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PubMed2004

Androgen and psychosexual development: core gender identity, sexual orientation and recalled childhood gender role behavior in women and men with congenital adrenal hyperplasia (CAH).

We assessed core gender identity, sexual orientation, and recalled childhood gender role behavior in 16 women and 9 men with CAH and in 15 unaffected female and 10 unaffected male relatives, all between the ages of 18 and 44 years. Women with congenital adrenal hyperplasia (CAH) recalled significantly more male-typical play behavior as children than did unaffected women, whereas men with and without CAH did not differ. Women with CAH also reported significantly less satisfaction with the female sex of assignment and less heterosexual interest than did unaffected women. Again, men with CAH did not differ significantly from unaffected men in these respects. Our results for women with CAH are consistent with numerous prior reports indicating that girls with CAH show increased male-typical play behavior. They also support the hypotheses that these women show reduced heterosexual interest and reduced satisfaction with the female sex of assignment. Our results for males are consistent with most prior reports that boys with CAH do not show a general alteration in childhood play behavior. In addition, they provide initial evidence that core gender identity and sexual orientation are unaffected in men with CAH. Finally, among women with CAH, we found that recalled male-typical play in childhood correlated with reduced satisfaction with the female gender and reduced heterosexual interest in adulthood. Although prospective studies are needed, these results suggest that those girls with CAH who show the greatest alterations in childhood play behavior may be the most likely to develop a bisexual or homosexual orientation as adults and to be dissatisfied with the female sex of assignment.

Adrenal Hyperplasia, Congenital↗
PubMed1988

[Disorders of the maturation process and psychosexual development of anorexic patients].

In a therapy outcome-study with 51 female anorectic patients most of them showed a delay in maturation, deviations in sexual behaviour and in attitudes towards sexuality. The interpretation of our data shows that family factors play a major role in the development of sexual disturbances. To interpret anorexia nervosa only as a rejection of the female role means to simplify the complex processes in this multidetermined illness.

Adolescent↗
PubMed1987

Symptomatology, psychosexual development and gender identity in 42 anorexic males.

Forty-two male patients with an anorexic syndrome were assessed. Twenty-nine of them had a primary anorexia nervosa (most of them also had bulimic symptoms). They were compared with a series of 23 female anorexia nervosa patients. The males scored more highly than female patients on a number of symptoms, but generally more similarities than differences in symptomatology were apparent. Male patients with primary anorexia nervosa also showed several signs of a disturbed psychosexual and gender identity development. The data support the hypothesis that males with atypical gender role behaviour have an increased risk for developing anorexia nervosa or bulimia in adolescence.

Adolescent↗
PubMed1999

Prenatal exposure to anticonvulsants and psychosexual development.

Animal studies have shown that prenatal exposure to the anticonvulsant drugs phenobarbital and phenytoin alters steroid hormone levels which consequently leads to disturbed sexual differentiation. In this study, possible sequelae of prenatal exposure to these anticonvulsants on gender development in humans were investigated. A follow-up study was carried out in phenobarbital- and phenytoin-exposed subjects and control subjects matched for age, sex, and the mothers' ages. Subjects were born in the Academic Medical Center between 1957 and 1972. Out of 243 exposed and 222 control subjects who were asked to volunteer, 147 exposed subjects (72 male, 75 female) and equal numbers of their matched control subjects participated in the follow-up study. They were interviewed and were asked to fill out questionnaires on gender role behavior, gender development, and sexual orientation. As a group, exposed and control subjects did not differ with respect to gender role behavior, although higher numbers of prenatally anticonvulsant-exposed subjects reported current or past cross-gender behavior and/or gender dysphoria. Three prenatally anticonvulsant-exposed subjects were transsexuals and had undergone sex reassignment surgery, a remarkably high rate given the rarity of transsexualism. In addition, two exposed males had exclusively homosexual experiences, whereas none of the control males reported exclusive homosexual behavior. The groups did not differ in attainment of pubertal psychosexual milestones.

Anticonvulsants↗
PubMed1980

[Comments on developmental psychology and some reflections on disorders of psychosexual development (author's transl)].

An attempt must be made to deal with the emotionally disturbed person in the test area of various social relationships, in order to learn to understand better the "language" of his symptoms. Moreover, Adler, Freud and Lorenz taught us to pay special attention to child development. This paper tries to project sexually disordered development on to a scale of emotional qualities differentiated from early childhood emotions. Emotional scaling of sexual information, which is perceived and interpreted according to cognitive development of the child, is influenced by parental attitudes and opinions. In particular, miscarried early childhood object relations endanger the "acquisition" of the sexual object and psychosexual identity.

Adolescent↗
PubMed2004

[Psychosexual development and sexual education].

The bio-environmental influence on the sexual development and ripeness includes to the morality as the essential element of the behavioral expression. There are few studies directed to the interface between the healthy sexual development and the early intervention destined for the child-youth sexual risky behaviors. A suitable development sociomoral waits that every individual genuine participant and healthily in his sexuality to share it with another human being, without moving away from his expression. Some behavioral differences between the genders are described; goals of development; importance of assigning sexual education to the child-youth population, its vectors and preventive recommendations in domestic and/or school ambiences, directed to the personnel of health, as the avoidance of not wished pregnancy, the prevention of STD and other behaviors of risk. It is invited to the revaluation of the welfare services; supervision of programs, familiar participation; increase of the education in means of information, with personal and social responsibility. Such a consolidation requires from the health personnel the fulfillment of the educational-preventive recommendations of the professional performance to the advantage of a responsible practice.

Adolescent↗
PubMed1989

The effects of a scientifically objectifying (self-) understanding on the psychosexual development.

The question as to whether a spiritualized technical-mechanical world and human image can play a role in the development of sexual perversions was posed. Sexually deviant behaviour could then be understood as being an escape from a mechanical self-experience, poor in sensitivity. The presence of concept contents in psychological tests and anamnestic details which indicate such a self-experience was examined in children and adolescents with disturbances in sexual identity, object choice and sexual behaviour and was analysed for patients with fetishistic or violent tendencies. In fetishistic patients the results came up to our expectations more than in those with tendencies to violence, but not all single results supported our hypothesis.

Adolescent↗
PubMed1990

On the girl's psychosexual development: reconsiderations suggested from direct observation.

Following on two decades of longitudinal direct observation of young children, revisions of two component parts of psychosexual theory seem warranted. First, direct observation does not support the concept of a "phallic" phase as being representative of the girl's first genital phase. Observational findings challenge "phallic" concept-dependent hypotheses Freud proposed in 1925, including how the girl enters her Oedipus complex as well as the nature of her wish to have a baby. In the children observed by the author, phallic aggression was not manifest as much in girls as in boys, between the ages of two and four. Second, it is proposed we put aside the "phallic" phase concept in our considerations of the girl's dynamics and that we heighten our awareness of her early experiences of ambivalence--which lie at the heart of the oedipal conflict--and which leads to a formulation of superego development in the girl more compatible with clinical findings.

Child↗
PubMed1981

The role of breast-feeding in psychosexual development and the achievement of the genital phase.

1. The role of the neurohormone oxytocin is a physiological factor in the reproductive cycle of coitus, birth, breast-feeding, the milk-ejection reflex, nipple erotism, and female sexual responsiveness. 2. The capacity for "motherliness," the attributes of empathy, consideration, confidence, and love are dependent on the level of psychosexual, ego, and superego maturity of the mother as well as on the pattern of mothering she experienced as a child. 3. The satisfaction of the oral hunger-satiation cycle is essential. Without it, even the most satisfactory maternal environment proves insufficient and results in serious ego constriction. 4. Bottle-feeding, as breast feeding, may offer a relatively satisfactory solution to the basic, physiological, hunger-satiation cycle and may fulfill, to a limited extent, the libidinal requirements of the crucial oral phase, depending on the psychosexual maturity and ego and superego development of the mother. 5. However, breast-feeding alone provides the experience of the original primal scene on which the later primal scene is based. 6. The breast-feeding capacity in itself is no more an indication that psychosexual maturity and the genital phase have been achieved than is the ability to achieve vaginal orgasm (or genital orgasm, in the male). 7. Sherfey's (1966) findings notwithstanding, Freud's (1925) statement that the elimination of clitoral primary (not participation) is essential for the development of femininity remains valid.

Breast Feeding↗
PubMed2003

The long term outcome of feminizing genital surgery for congenital adrenal hyperplasia: anatomical, functional and cosmetic outcomes, psychosexual development, and satisfaction in adult female patients.

BACKGROUND: There are only a few reports analyzing the long term outcome of feminizing surgery in females with congenital adrenal hyperplasia (CAH). Such analysis is crucial to evaluate the treatment and to make necessary adjustments. STUDY OBJECTIVES: To evaluate the adult outcome after feminizing surgery in adult females with salt wasting CAH. DESIGN: Retrospective observational followup investigation. SETTING: Outpatient clinic of a University Medical Center, in 2002. PARTICIPANTS: Eight patients (born 1973-1983) who underwent feminizing surgery in infancy by the same procedure and the same pediatric surgeon in our center, and 19 healthy female controls (for visual analog scales). METHODS: (a) Study of patients' records (n=8); (b) Systematic evaluation of the current situation (n=6): uroflowmetry, a written questionnaire to screen for psychopathology (Youth Adult Self Report, YASR), structured gynecologic examination and a structured psychosexual interview, including scoring on visual analog scales. RESULTS: (a) The first surgery (age 0.1-3.7 yr) consisted of clitoris reduction and vaginoplasty (single-stage) in 7 patients and clitoris reduction only in one patient. The latter patient had vaginoplasty in puberty. In puberty, 6 of the 7 patients with an initial single-stage procedure required re-vaginoplasty. All 6 patients who participated in this systematic evaluation had undergone (re-) vaginoplasty in puberty; (b) 2 of the 6 patients experienced some urinary incontinence, and in one of them, the uroflowmetry result was abnormal. The YASR showed no psychopathology, except for 1 patient with a slightly elevated externalizing score. Gynecologic examination (n=5) revealed vaginal strictures in 3 patients (1 severe, 2 mild). The 2 patients without vaginal strictures had coitus regularly. In the interview, 2 patients called themselves bisexual, the other 4 heterosexual. None of the patients had homosexual contacts. Sexual developmental milestones (romantic interest, falling in love, kissing and petting, coitus) had been reached by all, except for 1 patient who did not have coitus yet. In the patient group, satisfaction with height, body hair, and external genitalia and sexual fantasies and interest, measured with visual analog scales, was not different compared to the control group, except for satisfaction with total body appearance, which was significantly lower in the patients. CONCLUSION: Despite the poor outcome of the initial single-stage surgery in infancy and the inevitable re-operation in puberty, the adult outcome in our study population seems more positive than the findings in the few previous reports, especially with respect to sexual development and activity.

Adrenal Hyperplasia, Congenital↗