Sexual Medicine Flashcards
Define Sex.
Assigned at birth - ‘Male/female’ - dependent on external genitalia
Define gender identity.
intrinsic send of being ‘male/female/alternative’
Define gender role/expression.
personality, appearance and behaviour (cultural & historical context)
What are primary sexual characteristics?
-present before, during and after puberty
M - penis, scrotum and testes
F - vagina, vulva, and ovaries
What are secondary sexual characteristics?
-present during and after puberty
M - enlargement of genitalia, lowering of voice, redistribution of fat and muscle tissue, pubic/facial/body/armpit hair
F - enlargement of genitalia, development of breasts, pubic and armpit hair
Define transgender.
Diverse gender variance including transsexual, genderqueer, agender.
Define Gender Dysphoria.
distress due to incongruence between gender identity and sex assigned at birth.
Define Transsexual.
individuals who seek to change or have changed their primary and/or secondary sex characteristics
Define Transmale.
assigned female at birth changing or changed to male role/body
Define Transfemale.
Male at birth changing or changed to female role/body
Define Sexual orientation.
Sex of person/s to whom sexual fantasies, arousal and activities are directed
when and how is sex determined in utero?
- External genitalia and gonads - 8 weeks in utero
- defeminisation and masculination caused by the Y chromosome (SRY gene) - testes development caused by testosterone and Mullerian inhibiting substance
When is gender identity bought about?
- Second half of pregnancy
- sexual differentiation in the brain caused by testosterone, oestrogen and genes = gender identity
- HAPPENS INDEPENDENTLY OF SEX DETERMINATION
Some fun facts about gender identity and sex assignment.
- 2 processes can be influenced independently
- foetal gender identity remains permanent once influenced
- lack of influence from the sex-of-rearing environment
- Association with ASD
- fMRI studies of MtF shows typical female response to pheromones and erotic stimuli
How would you manage someone wanting to transition from female to male? (Transmale)
- assessment and diagnosis
- social transition +/- psychotherapy/OT
- fertility options
- Androgens +/- GNrH analogue
- Voice & communication Tx
- Male chest reconstruction
- hysterectomy & bilateral oophorectomy
- phalloplasty/metoidoplasty
How would you manage someone wanting to transition from male to female? (Transfemale)
- assessment and diagnosis
- social transition +/- psychotherapy/OT
- Fertility options
- Oestrogens +/- antiandrogens
- Voice and communication Tc
- Facial hair removal
- Vaginoplasty
- augmentation mammoplasty
- facial feminisation surgery
What’s the diagnostic criteria for Gender dysphoria according to the DSM-V?
a marked incongruence between one’s experienced/expressed gender and assigned gender or at least 6 months duration, as manifested by at least 2 of the following:
- incongruence between one’s gender and primary/secondary sex characteristics
- a strong desire to no longer have ones primary/secondary sex characteristics
- A strong desire to have the primary/secondary characteristics of the opposite gender (other genders)
- A strong desire to be of the other gender (or alternative from sex assigned at birth)
- A strong desire to be treated as the other gender
- A strong conviction that one’s typical feelings and reaction are that of the other gender
The condition is associated with clinically significant distress or impairment in social, occupational or other important areas of functioning.
Define Hypoactive Sexual Desire Disorder.
- lack or loss of sexual desire. This is primary problem and not secondary to something else e.g. anxiety or ED.
- Persistently deficient in sexual/erotic thoughts or fantasies and desire for sexual activity
What hormonal disorders could cause HSDD?
male - androgen deficient, hypogonadism, hyperprolactinaemia
female - androgen deficiency, hypothyroidism, hyperprolactinaemia, post pregnancy, addison’s disease.
