Sexuality and Gender Flashcards
Define sex and gender
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
Define gender identity
a category of social identity and refers to an individual’s identification as woman, man, or, occasionally, some category other than man or woman.
Define transgender
Refers to the broad spectrum of individuals who transiently or persistently identify with a gender different from their natal gender.
Define transsexual
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).
Define gender-atypical
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.
Define gender assignment
Gender assignment refers to the initial assignment as male or female. This occurs usually at birth and, thereby, yields the “natal gender”.
Define sexual orientation
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+
Origin of Sexual Behaviours / Activity / Practices
Diverse
Socio-sexual, cultural influences
Psychiatry and gender
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.
Psychiatry and Sexual Orientation
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
List some of the sexual conditions in the DSM 5
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
Discuss LGBT rights in Africa
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
Which sections of the contitution and which acts mentions LGBTQIA+ rights
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
Discuss the LGBT population with regards to health seeking behaviour, health and risks
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
Define gender dysphoria
A marked incongruence between the assigned gender (usually at birth) and experienced/expressed gender
Experienced incongruence –> distress
Discuss trans with regads to health seeking behaviour and health
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%)
Discuss trans with regards to Mental Health
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).
Cultural and historical background - reported transgender individuals in history
Hatshepsut (1478–1458 BCE)
Elagabalus (218–222 CE)
“Two-spirit”
Hijra
Explain the development of Gender Identity
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
Biology of gender incongruence - Explain genetics of gender incongruence
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
Define Gender Dysphoria according to the DSM 5
“Refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender”
Diagnostic features of Gender Dysphoria
Manifests itself differently in different age groups Children Adolescents Adults DSM 5 diagnostic criteria Changes from DSM IV TR Requirements for age groups
Prevalence of gender dysphoria
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%
Explain the outcome in the majority of the cases where gender dysphoria does not persist
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%)
