Disorders of gender identity

, medical expert
Last reviewed: 18.10.2021

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The sex of a person is determined at the time of fertilization when the spermatozoon and the ovum are combined. From this point on, the development of a man or woman is influenced by the complex interrelation of prenatal and postnatal factors.

Sexual identity is defined as self-perception of its belonging to the male or female sex, which does not always correspond to gender. The sex role is behavior that the individual identifies with the male or female. The sexual role is based on verbal and non-verbal guidance received from parents, peers and society on how boys and girls or men and women should behave.

In the first two or three years of life, the child's environment shapes his feelings about his belonging to a particular sex. Raised as a boy, a child usually considers himself to be a boy and behaves appropriately (sex role), even if he "biologically" refers to women. In the event that a child is born with the sex characteristics of both sexes (hermaphrodite), the same thing happens.

There are countless theories explaining the effect of many factors that are involved in the development of gender identity. Of great importance is the production of hormones during prenatal development. In general, everyone agrees that a large number of sensory, biochemical and psychological factors that have not been studied so far are involved in this, among which the character of the treatment of parents with the child at the early stages of its development should be highlighted. But none of the explanations is exhaustive. The confusion inherent in boys and girls has only a limited impact on their future sexual identity. It is not at all necessary that the choice of gender identity depends on what the boy plays with dolls as a child, and the girl prefers technical games.

After firmly establishing the child's gender identity, it usually does not change during the entire subsequent life. If a girl, for example, grows up and is brought up as a boy, she, as a rule, and later will consider herself a boy, despite the development of obvious signs of a female. Only sometimes it is possible to solve the problems of sexual identity that arise, by encouraging patterns of behavior that correspond to the biological sex. In some cases, anatomical abnormalities can be corrected surgically.

It should be taken into account that the gender identity of a person is determined not only by its erotic attractiveness for other people. It also depends on whether the man feels identified with the woman or does the woman feel identified with the man.

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Disorders of sexual identity in childhood

These disorders are related to children who feel themselves to belong to another sex. They are recognized by the repeated and fixed behavior inherent in the sexual role that corresponds to their misperception of themselves as boys or girls. The causes of these rare disorders are not clear.

There is a hypothesis that this disorder depends on parents encouraging the behavior of the child, which is more characteristic of the opposite sex. For example, one of the parents who wanted his daughter to be born, dresses the boy born in the place of the expected daughter in a girl's dress and tells him how attractive and sympathetic he is.

At the beginning of treatment it is recommended to help such child to become friends with other children belonging to the same sex with them, protecting them from ridicule and peer abuse. Behavioral therapy modifies the behavior corresponding to the opposite sex in a way that makes it acceptable. Psychodynamic therapy aimed at processing unresolved mental conflicts and problems is conducted in families associated with the manifestation of transsexuality.

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Sexual identity disorders, defined as transsexuality, attract the attention of the mass media, although they are, in fact, very rare. Before 1985, only 30,000 such cases were recorded worldwide. Transsexuality includes sexual identification, the opposite of the anatomical sex of the person. In these cases, the man is convinced that in fact he is a woman, and vice versa. Most transsexuals in their personal history had cases of transvestism and other patterns of behavior that contradicted their sex. To make such a diagnosis it is necessary to unequivocally confirm that this situation lasts for a long time (usually from childhood), does not change and is accompanied by a great force of conviction.

These cases are usually identified when transvestites seek a change in their sex, usually by surgery. The attending physician should consider that the patient may have had emotional problems in his childhood, which led to a crisis of gender identity. Perhaps, this crisis can be overcome without intervention.

To all persons who are striving for an operative change in their sex, psychotherapy is prescribed. It is aimed at clarifying the patient's setting for an irreversible operation and striving to make sure that the desire for surgical intervention is unshakable and is the result of voluntary conviction. Therapy can help the patient adapt to a new sexual role after the operation.

Sex change can result in success, when the patient lives in the selected sexual role for several years before the operation. So, a man who wants to be a woman can eliminate unwanted hair, apply cosmetics and wear women's clothing. A woman can hide her breasts and dress like a man. At the same time, both sexes tend, if possible, to confirm their belonging to the sex they chose for themselves.

Approximately 6 months before the operation, hormonotherapy, which promotes the redistribution of adipose tissue and hair, and changes in the genital area and other organs, begins. In the end, the decision is made to conduct the first plastic surgery. Sex change is a lengthy process, often requiring several operations. When a woman is converted to a man under the pressure of circumstances, as a rule, removal of the mammary glands, as well as the uterus and, often, a plastic operation for the construction of the penis. When a man is converted to a woman, the penis and testicles are removed, and an operation is performed to plasticly construct the vulva and the vagina.

Even after many years of preparation there can be no guarantee that surgery will bring satisfactory results. Psychotherapy often lasts for several years after surgery.

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