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.
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.