Gender identity disorders

A person's sex is determined at the moment of fertilization, when a sperm and an egg unite. From that moment on, the development of a man or woman is influenced by a complex interplay of prenatal and postnatal factors.

Gender identity is defined as the self-perception of one's gender identity, which does not always correspond to one's sex characteristics. Gender role is the behavior that an individual identifies as male or female. Gender role is based on verbal and nonverbal cues received from parents, peers, and society about how boys and girls or men and women should behave.

In the first two or three years of life, a child's environment shapes his feelings about his gender. A child raised as a boy usually considers himself a boy and acts accordingly (gender role), even if he is "biologically" female. The same thing happens if a child is born with the sexual characteristics of both sexes (hermaphrodite).

There are countless theories to explain the many factors that play a role in the development of sexual identity. Hormonal production during prenatal development is of great importance. In general, there is agreement that a large number of hitherto unexplored sensory, biochemical, and psychological factors are involved, including the way parents treat their children in the early stages of their development. But none of the explanations is exhaustive. Mixing activities that are typical for boys and girls has only a limited effect on their future sexual identity. It is not at all necessary that the choice of sexual identity depends on the fact that a boy plays with dolls in childhood, while a girl prefers technical games.

Once a child's gender identity has been firmly established, it usually does not change throughout life. If a girl, for example, grows up and is raised as a boy, she will usually continue to consider herself a boy later in life, despite developing obvious female characteristics. Only sometimes can the emerging gender identity problems be resolved by encouraging behavior patterns that correspond to the biological sex. In some cases, anatomical anomalies can be corrected surgically.

It should be taken into account that a person's sexual identity is not only determined by his erotic attractiveness to other people. It also depends on whether a man feels identified with a woman or whether a woman feels identified with a man.

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Gender Identity Disorders in Childhood

These disorders involve children who feel they belong to the opposite sex. They are recognized by repetitive and reinforced behaviors that are characteristic of the gender role that correspond to their misperception of themselves as boys or girls. The causes of these rare disorders are unclear.

There is a hypothesis that this disorder is caused by parents encouraging their child to behave in a way that is more typical of the opposite sex. For example, one parent who wanted to have a daughter dresses the boy born instead of the expected daughter in girls' clothes and tells him how attractive and cute he is.

At the beginning of treatment, it is recommended to help such a child make friends with other children of the same sex, protecting him from ridicule and bullying by peers. Behavioural therapy modifies the opposite-sex behaviour in such a way as to make it acceptable. Psychodynamic therapy, aimed at processing unresolved mental conflicts and problems, is carried out in families associated with the manifestation of transsexuality.

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Transsexuality

Gender identity disorders, defined as transsexuality, attract a great deal of media attention, although they are, in fact, very rare. Up to 1985, only 30,000 such cases were registered worldwide. Transsexuality refers to a gender identity that is opposite to the anatomical sex of the person. In these cases, a man is convinced that he is actually a woman, and vice versa. Most transsexuals have a history of transvestism and other gender-contradictory behavior. To make such a diagnosis, it is necessary to clearly demonstrate that the situation has been going on for a long time (usually since childhood), has not changed, and is accompanied by a strong sense of conviction.

These cases are usually discovered when transvestites seek to change their gender, usually through surgery. The treating physician must consider that the patient may have had emotional problems in childhood that led to a crisis of gender identity. Perhaps this crisis can be overcome without surgery.

All persons seeking surgical gender reassignment are prescribed psychotherapy. It is aimed at clarifying the patient's attitudes towards irreversible surgery and the desire to ensure that the desire for surgical intervention is unshakable and is the result of voluntary conviction. Therapy can help the patient adapt to a new gender role after surgery.

Sex reassignment can be successful when the patient lives in the chosen gender role for several years before the operation. Thus, a man who wants to be a woman can remove unwanted hair, use cosmetics and wear women's clothing. A woman can hide her breasts and dress like a man. At the same time, both sexes strive, if possible, to confirm their belonging to the gender they have chosen for themselves.

Approximately 6 months before the operation, hormone therapy is started, which promotes the redistribution of fat tissue and hair, as well as modification of the genital area and other organs. Eventually, a decision is made to perform the first plastic surgery. Sex change is a long process, often requiring several operations. When transforming a woman into a man under pressure of circumstances, as a rule, the mammary glands are removed, as well as the uterus, and, often, plastic surgery to construct the penis is performed. When transforming a man into a woman, the penis and testicles are removed, and plastic surgery to construct the vulva and vagina is performed.

Even after many years of preparation, there is no guarantee that the surgical intervention will bring satisfactory results. Psychotherapy often continues for several years after the operation.