Sexuality and Gender

Question 1

Define sex and gender

Answer 1

Sex
- biological indicators of male, female, intersex - sex chromosomes, gonads, sex hormones, and nonambiguous internal and external genitalia.

Gender

• denote the public (and usually legally recognized) lived role as boy or girl, man or woman, but, in contrast to certain social constructionist theories, biological factors are seen as contributing, in interaction with social and psychological factors, to gender development
• Gender assignment
• Gender identity
• Gender expression
• Transgender
• Cisgender
• Gender non-conformity

Question 2

Define gender identity

Answer 2

a category of social identity and refers to an individual’s identification as woman, man, or, occasionally, some category other than man or woman.

Question 3

Define transgender

Answer 3

Refers to the broad spectrum of individuals who transiently or persistently identify with a gender different from their natal gender.

Question 4

Define transsexual

Answer 4

Denotes an individual who seeks, or has undergone, a social transition from male to female or female to male, which in many, but not all, cases also involves a somatic transition by cross-sex hormone treatment and genital surgery (sex reassignment surgery).

Question 5

Define gender-atypical

Answer 5

refers to somatic features or behaviors that are not typical (in a statistical sense) of individuals with the same assigned gender in a given society and historical era; for behavior, gender-nonconforming is an alternative descriptive term.

Question 6

Define gender assignment

Answer 6

Gender assignment refers to the initial assignment as male or female. This occurs usually at birth and, thereby, yields the “natal gender”.

Question 7

Define sexual orientation

Answer 7

Attraction (romantic or emotional, sexual)
Gynephilic (attracted to woman), androphilic (attracted to men), ambiphilic (attracted to men and woman), asexual (no attraction to any gender)
LGBTIAQ+

Question 8

Origin of Sexual Behaviours / Activity / Practices

Answer 8

Diverse

Socio-sexual, cultural influences

Question 9

Psychiatry and gender

Answer 9

In medicine gender might not be influential, but in psychiatry it matters.
Mental health is above all about how a person thinks and feels - their sense of self, how they think that others perceive and treat them, and how they see their role in society.
Researchers and clinicians should also be aware of their own preconceptions, and how these might affect both the scientific questions they ask, and their interpretation of the data they collect.

Question 10

Psychiatry and Sexual Orientation

Answer 10

APA listed homosexuality in theDSM Iin 1952
Research and subsequent studies consistently failed to produce any empirical or scientific basis for regarding homosexuality as anything other than a natural and normal sexual orientation that is a healthy and positive expression ofsexual expression
APA removed homosexuality from theDSM II in 1973

Question 11

List some of the sexual conditions in the DSM 5

Answer 11

Sexual Dysfunctions
characterized by a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure

Paraphilic Disorders
a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others

Gender Dysphoria
refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender

Question 12

Discuss LGBT rights in Africa

Answer 12

Homosexualityis outlawed in 34/54 African countries
Sudan, Somalia, Somaliland, Mauritania and northern Nigeria -homosexuality is punishable by death
Uganda, Tanzania and Sierra Leone - can receive life imprisonment for gay sex
South Africahas the most liberal attitudes toward LGBT persons however, violence and social discrimination is still widespread
Nigeria has enacted legislation that would make it illegal for heterosexual family members, allies and friends of LGBT people to be supportive

Question 13

Which sections of the contitution and which acts mentions LGBTQIA+ rights

Answer 13

Section 9, Constitution, 1996
Promotion of Equality and Prevention of Unfair Discrimination Act, 2000
Alteration of Sex Description and Sex Act, 2003
Civil Union Act, 2006
Criminal Law (Sexual Offences and Related Matters) Amendment Act, 2007

Question 14

Discuss the LGBT population with regards to health seeking behaviour, health and risks

Answer 14

Barriers to Care – Sexual and Gender Minorities
LGBT patients may avoid or delay accessing healthcare
Internalized sexual prejudice
Heterosexism and microaggressions
Higher risk of intimate partner violence and violent victimization
Increased risk of mental health and substance use conditions (“minority stress”)
Suicide rates among gender and sexuality minorities ranging from 1.5 to 7 x higher

Question 15

Define gender dysphoria

Answer 15

A marked incongruence between the assigned gender (usually at birth) and experienced/expressed gender
Experienced incongruence –> distress

Question 16

Discuss trans with regads to health seeking behaviour and health

Answer 16

Barriers to Care

• Trans patients may avoid or delay accessing healthcare 1
• Internalized transphobia (shame and alienation) 2
• Cisgenderism and microaggressions 3

Health related issues 4
- Transgender women disproportionate burden of HIV infection (worldwide prevalence of 20%)

Question 17

Discuss trans with regards to Mental Health

Answer 17

Increased risk of mental health conditions 1
Depression, anxiety and somatization
Substances
Suicidal thoughts and behaviours are high 2
Lifetime suicidal ideation - 46.5% and attempts - 27.1%

Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98).

Question 18

Cultural and historical background - reported transgender individuals in history

Answer 18

Hatshepsut (1478–1458 BCE)
Elagabalus (218–222 CE)
“Two-spirit”
Hijra

Question 19

Explain the development of Gender Identity

Answer 19

Gender identity is not simply a psychological entity

Hormones and genes → differences in morphology and physiology → different interactions with the environment

Prenatal and postnatal hormone exposure play an important role but effects are not straightforward

Neuropsychological and imaging studies support that biological factors are fundamentally associated with specific gender identities → insufficient to form a concrete theory of the development of gender identity variance

Current evidence lacks a causal relationship between brain development and gender identity development

Psychological and environmental factors have also been shown to have important associations in gender nonconforming individuals

Gender identity development most likely occurs from a complex interplay between biological, environmental, cultural, and psychological factors

Question 20

Biology of gender incongruence - Explain genetics of gender incongruence

Answer 20

Hereditability has been suggested by observing concordance of gender incongruence in monozygotic twin pairs and in father–son and brother– sister pairs 1
A study of 112 pairs of twins → 33.3% concordance among monozygotic male twins and a 22.8% concordance among monozygotic female twins 2

Question 21

Define Gender Dysphoria according to the DSM 5

Answer 21

“Refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender”

Question 22

Diagnostic features of Gender Dysphoria

Answer 22

Manifests itself differently in different age groups
Children
Adolescents
Adults
DSM 5 diagnostic criteria 
Changes from DSM IV TR 
Requirements for age groups

Question 23

Prevalence of gender dysphoria

Answer 23

AMAB males - 0.005% to 0.014%
AFAB - 0.002% to 0.003%. 
Rates are likely modest underestimates
Rates of persistence of gender dysphoria from childhood into adolescence or adulthood:
AMABs  2.2% to 30%
AFABs 12% to 50%

Question 24

Explain the outcome in the majority of the cases where gender dysphoria does not persist

Answer 24

AMAB children whose gender dysphoria does not persist majority are androphilic and often self-identify as gay (63% to 100%)
AFAB children whose gender dysphoria does not persist less identify as gynephilic and self-identify as lesbian (32% to 50%)

Question 25

Functional consequences of gender dysphoria

Answer 25

Preoccupation with cross-gender wishes  interfere with daily activities
Failure to develop age-typical same-sex peer relationships and skills  isolation from peer groups and to distress
School refusal
Relationship difficulties
Barriers to care
associated with high levels of stigmatization, discrimination and victimization

Leading to:
negative self-concept, rates of mental disorder comorbidity, school dropout, and economic marginalization, including unemployment, with attendant social and mental health risks, (especially in individuals from resource-poor family backgrounds)

Question 26

Associated mental health issues with gender dysphoria

Answer 26

Children have higher levels of behavioural and emotional problems
- ↑ depression and anxiety
- 30.3% of TG youth reported a hx of at least one suicide attempt and 41.8% reported a hx of SIB 1
Autism spectrum disorders

Question 27

Explain and describe gender affirming care

Answer 27

Each person has differing needs and expectations
Be aware of imposing binary gender norms
Respect autonomy
Review guidelines and ask for assistance
Manage expectations

Question 28

List types or methods of gender affirming care

Answer 28

Psychiatric assessment, diagnosis and referral
Psychotherapy, counseling (not “Conversion Therapy”)
Endocrinology
Surgery
Speech therapy
Dermatology
Legal assistance
Fertility services
General medical care
Others
Spiritual