Amy B Wisniewski

Amy B Wisniewski
University of Oklahoma Health Sciences Center | ouhsc · Department of Urology

About

104
Publications
17,341
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
3,788
Citations

Publications

Publications (104)
Article
Study Objective Infants with genital development considered atypical for assigned female sex may undergo feminizing genitoplasty (clitoroplasty and/or vaginoplasty) in early life. We sought to identify factors associated with parent/caregiver decisions regarding genitoplasty for their children with genital virilization. Design Longitudinal, observ...
Article
Objective: The impact of parent-reported stigma due to their child's disorder/difference of sex development (DSD) on parent psychosocial adjustment is poorly understood. In other pediatric populations, perceived interference of medical conditions into daily activities (i.e., illness intrusiveness) mediates the relationship of stigma to adjustment....
Article
Stigma is a salient experience for both caregivers/parents and individuals with Disorders/Differences of Sex Development (DSD) as evidenced through qualitative and preliminary quantitative reports. However, few validated measures of associative stigma (i.e., vicarious stigma experienced through close association with someone who is socially stigmat...
Article
Full-text available
Structured Summary Introduction Caregivers of female infants with congenital adrenal hyperplasia (CAH) often confront complex medical decision-making (e.g., early feminizing genitoplasty). Objective This study aimed to evaluate the relevant medical decisions and subsequent decisional regret of caregivers following their child’s genitoplasty. Stu...
Article
Objective: This study identifies trajectories of parent depressive symptoms after having a child born with genital atypia due to a disorder/difference of sex development (DSD) or congenital adrenal hyperplasia (CAH) and across the first year postgenitoplasty (for parents who opted for surgery) or postbaseline (for parents who elected against surge...
Article
Introduction Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases i...
Article
Objective: A subset of parents of children with disorders/differences of sex development (DSD) including ambiguous genitalia experience clinically elevated levels of anxious and depressive symptoms. Research indicates that uncertainty about their child's DSD is associated with parent psychosocial distress; however, previous studies have been cross...
Article
Extended Summary Disorders/differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. While there remains controversy around the traditionally binary concept of sex, most patients with DSD are reared either male or female depending on their genetic sex, gonadal sex, genital...
Article
Differences/Disorders of sex development (DSD) are a heterogeneous group of congenital conditions that result in discordance between an individual’s sex chromosomes, gonads, and/or anatomic sex. Advances in the clinical care of patients and families affected by 46,XY DSD have been achieved since publication of the original Consensus meeting in 2006...
Article
Purpose: To evaluate demographic, financial, and support predictors of distress for parents of young children with Disorders of Sex Development (DSD) including atypical genital development, and to characterize early parental experiences. This extends our previous findings to identify those parents at risk for distress. Materials and methods: Par...
Article
Full-text available
Parents of children with disorders of sex development (DSD) report significant psychological distress, including posttraumatic stress symptoms (PTSS), with mothers consistently reporting higher rates of psychological distress than fathers. However, psychological factors contributing to PTSS in both parents are not well understood. The present study...
Article
Purpose of review: The review focuses on genitoplasty, performed on young children with disorders/differences of sex development (DSD) to 'typify' ambiguous external genitalia and intended to result in either male or female-appearing genitals. Consensus on whether or not early genitoplasty is optimal or appropriate has yet to be achieved. This art...
Article
Background/Aims: Parents of children born with a disorder of sex development (DSD) often experience anxiety, but risk factors, including parental perception of the severity of their child’s DSD, have not been examined. We hypothesized that severity of illness (SOI) ratings would relate to parental anxiety, and would be higher for parents of childre...
Article
Full-text available
Purpose Little is known about phenotypes, diagnoses and sex of rearing (SR) of infants with atypical genital development in the United States. As part of a multi-center study of these infants, we provide a baseline report from US difference/disorder of sex development (DSD) clinics describing diagnoses, anatomic features and SR. We also aim to dete...
Article
Introduction: Prior studies of outcomes following genitoplasty have reported high rates of surgical complications among children with atypical genitalia. Few studies have prospectively assessed outcomes after contemporary surgical approaches. Objective: The current study reported the occurrence of early postoperative complications and of cosmeti...
Article
Purpose: Provide recommendations for the development of an interdisciplinary care (IDC) clinic for the treatment of youth with disorders/differences of sex development (DSD). DSD consist of a group of complex congenital medical disorders in which the development of chromosomal, gonadal, or anatomical sex is atypical. Youth with DSD require care fr...
Article
Disorders/differences of sex development (DSD) comprise multiple congenital conditions in which chromosomal, gonadal, and/or anatomical sex are discordant. The prediction of future gender identity (i.e., self-identifying as male, female, or other) in children with DSD can be imprecise, and current knowledge about the development of gender identity...
Article
Purpose: The current study examined the psychological adjustment of parents of children born with moderate to severe genital atypia 12 months after their child underwent genitoplasty. Materials and methods: Parents were recruited longitudinally from a multi-center collaboration of 10 pediatric hospitals with specialty care for children with a Di...
Article
Full-text available
Background Painful bladder syndrome/interstitial cystitis (PBS/IC) is a chronic disorder that is commonly seen in women who report a history of adversity in early life. Here, we test the hypothesis that early life stress (ELS) induces sexually dimorphic abnormalities in urinary bladder smooth muscle function in adulthood. Methods Male and female r...
Article
Background The birth of a child with a disorder of sex development (DSD) and atypical genitalia can be traumatizing and isolating for families. Parents of children with DSD are at risk for increased levels of psychological distress, including depression, anxiety, illness uncertainty (IU), post-traumatic stress symptoms (PTSS), and impairments in qu...
Article
Full-text available
Introduction Little data exist about the surgical interventions taking place for children with disorders of sex development (DSD). Most studies that have evaluated cosmetic outcomes after genitoplasty have included retrospective ratings by a physician at a single center. Objective The present study aimed to: 1) describe frequency of sex assignment...
Article
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a bladder pain disorder associated with voiding symptomatology and other systemic chronic pain disorders. Currently diagnosis of IC/BPS is complicated, as patients present with wide ranges of symptoms, physical examination findings, and clinical test responses. One hypothesis is that IC sympto...
Article
Full-text available
The current study examined the psychosocial characteristics of parents of children with a disorder of sex development (DSD) at early presentation to DSD clinics. Parental anxiety, depression, quality of life, illness uncertainty, and posttraumatic stress symptoms were assessed. Additionally, the current study examined the relationship of child's as...
Article
A review of gender role (GR) differentiation from early childhood through adulthood was conducted on males and females in general, as well as on females affected by congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency or complete androgen insensitivity syndrome (CAIS). Additionally, retrospective and current, self-rated GR assessme...
Article
Within the chronic medical illness literature, associations exist between caring for an affected child and parent mental health. The few studies examining both mothers and fathers provide mixed results. The purpose of this study is to examine associations between caregiver anxiety, depression, and parenting variables in caregivers of youth with SB...
Article
Full-text available
It is clear that the major issues raised by the Chicago Disorders of Sex Development (DSD) Consensus meeting primarily the need of more data, especially outcome information, are still not available. Hence, there are insufficient data to merit another consensus statement. However, there has been a major shift in the thinking and approach to the care...
Article
Both otoacoustic emissions (OAEs) and auditory evoked potentials (AEPs) are sexually dimorphic, and both are believed to be influenced by prenatal androgen exposure. OAEs and AEPs were collected from people affected by 1 of 3 categories of disorders of sex development (DSD) – (1) women with complete androgen insensitivity syndrome (CAIS); (2) women...
Article
Purpose/background: To examine whether male and female caregivers of children with a disorder of sex development (DSD) differ in levels of anxious and depressive symptoms. Materials/methods: Participants included 80 caregivers (40 males, 40 females) of 40 children with a DSD. Children were categorized based on illness characteristics including a...
Chapter
Sexual development progresses throughout early childhood and into adolescence. This chapter addresses sexual knowledge and behavior in prepubescent children. Puberty onset and theories on earlier onset are described for context. Research on sexual knowledge and behavior, including sex play, in prepubescent children is reviewed. Cultural context and...
Article
Objective Caregivers of children with a disorder of sex development (DSD) are at increased risk for maladaptive parenting capacities, such as high levels of parental overprotection and perceived vulnerability of their child, in addition to parenting stress. The current study aims to examine whether there are relationships between these parenting ca...
Conference Paper
Full-text available
Purpose Caregivers of children with chronic medical conditions are at increased risk for higher levels of psychological distress and maladaptive parenting capacities. Two frequently studied parenting variables include perceived child vulnerability (PCV; i.e., perceiving the child as sick and vulnerable) and parenting stress (PS; i.e., stress relate...
Conference Paper
Purpose - Much debate is had over the optimal time for female genitoplasty for girls with a Disorder of Sex Development (DSD). The 2006 Consensus Statement on management of DSD cautioned on performing clitoral surgery on any girl except the most virilized (Prader III-IV) but cited literature to support that cosmetic surgery in infancy aids in paren...
Conference Paper
Purpose: Disorders of sex development, or DSD, are medical conditions in which affected individuals experience discordance between their genetic, gonadal, and/or phenotypic sex (Hughes et al., 2006). Anecdotal reports from parents of children with DSD suggest that these children show increased aggression and behavior problems . They may also be at...
Conference Paper
Correlations between Auditory Measures and Gender in DSD Purpose . Disorders of sex development, or DSD, are a group of congenital conditions in which affected individuals experience discordance between their genetic, gonadal, and/or phenotypic sex (Hughes et al., 2006). Depending on the type of DSD, up to 25% of people reject their female sex of...
Conference Paper
Purpose Identify developmentally appropriate tools for involving adolescent patients in their own continence-surgery decision-making. Methods Patient interactions involving two or more patients with bladder exstrophy were conducted with scripted and unscripted scenarios about the risks and benefits of surgery. All patients and their parents (...
Article
Full-text available
BACKGROUND AND OBJECTS: The patient's age at the first hypospadias repair may be an important factor for determining postoperative outcomes. Age at the first procedure differs between Western countries and medical centers in China. This review examines the differences between the incidence of surgical complications and surgical age in boys receivin...
Article
Background: Hypogonadism is common with opiate-like drug use and may contribute to cognitive abnormalities. With the increasing epidemic of HIV and substance use (SU) worldwide, it is important to understand the impact of these conditions on cognition, which may affect quality of life and possibly decrease adherence to treatment. We hypothesized t...
Article
Full-text available
Variables that impact gender development in humans are difficult to evaluate. This difficulty exists because it is not usually possible to tease apart biological influences on gender from social variables. People with disorders of sex development, or DSD, provide important opportunities to study gender within individuals for whom biologic component...
Article
We determined whether the degree of genital malformation at birth in children with a disorder of sex development is related to subsequent caregiver distress, specifically symptoms of depression and anxiety. A total of 66 caregivers of children with disorders of sex development were recruited from 3 centers that specialize in disorders of sex develo...
Article
Over the past twenty years, there has been an increasing awareness of the transition to adult-oriented health care in adolescents and young adults with a chronic illness. While general guidelines for health care transition have been established, some have called for illness-specific guidelines which are tailored to the needs of specific illness pop...
Article
Total and partial urogenital mobilization procedures are the most common contemporary vaginoplasty surgeries for patients with congenital adrenal hyperplasia, urogenital sinus and cloacal anomalies. There is controversy regarding the urinary continence outcomes of these procedures. We reviewed the urinary continence outcomes of children who underwe...
Chapter
An endocrine-disrupting compound (EDC) is “an exogenous agent that interferes with synthesis, secretion, transport, metabolism, binding action, or elimination of natural blood-borne hormones that are present in the body and responsible for homeostasis, reproduction, and developmental processes Diamanti-Kandarakis (Endocr Rev 30:293–342, 2009).” The...
Article
Full-text available
The current study sought to compare levels of overprotection and parenting stress reported by caregivers of children with disorders of sex development at four different developmental stages. Caregivers (N = 59) of children with disorders of sex development were recruited from specialty clinics and were asked to complete the Parent Protection Scale...
Article
In 2006, a consensus statement was jointly produced by the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society of Paediatric Endocrinology (ESPE) concerning the management of disorders of sex development (DSD) [1]. A recommendation provided by this consensus was that evaluation and long-term care for people affected by DSD s...
Conference Paper
Introduction Illicit drug use (IDU) is a major public health problem requiring interventions to prevent, treat, and minimize recidivism. Cognitive function abnormalities may impair decision-making/higher executive function and contribute to IDU. We sought to better understand the contribution of cognitive performance to drug abuse. Participants wer...
Conference Paper
Background: In populations affected by HIV/AIDS, women and those with SUD report worse HRQOL than men. To our knowledge, HRQOL sex differences have not been reported in HIV/AIDS and SUD-affected populations. Our objective was to investigate if sex differences in HRQOL exist in men and women affected by HIV/AIDS who also self-administer heroin and/o...
Conference Paper
Purpose: To examine parental distress and parenting characteristics of mothers and fathers of children with spina bifida (SB). We hypothesize parents of children with a more severe form of SB exhibit greater distress and more maladaptive parenting characteristics. Additionally, we predict that mothers will exhibit more distress and maladaptive pare...
Article
Full-text available
Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is the most common presentation of a disorder of sex development (DSD) in genetic females. A report of prenatal growth retardation in cases of 46,XY DSD, coupled with observations of below-optimal final height in both males and females with congenital adrenal hyperplasia due to 21-hydr...
Article
Rearing a child with a chronic illness is stressful and can potentially affect parenting style, which may result in poorer outcomes for children. The purpose of this study was to compare parenting characteristics of female caregivers rearing children with a disorder of sex development (DSD) to female caregivers rearing children with type 1 diabetes...
Conference Paper
Purpose: It has been well established that patients with complete androgen insensitivity syndrome (CAIS) often require surgical intervention for augmentation of a hypoplastic vagina. However, the literature is lacking in the number of actual patients requiring vaginoplasty. This study looks at the past 60 years of experience with CAIS patients at o...
Article
Full-text available
Purpose. To determine the relationship between having a child with a DSD including ambiguous external genitalia, as well as the decision of whether or not to have early genitoplasty for that child, on the mental health and parenting characteristics of caregivers. Materials and Methods. Caregivers were recruited from centers that specialize in DSD m...
Article
Purpose. To determine the relationship between having a child with a DSD including ambiguous external genitalia, as well as the decision of whether or not to have early genitoplasty for that child, on the mental health and parenting characteristics of caregivers. Materials and Methods. Caregivers were recruited from centers that specialize in DSD m...
Article
Full-text available
In 2002 a consensus statement pertaining to the management of classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency was jointly produced by the Lawson Wilkins Pediatric Endocrine Society and the European Society of Pediatric Endocrinology. One of the recommendations of this consensus was that centers should maintain multidiscipl...
Article
Full-text available
Endocrine disruptors, chemicals that disturb the actions of endogenous hormones, have been implicated in birth defects associated with hormone-dependent development. Phytoestrogens are a class of endocrine disruptors found in plants. In the current study we examined the effects of exposure at various perinatal time periods to genistein, a soy phyto...
Article
The prevalence of obesity among children in the United States represents a pool of latent morbidity. Though the prevalence of obesity has increased in both boys and girls, the causes and consequences differ between the sexes. Thus, interventions proposed to treat and prevent childhood obesity will need to account for these differences. This review...
Article
Full-text available
Disorders of sex development refer to a collection of congenital conditions in which atypical development of chromosomal, gonadal, or anatomic sex occurs. Studies of 46,XY DSD have focused largely on gender identity, gender role, and sexual orientation. Few studies have focused on other domains, such as physical and mental health, that may contribu...
Article
The profound hypogonadism due to androgen deprivation therapy for prostate cancer results in complications such as sexual dysfunction, poor quality of life, vasomotor symptoms and altered cognition. Since estrogen is associated with cardiovascular risks, phytoestrogens are being increasingly evaluated as a potential treatment for these adverse effe...
Article
Early development of the percentage of fat and muscle is rarely considered, but is important because excessive fat is related to the development of diabetes and other morbidities later in life. In pediatric medicine, there are few to no data comparing sex differences in body composition in the first months of life despite the fact that males are ty...
Article
Full-text available
Neurodevelopmental disorders are associated with altered patterns of neuronal connectivity. A critical determinant of neuronal connectivity is the dendritic morphology of individual neurons, which is shaped by experience. The identification of environmental exposures that interfere with dendritic growth and plasticity may, therefore, provide insigh...
Article
Recent interventional studies indicate that post-menopausal hormone replacement therapy is associated with an increased risk of cardiovascular mortality and breast cancer. Isoflavones, a class of plant estrogens, have structural similarities to estradiol. Hence, isoflavones may exert beneficial estrogenic health effects in postmenopausal women with...
Article
Full-text available
The medical, surgical and psychosocial management of individuals affected by disorders of sex development (DSD) is currently under scrutiny. Patients who possess a 46,XY chromosomal complement (i.e., those affected by 46,XY DSD) pose particular challenges to healthcare professionals because this group is most likely to report dissatisfaction with t...
Article
We used current methods of screening for prostate cancer, digital rectal examination and serum prostate specific antigen as an initial assessment of risk in a young group of adult 46,XY patients affected by disorders of sex development. Adult intersex patients older than 21 years, under long-term followup at the Pediatric Endocrinology Clinic of th...
Article
Self-rated degree of femininity and masculinity across development were evaluated for 40 adults affected by 46,XY disorders of sex development (DSDs) who presented at birth with a small phallus and perineoscrotal hypospadias, raised either male (n = 22) or female (n = 18). Most participants were confirmed or presumed to be affected by partial andro...
Article
Most studies of hypothalamic-pituitary-gonadal (HPG) function in illicit drug users either focus on men or do not consider the impact of HIV. This study investigated the relationships between cocaine and/or opiate use, HIV status, and HPG function in both men and women. Men and women between 18 and 50 years of age were stratified by sex, drug use,...
Article
Prenatal exposure to testicular hormones influences the development of brain structures and behavior in many non-human mammalian species. Less understood is the role of possessing a Y chromosome, independent of testicular hormones, on psychosexual differentiation. Phenotypic women affected by complete gonadal dysgenesis possess a 46,XY chromosome c...
Article
Concern has been raised regarding the potential impact of chronic glucocorticoid therapy on the bone mineral density (BMD) of patients with congenital adrenal hyperplasia (CAH). The purpose of this investigation was to assess the impact of chronic glucocorticoid replacement in adult women with classical CAH. We used dual energy x-ray absorptiometry...
Article
Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are well documented in men using illicit drugs and/or infected with HIV; however, less is known about HPA function, or the health consequence of HPA dysfunction, in their female counterparts. People with depression exhibit hypercortisolemia, and depression is common in people with HIV o...
Article
Opiates and cocaine both have effects on adrenal and gonadal function. Opiates suppress the hypothalamic-pituitary adrenal (HPA) axis, whereas cocaine leads to HPA activation. Opiates also cause gonadal dysfunction in both men and women. During withdrawal from opiates and cocaine, the HPA axis is activated which may reinforce relapse behavior. This...
Article
Some research suggests that girls with congenital adrenal hyperplasia (CAH), who are exposed to higher than normal levels of prenatal androgens, perform better on spatial tasks, worse on verbal tasks and have a greater incidence of left-handedness than unaffected controls, all of which suggests the development of a more male-typical cognitive patte...
Article
Full-text available
Limited attention has been paid to the potential impact of gender and injection drug use (IDU) on mood, quality of life, and neuropsychological performance in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Several studies that describe the natural history of HIV/AIDS in terms of mental health and neuropsychological abil...
Article
This study examined the impact of sex hormones on functional cerebral hemispheric lateralization and cognition in a group of male-to-female transsexuals receiving cross-sex hormone therapy compared to eugonadal men with a male gender identity. Cerebral lateralization was measured with a handedness questionnaire and a visual-split-field paradigm and...
Article
Exposure to endocrine disrupting chemicals adversely affects reproductive development and behavior in males. The goal of this study was to determine if exposure to genistein, an isoflavone found in soy, during early periods of sex differentiation alters reproductive development and behavior in male mice. Female C57BL/6 mice were fed a phytoestrogen...
Article
This study evaluated the degree of femininity and masculinity at different developmental stages in a group of adult women, some of whom were exposed to elevated prenatal adrenal androgens as a result of congenital adrenal hyperplasia (CAH) due to 21 hydroxylase (21-OH) deficiency. Women who had presented to the Johns Hopkins Hospital Pediatric Endo...
Article
T his study evaluated the degree of femininity and masculinity at different developmental stages in a group of adult women, some of whom were exposed to elevated prenatal adrenal androgens as a result of congenital adrenal hyperplasia (CAH) due to 21 hydroxylase (21-OH) deficiency. Women who had presented to the Johns Hopkins Hospital Pediatric End...
Article
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency results in increased adrenal androgen secretion. When the deficiency is severe, the result is the salt losing (SL) form, and when the deficiency is partial, the result is the simple virilizing (SV) form of CAH. We documented long-term satisfaction with gender, cosmetic appearance...