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Psychiatry > Gender and Sexuality > Flashcards

Gender and Sexuality Flashcards

1
Q

Sex

A

Biological indicators of male/female vs sexuality.

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2
Q

Gender

A

The publicly lived role, and internally-recognized self, as girl or boy, woman or man, non-binary, fluid, or intersex +.

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3
Q

Gender identity

A

One aspect of social identity.

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4
Q

Gender role/ expression

A

Chosen appearance and behaviour to represent gender identity.

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5
Q

Cisgender

A

Gender identity which is congruent with sex assigned at birth.

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6
Q

Transgender/ gender diverse

A

Transient or persistent identification with a gender that is different from assigned gender/natal gender.

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7
Q

Nonbinary

A

Gender identity lies outside of the gender binary of male and female.

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8
Q

Gender assignment

A

Initial assignment as male or female (or intersex), usually at birth a.k.a. “natal gender”.

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9
Q

Gender atypical

A

Biological structures or behaviours that are less commonly seen (statistically) in individuals with the same assigned gender, in the same society, in the same historical period.

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10
Q

Transsexual

A

An individual who would like to, or who has already, transitioned from one gender to another – socially and/or biologically.

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11
Q

Intersex

A

Used informally in medicine to apply to individuals with significantly atypical congenital variations of the reproductive tract.

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12
Q

Disorders of Sexual Development (DSD):

A

Congenital differences in the formation of the reproductive system which often make it difficult to classify a person (usually a neonate) as binary male or female.

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13
Q

Cross-sex hormone treatment:

A

The use of feminizing hormones in an individual assigned male at birth, or the use of masculinizing hormones in an individual assigned female at birth.

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14
Q

Gender reassignment:

A

An official (and often legal) change of gender.

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15
Q

AMAB

A

Assigned male at birth

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16
Q

AFAB

A

Assigned female at birth

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17
Q

Gender dysphoria:

A

Disorder that meets DSM V diagnostic criteria as below.

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18
Q

Gender identity disorder:

A

The DSM IV version (diagnosis) of what is now referred to as gender dysphoria.

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19
Q

Gender incongruence (of adolescence and adulthood/of childhood):

A

The ICD-11 diagnostic guidelines.

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20
Q

Gender-affirming health care:

A

Psychological, social, behavioural and/or medical interventions aimed at affirming an individual’s gender identity.

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21
Q

Gender dysphoria according to DSM 5

A

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

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22
Q

Gender dysphoria in Children

A

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1):

  1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender).
  2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.
  3. A strong preference for cross-gender roles in make-believe play or fantasy play.
  4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
  5. A strong preference for playmates of the other gender.
  6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.
  7. A strong dislike of one’s sexual anatomy.
  8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender.

B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.

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23
Q

Gender dysphoria in adolescents and adults

A

A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following:

  1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).
  2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).
  3. A strong desire for the primary and/or secondary sex characteristics of the other gender.
  4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).
  5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).
  6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).

B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.

24
Q

What is the estimated prevalence of gender dysphoria in natal adult males?

A

The prevalence of gender dysphoria in natal adult males is estimated to be between 0.005% and 0.014%.

25
Q

What is the estimated prevalence of gender dysphoria in natal adult females?

A

The prevalence of gender dysphoria in natal adult females is estimated to be between 0.002% and 0.003%

26
Q

Why might the prevalence rates of gender dysphoria be modest underestimates?

A

The rates are likely modest underestimates due to underreporting, social stigma, and varying access to healthcare services.

27
Q

What is the rate of persistence of gender dysphoria from childhood into adolescence or adulthood in assigned males at birth (AMABs)?

A

The rate of persistence of gender dysphoria from childhood into adolescence or adulthood in AMABs ranges from 2.2% to 30%.

28
Q

What is the rate of persistence of gender dysphoria from childhood into adolescence or adulthood in assigned males at birth (AMABs)?

A

The rate of persistence of gender dysphoria from childhood into adolescence or adulthood in AMABs ranges from 2.2% to 30%.

29
Q

What is the rate of persistence of gender dysphoria from childhood into adolescence or adulthood in assigned females at birth (AFABs)?

A

The rate of persistence of gender dysphoria from childhood into adolescence or adulthood in AFABs ranges from 12% to 50%.

30
Q

At what age do gender-specific behaviors typically begin to appear?

A

Gender-specific behaviors generally appear around 2-4 years of age, including both typical and atypical behaviors.

31
Q

When may Gender Dysphoria occur in children?

A

Gender Dysphoria may occur in toddlers or later, such as on entry to primary school.

32
Q

How does discontentment with genitalia change as a child approaches puberty?

A

As puberty is approached, discontentment with one’s genitalia typically becomes more prominent in children with Gender Dysphoria.

33
Q

How strong is the genetic influence on Gender Dysphoria?

A

Genetics have a weak effect on the development of Gender Dysphoria.

34
Q

What endocrine factors might contribute to Gender Dysphoria?

A

There may be a possible mild increase in androgens in 46, XX individuals with Congenital Adrenal Hyperplasia (CAH) and without Disorders of Sex Development (DSD), as well as in 46, XY individuals with DSD, such as 5-alpha reductase-2 deficiency

35
Q

Can gender identity be predicted based on genetic or endocrine factors?

A

No, gender identity cannot be predicted based on genetic or endocrine factors.

36
Q

Is there an association between Autism Spectrum Disorder (ASD) and Gender Dysphoria (GD)?

A

Yes, there is an association between Autism Spectrum Disorder (ASD) and Gender Dysphoria (GD).

37
Q

What are the main mental health conditions associated with Gender Dysphoria?

A
  • Suicidality
  • Depression and anxiety
  • Substance-use disorders
  • School-refusal
  • Relationship and sexual health issues
  • Stigma, discrimination
38
Q

How common are suicidal thoughts and behaviors in individuals with Gender Dysphoria?

A

Suicidal thoughts and behaviors are common in individuals with Gender Dysphoria. Lifetime suicidal ideation is reported in 46.5% of cases, and suicide attempts in 27.1% of cases.

39
Q

Differential diagnosis for gender dysphoria

A
  • Nonconformity to gender roles
  • Transvestic disorder
  • Body dysmorphic disorder
  • Psychotic disorders
  • Other clinical presentations
40
Q

Gender affirming care

A
  • Each person has differing needs and expectations.
  • Be aware of imposing binary gender norms.
  • Respect autonomy.
  • Review guidelines and ask for assistance.
  • Manage expectations.
  • Psychiatric assessment, diagnosis and referral
  • Psychotherapy, counseling (not “Conversion Therapy”)
  • Endocrinology
  • Surgery
  • Speech therapy
  • Dermatology
  • Fertility services
  • General medical care
  • Legal assistance
  • Spiritual counseling
  • Other
41
Q

What factors influence normal sexuality?

A

Normal sexuality is influenced by anatomy, physiology, culture, interpersonal relationships, and developmental experiences.

42
Q

Why is healthy sexuality important?

A

Healthy sexuality is an important source of intimacy, love, and fulfillment for many people.

43
Q

Are all pleasure-seeking behaviors related to sex?

A

No, not all pleasure-seeking behaviors are sexual.

44
Q

Are all sexual behaviors purely about sex?

A

No, not all sexual behaviors are about sex. They can be influenced by a variety of factors and motivations.

45
Q

Psychosexual factors

A
  • Sexual identity
  • Gender identity
  • Sexual orientation
  • Sexual behaviour
46
Q

What are Sexual Dysfunctions as defined in DSM-5?

A

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

47
Q

What are Paraphilic Disorders according to DSM-5?

A

Paraphilic Disorders are deviations from normal sexual activity that cause distress or impairment to the individual, harm to the individual, harm to the individual’s partner, or harm to the community.

48
Q

How was homosexuality classified in the DSM I (1952) and DSM II (1968)?

A

The APA listed homosexuality as a mental disorder in the DSM I (1952) and DSM II (1968).

49
Q

What led to the removal of homosexuality from the DSM?

A

The APA could find no evidence that homosexuality constitutes a mental disorder and affirmed it as a natural variant.

50
Q

When was homosexuality removed from the DSM?

A

Homosexuality was removed from the DSM III in 1973 and subsequent editions.

51
Q

How many African countries outlaw homosexuality?

A

Homosexuality is outlawed in 33 out of 54 African countries.

52
Q

Which African countries have the death penalty for homosexuality?

A

In Sudan, Somalia, Somaliland, Mauritania, and Northern Nigeria, homosexuality is punishable by death.

53
Q

What is the punishment for consensual same-sex activity in Uganda, Tanzania, and Sierra Leone?

A

In Uganda, Tanzania, and Sierra Leone, individuals can receive life imprisonment for consensual same-sex activity.

54
Q

Which African country has the most liberal attitudes towards LGBTQI+ persons, and what challenges remain?

A

South Africa has the most liberal attitudes towards LGBTQI+ persons, but violence and social discrimination are still widespread

55
Q

Relevant South African Legislation

A
  • The Constitution of the Republic of South Africa, 1996 (Section 9)
  • Promotion of Equality and Prevention of Unfair Discrimination Act 4 of 2000
  • Alteration of Sex Description and Sex Act 49 of 2003
  • Civil Union Act 17 of 2006
  • The Children’s Act 38 of 2005
  • Criminal Law (Sexual Offences and Related Matters) Amendment Act of 2007
56
Q

What was the significance of the UK court ruling reported by The Guardian on 17/09/2021 regarding puberty blockers?

A

The ruling gave clinicians the legal right to determine the capacity of adolescents under 16 years to consent for puberty-blocking hormones.

57
Q

What legal challenges did the Tavistock gender clinic face as reported by The Independent on 11/08/2022?

A

The Tavistock gender clinic was accused of medical negligence and faced legal action over claims of a “failure of care.” Staff reportedly faced pressure to adopt an “unquestioning affirmative approach.”

Psychiatry (6 decks)

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