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PubMed1995

A sex difference in the human brain and its relation to transsexuality.

Transsexuals have the strong feeling, often from childhood onwards, of having been born the wrong sex. The possible psychogenic or biological aetiology of transsexuality has been the subject of debate for many years. Here we show that the volume of the central subdivision of the bed nucleus of the stria terminals (BSTc), a brain area that is essential for sexual behaviour, is larger in men than in women. A female-sized BSTc was found in male-to-female transsexuals. The size of the BSTc was not influenced by sex hormones in adulthood and was independent of sexual orientation. Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Stone formation in genetic hypercalciuric rats.

Our genetic hypercalciuric (GH) rats have been selected and inbred for 29 generations to maximize urine calcium (UCa) excretion compared to identical gender controls (Ctl). To determine the effect of the increased UCa on urinary supersaturation and stone formation, we pair fed 15 GH and 15 Ctl rats a standard 1.2% calcium diet for 18 weeks, measured urine supersaturation every two weeks, and examined the urinary tract of 1/3 of the rats for the presence of stones every six weeks. Any stones formed were studied by SEM, X-ray and electron diffraction and X-ray microanalysis. Over the entire study UCa was increased in the GH compared to Ctl, resulting in greater supersaturation with respect to calcium hydrogen phosphate (CaHPO4) at all times and calcium oxalate (CaOx) at most times. There was a progressive increase in the incidence of stone formation in GH rats with one of five rats having stones at six weeks, three of five with stones at 12 weeks and five of five with stones at 18 weeks. There were no stones formed in Ctl rats. SEM reveals discrete stones and not nephrocalcinosis. X-ray and electron diffraction and X-ray microanalysis reveal the stones to be poorly crystalline apatite which is a solid phase of calcium and phosphate. Compared to Ctl, in the GH rats the saturation ratio for CaHPO4 increased proportionally more than that for CaOx, perhaps explaining why the rats formed apatite and not oxalate stones. This is the first description of an animal model of spontaneous nephrolithiasis.

Animals↗
PubMed2002

Two theories/a sharper lens: the staff nurse voice in the workplace.

AIM OF THE PAPER: This paper (1) introduces the two theoretical frameworks, Silencing the Self and the Framework of Systemic Organization (2) describes the design and findings briefly of a study exploring spillover in nurses utilizing the frameworks, and (3) discusses the process and value of theory triangulation when conducting research in the context of complex nursing systems phenomena where gender, professional work, and gender identity merge. BACKGROUND/RATIONALE: A research study was designed to analyse the actual workplace behaviours of nurses in the context of their lives at work and outside work. An exploration of theoretical frameworks that could direct the measurement of the phenomena in question led to the use of two frameworks, the Framework of Systemic Organization (Friedemann 1995) and the Silencing the Self Theory (Jack 1991), and the creation of a valid and reliable summative rating instrument (the Staff Nurse Workplace Behaviours Scale, SNWBS). DESIGN/METHODS: A descriptive correlational design was used to measure behaviours between work and home. RESULTS/FINDINGS: There were statistically significant relationships found between workplace behaviours, family behaviours, and silencing behaviours as measured by the two separate scales measuring framework concepts. CONCLUSIONS: Although both theories had different origins and philosophical tenets, the findings of a research study created an opportunity to integrate the concepts of each and unexpectedly increase and broaden the understanding of spillover for women who are often nurses.

Adaptation, Psychological↗
PubMed2000

Rural mental health: neither romanticism nor despair.

This paper explores the relationship between rural places and mental health. It begins with a definition of mental health and an outline of the data that have led to the current concern with promoting positive mental health. We then consider aspects of rural life and place that contribute to positive mental health or increase the likelihood of mental health problems. Issues identified include environment, place, gender identity, violence and dispossession and the influence of the effects of structural changes in rural communities. The paper concludes with a discussion of some of the determinants of resilience in rural places, including social connectedness, valuing diversity and economic participation.

Australia↗
PubMed2002

Disorders of androgen action.

Disorders of androgen action are the main cause of male pseudohermaphroditism and include 5alphaR deficiency and androgen receptor defects. 5alphaR deficiency is characterized by female genitalia with some degree of masculinization, clitoromegaly, and severely bifid scrotum corresponding to the so-called pseudovaginal perineoscrotal hypospadias. At the onset of puberty, increased muscle mass, development of pubic hair, and phallic growth are associated with the acquisition of male gender identity. Normal or increased levels of testosterone and an elevated testosterone-to-dihydrotestosterone ratio after human chorionic gonadotropin stimulation testing suggest 5alphareductase deficiency, and the diagnosis can be ascertained by identifying the mutation in the 5alphaR-2 gene. Whatever the patient's age at diagnosis, psychological evaluation with 5alphaRD is vital. Androgen receptor defects encompass two clinical expressions: the complete and partial androgen insensitivity syndromes. Complete androgen insensitivity syndrome should be suspected at birth in the presence of inguinal hernia in a girl without genital ambiguity. At puberty, the sign of alert is primary amenorrhea with normal female phenotype and harmonious mammary development but no pubic hair growth. Partial androgen insensitivity syndrome covers a wide spectrum of undervirilized phenotypes ranging from clitoromegaly at birth to infertile men. In all cases, complementary investigations should include plasma testosterone and luteinizing hormone as well as androgen-binding capacity in cultured genital skin fibroblasts. Diagnosis is confirmed by identification of the androgen receptor gene mutation. Although patients with complete androgen insensitivity syndrome are raised as females, patients with partial androgen insensitivity syndrome should be managed according to age at diagnosis, response to treatment with exogenous androgens, and the presence of an androgen gene mutation. Gonadectomy in complete androgen insensitivity syndrome should be performed before puberty, and androgen substitution may improve the development of external genitalia in some patients with partial androgen insensitivity syndrome. Psychological follow-up is necessary.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1988

[Franz Kafka's anorexia nervosa].

The evidence for the hypothesis that the poet Franz Kafka had suffered from an atypical anorexia nervosa is presented. Kafka was slim and underweight throughout his life and showed an ascetic attitude and abjuration of physical enjoyment and pleasure (fasting, vegetarianism, sexual abstinence, emphasis on physical fitness). The analysis is mainly based on Kafka's own descriptions in his letters, diaries, and literary work. Kafka was achievement oriented, reported many sadomasochistic fantasies, and had an anancastic (obsessive-compulsive) depressive personality. In addition there is evidence for a disturbed psychosexual and gender identity development. Our results concerning Kafka's psychopathology do not question his genius as a poet.

Anorexia Nervosa↗
PubMed2000

Progress in laryngeal framework surgery.

This paper reviews progress in laryngeal framework surgery since it was first reported about 25 years ago. The success of this type of surgery requires both a basic knowledge of the physiology of phonation, in order to make decisions about the surgical procedure, and surgical skill, in order to accomplish the intended procedure successfully. The main reason for hoarseness is imperfect closure of the glottis, but the second most important reason for hoarseness, increased stiffness of the vocal fold, cannot be corrected by mere medialization of the vocal fold. Laryngeal framework surgery is different in concept from conventional surgery, which is intended to remove the lesion. Controversial points discussed here regarding type I thyroplasty include: (i) whether the cartilage window should be removed; (ii) materials for fixation of the window; and (iii) comparison of type I thyroplasty with arytenoid adduction. A new surgical treatment for spasmodic dysphonia and its results in three patients are described briefly. Surgery for raising the vocal pitch requires further improvement. In the future, laryngeal framework surgery will have wider application in treatment of dysphonias, such as asthenic voice due to atrophy in professional singers or aging, pitch problems in females and gender identity disorder and spasmodic dysphonia.

Glottis↗
PubMed2003

The contributions of John Money: a personal view.

John Money has been a dominant voice in sexology in the last part of the 20th century, breaking new ground in a wide variety of areas. In the process, he has been cantankerous, outspoken, and ever willing to do battle, but also original and thought provoking. This paper begins with an examination of science in general, moves on to psychology and sexology, and then examines Money s contributions to sexology in some detail. The latter are many and varied, including the development of the concept of gender, his theory of gender identity based on his work with intersex individuals, the John-Joan case, and his importance in establishing transsexualism as a diagnostic category and an academic discipline. Also important are his contributions to the development of the nomenclature of sexology, his importance to the sexology movement as a teacher, his significant research on a large variety of sexual topics, his ability to convince government agencies that sex was deserving of funding, and his association with the Erickson Educational Foundation. He also was a significant figure in the development of the Society for the Scientific Study of Sexuality (SSSS) and in raising the standard of its journal (The Journal of Sex Research), and therefore it is only fitting that an award be named after him. Though Money remains controversial, he has contributed significantly to the development of sexology as a discipline.

Female↗
PubMed1981

Castration fantasies and assertiveness in father-absent males.

In a previous report (Shill 1981), father-absence was linked to insecurity in core male gender identity in a nonclinical sample of college males. The present paper describes further aspects of the experimental use of projective techniques, based on psychoanalytic theory and clinical discussions, to assess the effect of father-absence on male personality development. Castration fantasies and sense of competence in the mastery of external reality as an index of masculine self-representation were coded from the projective test responses of 103 father-present and 28 father-absent college males. When given a choice of castrating figure at the human or animal level, all subjects identified the human mother rather than the father as the more frightening castrating figure. Father-absent subjects, however, identified the animal mother as the more frightening castrating figure, compared to the animal father, more frequently than the father-present subjects, suggesting a denial and displacement of castration fear toward the human mother onto the animal substitute. The father-absent subjects also evidence significantly less sense of mastery, suggesting less self-assertiveness and sense of competence than the father-present controls. The importance of identification with the father as the basis for a masculine ego style and of father absence as a developmental interference affecting the appropriate management of aggression in males is discussed.

Adult↗
PubMed2000

The development and consequences of an aggressive symbiotic fantasy.

Chronic anxiety in a female patient was understood to have multiple meanings in relating to the mother through the fantasy of a symbiotic union. The origins of the fantasy are traced to the patient's poor relationship with a preoccupied and unavailable mother. The fantasy underwent several transformations under the influence of subsequent developmental phases and the special role of aggression in its elaboration. This paper illustrates the reciprocal interactions between separation-individuation and psychosexual development and their influence on the development of the self and gender identity, defenses against aggression, development of a sadomasochistic style, and transference-countertransference interactions. The symbiotic fantasy is seen as carrying the imprints of all developmental phases and as having multiple functions.

Adult↗
PubMed2005

Psychophysiological and subjective sexual arousal to visual sexual stimuli in new women.

Conflicting data exist regarding the sexual arousal patterns of post-operative male-to-female (MTF) women with Gender Identity Disorder. The purpose of this study was to examine objective and subjective aspects of the sexual arousal response using a vaginal photoplethysmograph. Fifteen MTF women viewed neutral and erotic audiovisual film segments while their blood flow patterns were monitored. Subjective measures of affect and sexual arousal were taken before and immediately after the films. There was a significant increase in self-reported subjective arousal, perceived genital arousal, perceived autonomic arousal, and positive affect; however, movement artefacts interfered with our assessment of the genital arousal response. MTF women reported both low levels of pain and low levels of awareness of the vaginal probe during testing. These data are discussed in the context of differences in pelvic musculature between natal and new women and have implications for future studies that aim to measure sexual arousal objectively in MTF women.

Adult↗
PubMed1999

Understanding HIV risks of chronic drug-using men who have sex with men.

Focus groups and individual structured interviews were conducted in six cities with 98 predominantly street-recruited men who had a recent history of smoking crack or injecting drugs and who reported having had sex with other men (MSM) in the past year. Twenty-six focus groups explored the cultural and social context of participant's drug use and sexual activity and addressed outreach and HIV prevention issues pertinent to this population. Narrative summaries developed from verbatim focus group transcripts identified seven themes: (a) sexual orientation and gender identity; (b) interactions within and between MSM networks; (c) drug use, sexual activity and personal relationships; (d) HIV transmission bridges; (e) preferred HIV information sources; (f) HIV knowledge, prevention practices and risk behaviours; and (g) availability of HIV and drug-related services. Of the 98 MSM drug users, 42% identified publicly as gay or homosexual; 35% identified publicly, but only 21% privately, as heterosexual. A total of 51% had one or more female sex partners in the past year. There was a high frequency of unprotected sex in conjunction with drug use and a distinct preference for having sex when high. For most participants, drug use rather than sexual orientation formed the core of personal identity. Participants reported associating primarily with other drug users, usually MSM, and had limited contact with people who did not use drugs and the mainstream gay community. Participants' sexual and drug-injecting activities were judged to be a bridge for transmission of HIV to both people who used drugs and those who did not.

Adolescent↗
PubMed2004

Advocacy for women's health should include lesbian health.

Although research confirms that homosexuality is a normal expression of human sexuality, established scientific studies are often not reflected in laws and judicial opinions for lesbians with regard to employment, taxation, pensions, disability, healthcare, immigration, military service, marriage, custody, and adoption. The expression of homosexual attraction or behavior is sometimes met by disdain or violence. Psychological and epidemiological research confirms that the public discriminatory attitudes and second-class legal status cause physical, emotional, and financial harm to lesbians, their families, and their children. Some lesbians experience discrimination in healthcare and avoid routine primary healthcare. To decrease the harm, and improve the health of lesbians, medical institutions can include sexual orientation and gender identity in their nondiscrimination policies and offer domestic partner coverage in employment benefits. Our specialty societies should review current laws and judicial opinions and advocate for change. Further, specialty societies can effect change by issuing policy statements about issues of orientation and by writing orientation/identity curricula for public schools, colleges, and postcollegiate education to improve their accuracy, reduce sexually transmitted diseases, delay sexual activity, and reduce morbidity from homophobic violence.

Female↗
PubMed2004

High-risk premenopausal women's experiences of undergoing prophylactic oophorectomy: a descriptive study.

Women who are at increased risk of developing ovarian cancer because of their family history may need to make decisions about the medical management of their cancer risk--whether to have ovarian screening or undergo prophylactic surgery. This qualitative study explores the perceived physical and emotional implications of undergoing preventative surgery using data collected during interviews with 23 high-risk premenopausal women who had undergone prophylactic oophorectomy because of their family history of cancer. Despite the fact that all of these women regarded their decision to undergo surgery extremely positively, 20 women also described what they regarded as the costs of undergoing surgery. These included post-operative complications, the onset of menopausal symptoms, side effects of hormone replacement therapy, and negative effects on body image and gender identity. The perceived benefits of surgery were described as risk reduction, enabling one to fulfil family obligations, removing the need for gynecological screening, cessation of menstruation, and positive side effects of hormone replacement therapy. This study suggests there is a need to inform women about potential physical and emotional sequelae of oophorectomy prior to undergoing this procedure.

Adult↗
PubMed1996

Reproductive health and AIDS prevention in sub-Saharan Africa: the case for increased male participation.

Reproduction is a dual commitment, but so often in much of the world, it is seen as wholly the woman's responsibility. She bears the burden not only of pregnancy and childbirth but also the threats from excessive child bearing, some responsibility for contraception, infertility investigation and often undiagnosed sexually transmitted diseases (STDs) including AIDS. Failure to target men in reproductive health interventions has weakened the impact of reproductive health care programmes. The paper proposes that sophisticated and dynamic strategies in Africa and elsewhere which target women's reproductive health and research (such as control of STDs including AIDS, family planning, infertility investigation) require complementary linkage to the study and education of men. Men's perceptions, as well as determinants of sexual behavioural change and the socioeconomic context in which STDs, including AIDS, become rife, should be reviewed. There is a need to study and foster change to reduce or prevent poor reproductive health outcomes; to identify behaviours which could be adversely affecting women's reproductive health. Issues of gender, identity and tolerance as expressed through sexuality and procreation need to be amplified in the context of present risks in reproductive health. Researchers and providers often ignore the social significance of men. This paper reviews the impact of male dominance, as manifested through reproductive health and sexual decisions, against the background of present reproductive health problems. A research agenda should define factors at both macro and micro levels that interact to adversely impinge on reproductive health outcomes. This should be followed up by well-developed causal models of the determinants of positive reproductive health-promoting behaviours. Behaviour specific influences in sexual partnership include the degree of interpersonal support towards prevention, for example, of STDs, unwanted pregnancy or maternal deaths. Perceived efficacy and situational variables influencing male compliance in, say, condom use, form part of the wider study that addresses men. Thus preventive reproductive health initiatives and information should move from the female alone to both sexes. Women need men as partners in reproductive health who understand the risks they might be exposed to and strategies for their prevention.

Acquired Immunodeficiency Syndrome↗
PubMed2000

An unmanly vice: self-pollution, anxiety, and the body in the eighteenth century.

The campaign against masturbation offers one of the outstanding success stories in the history of medical popularization. This paper seeks to identify the reasons for this success, focusing on the campaign's early stages, from the late seventeenth century onwards. It first identifies a series of often quite explicit political, ideological, and economic motives such as religious notions of 'uncleaniness', bourgeois concerns about self-control, marriage, and population growth, and the financial interests of the London veneral trade. Drawing, in particular, on the 'confessions of self-declared victims of masturbation in eighteenth-century patient letters, it then shows that the physical and mental symptoms attributed to masturbation very successfully addressed some of the deepest anxieties in contemporary society, anxieties about virility, gender identity, and physical selfhood. Finally, applying Bourdieu's notion of 'habitus', the central role of a new, implicitly male, more solid, closed and self-contained dominant body image is underlined. Framing the interpretation and the very experience of the body among the proponents and the recipients of anti-onanist discourse alike, it helped to make the dangers of masturbation an almost irrefutable, objective truth.

Anxiety↗
PubMed2001

The assault on ignorance: teaching menstrual etiquette in England, c. 1920s to 1960s.

At the end of the nineteenth century, medical paradigms of menstruation were located in a language of pathology and disability. Women were, therefore, perceived as incapable of competing with men in the world of education, work, and economics on account of their erratic and debilitating biology. This essay examines the challenge posed to this vision of menstrual disability by female medical practitioners in the early decades of the twentieth century. The new narratives of menstruation authored by these women not only re-cast normative menstrual experience as non-disabling, but were also formulated on the basis of canvassing the opinions of healthy schoolgirls rather than developing theories based on clinical contact with a minority of women defined as 'ill'. Yet female practitioners remained tied to a culture of 'menstrual discretion', thus perpetuating the secrecy and taboo associated with menstruation in the nineteenth century. This essay explores the tensions inherent in striving to overturn an oppressive medical model of menstruation whilst promoting menstrual discretion, and aims to place such apparent contradictions within the context of cultural notions of gendered identity and feminine sexuality.

Adolescent↗
PubMed2005

Reproduction in same sex couples: quality of parenting and child development.

PURPOSE OF REVIEW: Same sex couples are steadily becoming more open about their relationships. One consequence of this growing openness is that more couples of the same sex are choosing to have children and infertility treatment centers are increasingly faced with requests for assistance in creating these families. The aim of this review is to address new trends in reproduction in same sex couples, to consider the quality of parenting in lesbian mother and gay father households, and to review the literature on the development of children raised by same sex couples. RECENT FINDINGS: The current literature on these families is limited by small sample sizes and a predominance of studies of lesbian mothers and their children, with few studies of gay fathers and their children. A recent study of adolescents living with same sex parents recruited from a large national sample supports the notion that adolescents raised by same sex couples are doing well psychologically and are not more likely to be homosexual. The authors concluded that it was the quality of parenting, not parental sexual orientation that accounted for developmental differences. SUMMARY: The literature supports the notion that children of lesbian mothers and gay fathers are not more likely to become homosexual and are not measurably different from children raised by heterosexual parents in terms of personality development, psychological development, and gender identity. Larger longitudinal studies of same sex parents, particularly gay men, are needed, including those who choose to become parents through the use of assisted reproduction.

Child↗