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PubMed2004

Women and the implantable cardioverter defibrillator: a lifespan perspective on key psychosocial issues.

The clinical success of the implantable cardioverter defibrillator (ICD) in reducing mortality suggests that more women will be receiving ICDs in the future. The impact of ICD therapy in women is unique in western societies; the ICDs scar and lump in the pectoral area can lead to body image concerns due to the emphasis on women's physical attractiveness. Social support and roles are challenged because women's reaction to stress has been characterized by a "tend and befriend" response, involving cultivating and utilizing social networks, rather than the "fight or flight" response more typical of men. In addition, a woman's identity as a caretaker and caregiver can be threatened by the actual and perceived activity limitations imposed by the ICD or the underlying heart condition. Finally, reproductive and sexual health are important issues, as 25 to 50% of patients with ICDs report concerns in this area, but also report discomfort in discussing these concerns with their health care providers. The purpose of the present paper is to review the relevant literature and to identify the unique impact of the psychosocial issues of body image, social support and roles, and sexual development and reproductive functioning for women with ICDs across the lifespan. In the absence of complete empirical research data on the impact of these concerns, hypotheses to test in future research are offered.

Attitude to Health↗
PubMedDate not supplied

Sexual intercourse, abuse and pregnancy among adolescent women: does sexual orientation make a difference?

CONTEXT: Although a limited amount of research has retrospectively explored the childhood and adolescent heterosexual experiences of lesbians, little is known about the prevalence of heterosexual behavior and related risk factors or about pregnancy histories among lesbian and bisexual teenagers. METHODS: A secondary analysis was conducted using responses from a subsample of 3,816 students who completed the 1987 Minnesota Adolescent Health Survey. Behaviors, risk factors and pregnancy histories were compared among adolescents who identified themselves as lesbian or bisexual, as unsure of their sexual orientation and as heterosexual. RESULTS: Overall, bisexual or lesbian respondents were about as likely as heterosexual women ever to have had intercourse (33% and 29%, respectively), but they had a significantly higher prevalence of pregnancy (12%) and physical or sexual abuse (19-22%) than heterosexual or unsure adolescents. Among sexually experienced respondents, bisexual or lesbian and heterosexual women reported greater use of ineffective contraceptives (12-15% of those who used a method) than unsure adolescents (9%); bisexual or lesbian respondents were the most likely to have frequent intercourse (22%, compared with 15-17% of the other groups). In the sample overall, among those who were sexually experienced and among those who had ever been pregnant, bisexual or lesbian women were the most likely to have engaged in prostitution during the previous year. CONCLUSIONS: Providers of reproductive health care and family planning services should not assume that pregnant teenagers are heterosexual or that adolescents who say they are bisexual, lesbian or unsure of their sexual orientation are not in need of family planning counseling. Further research should explore the interactions between adolescent sexual identity development and sexual risk behaviors.

Adolescent↗
PubMed2006

[Arterial prehypertension and elevated pulse pressure in adolescents: prevalence and associated factors].

OBJECTIVE: To estimate the prevalence of prehypertension and elevated pulse pressure in adolescents and assess the association between those two conditions and sex, age, sexual development, obesity and physical activity. METHODS: Anthropometrical data and blood pressure were measured in and a questionnaire was applied to 456 adolescents (aged 12 to 17 years) recruited from public and private schools, in the Fonseca district, in the city of Niterói, state of Rio de Janeiro, Brazil, from 2003 to 2004. RESULTS: Thirty nine (8.6%) presented prehypertension (PH) and 13.4%, elevated pulse pressure (PP). At bivariate analysis, PH was significantly associated with sex, age and obesity, with more prevalent in boys aged between 15 and 17 years, and in the obese. Elevated PP was associated with gender only, as it was more prevalent in boys. Sexual maturation did not show an association with PH or elevated PP. Similar correlations were found at logistic regression. PH prevalence odds ratio was 7.7 for sex, 4.3 for age and 4.6 for obesity. Elevated PP prevalence odds ratio was 10.8 for sex. The correlation between PP and physical activity was positive and significant. The elevation of PP was attributable to systolic blood pressure. CONCLUSION: PH and the elevated PP were shown to be present in adolescents from a population with a low prevalence of hypertension, mostly in boys. Further prospective studies are necessary to assess the persistence and the impact of those conditions.

Adolescent↗
PubMed1991

[Critical periods in the pubertal development of girls].

The authors analyze the results of physical and sexual development of girls at the pubertal period, as well as their blood levels of hormones participating in the growth regulation and characterizing the +hypophyseal-gonadal relations. A staged pattern of pubertal period is emphasized+ and the critical period singled out: the age of menarche onset and establishment of the ovulation cycle (at the age of 14-15).

Adolescent↗
PubMed1997

Female adolescent sexuality. The risks and management.

Human sexuality goes through many stages from birth onward before reaching adult meaning and expression. Apart from the physical aspects, sexuality involves complex cognitive and social-emotional developmental processes including capacity for intimacy, affiliation, communication, mutual respect and responsibility. A variety of risks may affect sexuality development at any stage and facet of it. To support healthy sexuality functioning in the female adolescent, physicians need to identify early risk markers, some of which are biological and others intrapsychic or sociocultural. Identification should lead to preventative action in support of the adolescent.

Adolescent↗
PubMed1979

Ego development and sex attitudes in heterosexual and homosexual men and women.

A comparison was made of heterosexual and homosexual men and women utilizing Loevinger's concept of ego development and focusing on the relationships among ego levels and attitudes toward homosexuality and on personal sex guilt and other sociosexual variables. Previous comparative studies were critically analyzed with respect to the adequacy of definition and description of sampling procedures, and the appropriateness of research question. A pilot study reported here concerns the development of a measure of "attitudes toward homosexuality." The major study utilized 200 subjects who completed an anonymous and lengthy questionnaire. This sample was relatively young, well-educated, white, and Protestant. Self-ratings on the two Kinsey-type scales clearly differentiated the self-identified primarily heterosexual and homosexual groups. In this study there were no significant differences in ego levels between the heterosexual and the homosexual groups, suggesting that ego development and sexual orientation development are independent phenomena. Among both homosexual and heterosexual subjects there were low but significant correlations between higher levels of ego development and more positive attitudes toward homosexuality. More negative attitudes toward homosexuality were correlated with higher levels of personal sex guilt for heterosexual and homosexual men and for heterosexual women. Our measure of sex guilt proved to be related to ego level only for heterosexual males, although the measure of this construct requires additional research and refinement. Other correlates of these variables are also reported.

Adaptation, Psychological↗
PubMed1987

A group treatment program for adolescent sex offenders: five steps toward resolution.

This article describes a five-step group therapy program for adolescent sex offenders. The key elements of this approach are peer interaction and a system of incentives to move on in therapy, both of which are believed to be crucial in treating adolescents most effectively. While progressing through the steps, the participants acknowledge their adjudication, detail their offenses and personal sexual development, enhance their insights into their behavior and sexuality at large and plan how to avoid offending again. This paper describes the program of a rural outpatient guidance clinic in which a male-female therapist team met with several groups of boys (21 boys). The group program is part of a total treatment approach which also includes assessment, individual and family therapy.

Adaptation, Psychological↗
PubMed1997

5 alpha-reductase deficiency in patients with micropenis.

The enzyme 5 alpha-reductase (5 alpha R), by virtue of its peripheral 5 alpha-reduction of testosterone (T) to dihydrotestosterone (DHT), is believed to play a major role in the differentiation and the subsequent growth of the penis. However, recent studies have reported 5 alpha R deficiency (5 alpha RD) in patients with isolated micropenis and hypothesized that 5 alpha RD is not invariably associated with genital ambiguity. In Egypt, 5 alpha RD has been reported frequently among intersex patients. The aim of this study was to assess the role of 5 alpha RD in the development of micropenis among Egyptian patients with abnormal sexual development. The study included 29 patients who were categorized into three groups (isolated micropenis, 9 patients; microphallus with genital ambiguity, 11 patients; genital ambiguity with normal-sized phallus, 9 patients). Activity of 5 alpha R was assessed by estimating T/DHT ratios in the basal state in pubertal subjects and following human chorionic gonadotropin (HCG) stimulation test in prepubertals. The results showed that the incidence of 5 alpha RD was much higher in cases of ambiguous genitalia with micropenis (5 families out of 10, 50%) than in those with isolated microphallus (1/9, 11.1%) or those with ambiguous genitalia and normal-sized phallus (1/8, 12.5%). In conclusion, the study showed that isolated micropenis is a heterogeneous disorder and that 5 alpha RD, despite its relative prevalence in Egypt, has a minimal role in the aetiology. On the other hand, 5 alpha RD seems to correlate with penile length in intersex cases.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMedDate not supplied

[Late results of treating congenital hypothyroidism].

The authors present remote results of treatment of 23 patients with congenital hypothyroidism in whom the disease manifested itself in childhood; these patients reached the age of 20-30 years by the end of their examination. The efficacy of replacement hormonal therapy was connected not only with the early diagnosis of the disease, and timely treatment, but also with regularity of its institution at later years. Stable hypothyroidish compensation at the early stages of child development led to a proper physical, mental and sexual development of the patients, and promoted normalization of the metabolic processes and functional activity of the internal organs, preventing the patients' invalidization.

Adolescent↗
PubMed1977

Some guidelines for collection and reporting of nonhuman primate growth data.

Some basic guidelines were offered to aid researches in planning and implementing the collection and reporting of data on growth and development of nonhuman primates. Weight and linear dimensions are the most frequently used measures of growth, and asseous and dental development are the most useful indicators of general bodily maturity. Estimates of sexual development can be made from general bodily maturity but more accurate assessments are based on the appearance of certain secondary sex characters. The most useful growth data are obtained from repeated, regularly scheduled examinations of the same individual. Standard procedures for measuring the external body utilize certain specific measuring points and measurements. Serial radiographs are also extremely valuable. When reporting data, age of subjects should be given in years and decimals. Means and other measures of central tendency and variability should be reported separately for each species, subspecies, and sex.

Animals↗
PubMed1993

Neonatal treatment of male monkeys with a gonadotropin-releasing hormone agonist alters differentiation of central nervous system centers that regulate sexual and skeletal development.

Male rhesus monkeys treated continuously with a GnRH agonist for the first 4 months of postnatal life exhibited a delay in the onset of puberty and an attenuated peripubertal rise in testosterone (T) secretion. The objectives of the current study were to determine whether these effects on sexual development were permanent and whether the hypothalamic-pituitary-testicular axis was functioning normally in these animals as adults. Neonatal GnRH agonist treatment delays but does not permanently block sexual maturation in male monkeys. Treated animals that did not show a pubertal rise in serum T during the breeding season of their 4th year exhibited a seasonal but subnormal elevation of serum T during the subsequent breeding season. Growth of the skeleton was diminished as evidenced by shorter adult crown-rump, tibia, and femur length and reduced bone mineral density of the humerus and lumbar spine. The magnitude of the serum LH and T response to iv pulses of GnRH [50 ng/kg body weight (BW)] and naloxone (1 mg/kg BW) did not differ between control and treated animals during the nonbreeding or breeding season at 6 yr of age. Conversely, treated animals showed a subnormal serum LH and T response to N-methyl-D,L-aspartic acid (5 mg/kg BW iv) during the nonbreeding season. These data suggest that adult monkeys treated neonatally with a GnRH agonist exhibit subnormal sensitivity of the central nervous system to one or more excitatory amino acids (e.g. aspartate or glutamate). Thus, abolishing neonatal activation of the pituitary-testicular axis with a GnRH agonist may permanently alter differentiation of central nervous system centers that are either involved in GnRH secretion or govern this process.

Animals↗
PubMed1990

Disorders of sexual differentiation and development. Psychological aspects.

Children with abnormalities in sexual differentiation and development can have a smooth course of psychosocial development in spite of the significant risks and challenges they face. Chances for a positive emotional outcome are made more likely by the careful handling of these patients at the time of first presentation. Parents' unambiguous acceptance of the child's sex of rearing and early surgical intervention to normalize the child's external genital appearance are critical elements in a positive outcome. Further, the patterns of behavior documented in the materials reviewed in this article suggest difficulties of immaturity and social development rather than significant psychopathology. Parent-child interactions were repeatedly found to be central to the child's emotional well-being, underscoring the need to provide parents with adequate counsel and support. These patterns, however, represent findings across groups of patients and cannot predict the emotional, social, or academic functioning of any individual. Within all these clinical syndromes there is great individual variation in social, emotional, and physical presentation. Finally, rather than minimizing problems, physicians need to educate parents so they can be active advocates for their children in the educational and social arenas.

Adolescent↗
PubMed2001

[Epidemiology of cervical papillomavirus infections. Recent knowledge].

GENERAL DATA: There is now considerable evidence that high risk human papillomaviruses (HPV), such as HPV 16, are closely associated with cancer of the cervix. HPVs that are primarily transmitted through sexual contact, are found in over 99% of the cases of invasive cervical cancer. Although most women can be infected during their sexual life, a small minority is at risk for developing cancer. The long latency period between primary infection and cancer emergence suggests that additional factors are involved in the process of tumor development: sexual behavior, immune status, genetic predispositions, nutritional status, tobacco use, socio-economical level. NATURAL HISTORY: HPVs infect epithelial cells of the transformation zone of the cervix. As with other sexually transmitted diseases, the incidence of HPV infection is highest among young women. However, this viral infection is more often than not transient, because most individuals develop an effective type-specific immune response. Approximately 1% of the population has genital warts and 4% of women have cervical precancerous lesions: low grade squamous intraepithelial lesion (LGSIL) or high grade SIL. These last lesions preferentially observed in women aged 35-40 yrs are at high risk of progression towards an invasive cancer. ONCOGENIC POTENTIAL OF HPV: Pre-malignant and malignant cells arise as a result of HPV DNA integration in the host cellular genome, and overexpression of the viral E6 and E7 oncogenes. Cells acquire a proliferative advantage by escaping growth control exerted by p53 and p 105Rb. Both cellular proteins are indeed inactivated respectively by E6 and E7 proteins. Aneuploidy and karyotypic abnormalities are also key events in the tumor progression. A PREVENTABLE DISEASE: Cervical cancer is more than ever a preventable disease. While waiting for clinically applicable vaccination programs, strategies to prevent cervical cancer include 1) improved screening covering the widest possible population and using HPV testing, 2) close management and follow-up of women with precancerous lesions.

Adult↗
PubMedDate not supplied

Sexual behavior in children: normal or not?

Sexual abuse is a problem of epidemic proportions in the United States. Given the scope of the problem of sexual abuse and the amount of media attention it receives, it is not unusual for parents or caretakers who witness a child exhibiting sexual behavior to become alarmed. Primary care providers, including pediatric nurse practitioners, may be the first professional parents contact with concerns regarding a child's sexual behavior. It is imperative that primary care providers understand childhood sexuality and respond appropriately when confronted with child sexual behaviors in their practice. Although the literature includes little research on the subject of normal child sexual development, certain guidelines have been identified to describe normal child sexual behaviors and those of concern. Case studies illustrate the response of two primary care providers when they are confronted with sexual behaviors in their patients. Implications for practice are discussed, with examples and guidelines provided for primary care providers to use when evaluating sexual behavior in their pediatric patients.

Adolescent↗
PubMed1975

Grudge and the hysteric.

Our understanding of the bizarre sexuality of the hysteric began with Freud's discovery that its roots lay in infantile sexuality, but since then little knowledge has been added. This paper argues that the hysteric in early childhood deals with the failures of good-enough mothering and care by precocious sexual development, which is accompanied by an inability to be nurtured by any loving relationship. Sexual solutions to problems prove, for the hysteric, temporary, and inevitably end in grudge and complaints, as the love-object misreads the hysteric's gestures as expressing sexual wishes and desires instead of as a symbolic body language for care and protection. The author briefly examines the nature of the deprivation in childhood and the reason that the hysteric is such a promising yet recalcitrant patient, and offers a case illustration.

Fantasy↗
PubMed1998

[Female pseudohermaphroditism. Mixed germ cell tumor of the ovary. A case report].

It is known as Pseudohermaphroditism or intersexual state, those entities in which external genitalia are ambiguous or are not according with gonadal o genetic chromosomic sex. They can have diverse etiology. Continual exposition to estrogens or androgens may induce female or male dysmorphism, and also development of benign or malignant tumors at target organs. We present a case of a young woman, 15 years old, with virilization, who attend medical consultation for progressive abdominal growing. The presence of ambiguous, genitalia since birth, was not a previous reason of concern. Diagnostic, findings, management and follow up for about 4 months are described and also a topic review. Genitalia develop during first trimester of intrauterine life, under influence of sexual steroids, and changes of sexual development can emerge as consequence of endocrine or morphologic disorders and the later ones, related to karyotypic abnormalities. Sexual steroid and their metabolites can demonstrate individually, different biological effects, suggesting the presence of individual receptors. The presence of cooperative effects between each steroid produce even more complexity to the evaluation of each steroid. Various mutations principally at gene receptors of sexual steroids, cause resistance to them. At female pseudohermaphroditism in difference from male P. there is no errancy at genetic gonadal transmission. These women are intrauterine exposed to excessive quantities of androgens, and they have normal internal genitalia but external ambiguous genitalia. The involved androgen comes from external factors, a it occurs at mother who receives progesterone to avoid abortion, but it is due frequently to androgen storage, caused by enzymatic blockade at steroidogenesis (adrenogenital syndrome).

Adolescent↗
PubMed1994

Zfy is transcribed in the normal mouse epididymis and in the XXSxr ("sex reversed") testis.

The presence of the mutation Sex reversed (Sxr), a copy of a Y-chromosomal segment that gets transferred to an X chromosome, causes the resulting XXSxr mice to develop as apparent males. However, several features of male sexual development are abnormal in these animals. The testes are small and aspermatogenic, and the epididymides lack the initial segment. Testes and epididymides show abnormalities of extracellular matrix. In this study we examined transcription of the conserved Y chromosomal gene Zfy, which has an X-chromosomal homologue (Zfx). Northern blotting showed Zfy to be expressed in the testes of XXSxr animals, except for those that carry the coat-marker gene Tabby (Ta), despite the lack of germ cells in XXSxr mice. Reverse transcription polymerase chain reaction (RT-PCR) studies detected Zfy in mRNA in testes even when Ta was present. RT-PCR also demonstrated Zfy transcription in epididymides of normal males, though not in XXSxr mice. Previous authors reported an absence of Zfy transcription in XXSxr testes; Zfy transcription in normal testes has been ascribed to germ cells. Our observation indicates that this idea requires re-evaluation. The occurrence of Zfy transcription in the normal epididymis is similarly a novel finding that may help explain those aspects of epididymal development that occur in the absence of androgen.

Animals↗