the Psychosexual Disorder Scale was replaced by a factor specific to gender identity problems, and the Schizophrenia Scale by two factors concerning isolation and bizarre behaviors, respectively. The items of the Depression Scale were distributed over the three factors concerning anxiety, adjustment, and psychosomatic disorders, while the items of the Personality Disorder Scale were scattered over almost all the factors. Moreover, 55 subjects with anxiety disorders and 49 with depression were compared to 50 control subjects of the same age, intelligence level, and gender ratio but without dual diagnosis and obtained significantly higher factorial scores both on the overall scale and on the factors specifically related to their disorders. PIMRA has been found to show good construct validity. These results could be considered particularly valid as they were obtained from a large sample comprising different levels of mental retardation and thus showing all possible psychopathological behaviors.

Adolescent↗
PubMed1994

A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics.

Nonhomosexual male gender dysphorics often make their first requests for clinical assessment when they are in or approaching middle age. This study investigated how well patients' explanations for the timing of these requests fit the objective data. Subjects were 194 outpatients presenting for the first time at a gender identity clinic. Their common explanations for the timing of their requests were incorporated into a formal path model, which was tested using Bentler's structural equations program. The model provided an acceptable fit to the data. The more times a patient has been married and the more children he has fathered, the older he is likely to be when first presenting for clinical attention. This outcome is consistent with the claims of patients that they would have come to a gender clinic sooner if they had not been restrained by commitments to wives and children.

Adolescent↗
PubMed1990

Surgical management of neonates and children with ambiguous genitalia.

Gender assignment is a neonatal surgical emergency. Early evaluation and treatment of intersexuality must be done as a team approach with a genetist, a paediatric endocrinologist and a paediatric surgeon/urologist taking part in it. Change of gender after 2 years of confusion of gender identity often results in social disaster. Over a period of 20 years the authors managed a total of 27 patients with ambiguous genitalia. They favour early reconstruction of most anomalies at about 3 years of age, which seems to be optimal in terms of surgical feasibility and avoidance of the obvious emotional problems caused by delayed intervention. A detailed description of policy and techniques is given for surgical intervention in the patient to be raised as a female or as a male. They changed the gender in three patients, twice in neonates and once before two years of age.

Adolescent↗
PubMed2006

Selectivity for the configural cues that identify the gender, ethnicity, and identity of faces in human cortex.

We used psychophysical and functional MRI (fMRI) adaptation to examine how and where the visual configural cues underlying identification of facial ethnicity, gender, and identity are processed. We found that the cortical regions showing selectivity to these cues are distributed widely across the inferior occipital cortex, fusiform areas, and the cingulate gyrus. These regions were not colocalized with areas activated by traditional face area localizer scans. Traditional face area localizer scans isolate regions defined by stronger fMRI responses to a random series of face images than to a series of non-face images. Because these scans present a random assortment of face images, they presumably produce the strongest responses within regions containing neurons that are face-sensitive but not highly tuned for face type. These areas might be expected to show only weak selective adaptation effects. In contrast, the largest responses to our selective adaptation paradigm would be expected within areas containing more selectively tuned neurons that might be expected to show only a sparse collective response to a series of random faces. Many aspects of face processing (e.g., prosopagnosia, recognition, and configural vs. featural processing) are likely to rely heavily on regions containing high proportions of neurons that show selective tuning for faces.

Cerebral Cortex↗
PubMed2005

Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder.

BACKGROUND: The objective of this paper is to describe and conceptualize an unusual and probably rare condition: the intense longstanding desire to have an amputation. METHOD: Structured interviews were conducted by telephone of 52 subjects (mean age: 48.6, range 23-77 years; 47 male, 4 female, 1 intersexed) self-identified as having had a desire to have an amputation. RESULTS: Seventeen per cent (n = 9) had an arm or leg amputated with two-thirds using methods that put the subject at risk of death and one-third enlisting a surgeon to amputate their healthy limb. The most common reported reason for wanting an amputation was the subject's feeling that it would correct a mismatch between the person's anatomy and sense of his or her 'true' self (identity). None were delusional. For all but one subject age at onset was during childhood or early adolescence. For those who had psychotherapy or medication there was no change in the intensity of the desire for amputation. The six subjects who had an amputation at their desired site reported that following the amputation they felt better than they ever had and no longer had a desire for an amputation. CONCLUSIONS: These preliminary results suggest the existence of an extremely unusual clinically distinct condition characterized by a lifelong desire to have an amputation of a particular limb. The condition is associated with serious negative consequences: amputation attempts, impairment and marked distress. Reflecting similarities between Gender Identity Disorder and this condition, the author suggests that it may be conceptualized as an unusual dysfunction in the development one's fundamental sense of anatomical (body) identity.

Adult↗