Griet De Cuypere

• M.D., Ph.D.
• Ghent University

Gender incongruence describes a condition in which an individual's gender identity does not align with their sex assigned at birth, based on anatomic characteristics. Individuals with gender incongruence may request surgical interventions, and gender-affirmation surgery plays an important role for these individuals. The basis of care derives from p...

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this are...

Quantitative studies indicate an overrepresentation of ASD in individuals with GD. This study aims to determine the prevalence of autistic traits or ASD in adults with GD using two different data collection methods: (1) cross-sectional data using the social responsiveness scale-adults (SRS-A) and the autism quotient (AQ) (n = 63). (2) Clinical char...

Gender dysphoria describes the psychological distress caused by identifying with the sex opposite to the one assigned at birth. In recent years, much progress has been made in characterizing the needs of transgender persons wishing to transition to their preferred gender, thus helping to optimize care. This critical review of the literature examine...

Objectives: The aim of the European Network for the Investigation of Gender Incongruence is to investigate the status of all individuals who had applied for gender confirming interventions from 2007 until 2009, irrespective of whether they received treatment. The current article describes the study protocol, the effect of medical treatment on gend...

The World Health Organization (WHO) is revising the tenth version of the International Classification of Diseases and Related Health Problems (ICD-10). This includes a reconceptualization of the definition and positioning of Gender Incongruence of Childhood (GIC). This study aimed to: 1) collect the views of transgender individuals and professional...

The UK Survey (this article reports on the questions marked in yellow). (DOCX)

Additional information on the background of the respondents. (DOCX)

The ICD-11 draft criteria of ‘Gender Incongruence of Childhood’ of the WGSDSH criteria used in this study. (DOCX)

ICD-11 (the eleventh edition of the World Health Organization International Statistical Classification of Diseases and Related Health Problems) is due for approval in 2018. For transgender health care, the most important proposals for ICD-11 are as follows: (1) the five ICD-10 diagnoses (most notably Transsexualism and Gender Identity Disorder of C...

Norms are considered to influence expectations toward gender-related behavior. Deviations from these norms are often perceived negatively by the social environment. The objective of this study was to investigate adults diagnosed with a Gender Identity Disorder (GID), their recalled play behavior, and peer preferences in childhood and adolescence. D...

The alteration of sex-specific body features and the establishment of a satisfactory body image are known to be particularly relevant for individuals with Gender Dysphoria (GD). The aim of the study was to first develop new scales and examine the psychometric properties of the Hamburg Body Drawing Scale (Appelt & Strauß 1988). For the second part o...

Gender dysphoria (GD) is often accompanied by dissatisfaction with physical appearance and body image problems. The aim of this study was to compare body satisfaction with perceived appearance by others in various GD subgroups. Data collection was part of the European Network for the Investigation of Gender Incongruence. Between 2007 and 2012, 660...

This study examined two instruments measuring gender dysphoria within the multicenter study of the European Network for the Investigation of Gender Incongruence (ENIGI). The Utrecht Gender Dysphoria Scale (UGDS) and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA) were examined for their definitions of gender...

Findings on women’s sexuality across the menstrual cycle are inconsistent. One relatively consistent finding is a mid-cycle and premenstrual peak in sexual desire in freely cycling women. Results on the cycle-related effects of sexual behaviour are less clear. Large proportions of reproductive-aged women use combined oral contraception (COC), but s...

Gender confirming treatment has proven to relief gender dysphoria as a symptom and to improve psychological functioning in transgender persons. Nevertheless, a small percentage shows regret after their surgical treatment. Risk factors for regret are the presence of psychiatric problems, dissatisfaction with the results of surgery and poor socializi...

Background Research has highlighted the complex association between female sexual dysfunction (FSD) and distress regarding sexual activity, with decreased physical pleasure being an important mediator. The current study aims to elucidate the association between pleasurable and painful genital sensitivity and FSD, and to further investigate whether...

Presentation at the First Biennial Conference "Transgender Health Care in Europe" March 12-14, 2015

The WPATH Standards of Care (SOC) Revision Committee are reassessing criteria for sex reassignment surgery. The major points of discussion for which WPATH might provide additional guidelines are: (1) gender binary defying surgery, (2) gonad retention for fertility preservation prior to hysterectomy in transmen and castration (+ vaginoplasty) in tra...

Gender nonconformity refers to the extent to which a person’s gender identity, gender role and/or gender expression differs from the cultural norms prescribed for people of a particular sex, within a certain society and era. Most data on gender nonconformity focus on the prevalence of gender dysphoria (which also includes a distress factor) or on t...

By performing secondary data analyses of existing medical, social, and state data, this study examined the sociodemographic profile of trans persons in Belgium and gains knowledge on those who are functionally invisible in traditional epidemiological studies or clinical samples. Based on medical interventions, post-operative transsexual persons wer...

In gender dysphoria (GD), much of the experienced distress results from body dissatisfaction. The current study analyzed the configuration of body satisfaction in trans men and women using network analysis. In total, 485 individuals diagnosed with GD from four European countries, applying for medical treatment, filled out the Body Image Scale for T...

Sexual complaints in the general population are prevalent, are accompanied by a significant distress and influence the quality of life of the individual and/or couple. While population surveys have looked at sexual complaints, sexual dysfunction and distress in the general population, information on the sexuality of individuals applying for gender-...

Objective Vaginal dilation treatment has been shown to be a (cost) effective first line alternative to surgery in normalizing vaginal length and improving sexual function in women with vaginal hypoplasia. There remains, however, a need for prospective studies, with long-term assessment of multiple outcomes. Study Design A prospective, single-centr...

Sexuality is a part of life for men and women of all ages and determines the quality of life. Sexual problems are a common finding in the chronically ill and physically disabled patient, such as those with cerebrovascular accidents. Although the physical problems after a stroke have been studied thoroughly, sufficient information is lacking on one...

BACKGROUND In women with vaginal hypoplasia, such as in Mayer–Rokitansky–Küster–Hauser syndrome (MRKH) and in Complete Androgen Insensitivity Syndrome (CAIS), surgical vaginoplasty and non-surgical self-dilation treatments are available to lengthen the vagina and facilitate sexual intercourse, but the best treatment remains controversial. Vaginal d...

A transsexual course of development that starts before puberty (early onset) or during or after puberty, respectively (late onset), may lead to diverse challenges in coping with sexual activity. The authors explored the sexual behavior of 380 adult male-to-female and female-to-male individuals diagnosed according to DSM-IV-TR criteria who had not y...

For many decades of the twentieth century, gender dysphoria was seen as an intrinsic symptom of another psychiatric disorder (e.g., schizophrenia) that should be resolved by addressing the “underlying” psychiatric disorder. DSM-III (American Psychiatric Association, 1980) broke with that view and classified the gender identity disorders as a separa...

Total phalloplasty is rarely performed today in males with severe penile deficiency, despite its successful use in the transgender population. Can phalloplasty replicate the complexity of penile anatomy and function on the long term? Sexual quality of life (QoL) was assessed in 10 men (aged 20-43 years) at least 1 year after phalloplasty in a singl...

Objectives: This study focuses on sexual health aspects in partnered gender-dysphoric individuals at the start of medical treatment by examining their partnership constellations, sexual experiences, and reports of psychological problems. Methods: As part of the cross-national European Network for the Investigation of Gender Incongruence Study, 168...

This chapter gives an overview of the care for adults with gender dysphoria from the last decades of 1900 until recently, with a short vision for the future. The view on the care of individuals with gender issues has changed tremendously. This evolution is described here: from a psychotic illness, through a rather strict definition of “transsexuali...

At the start of gender reassignment therapy, persons with a gender identity disorder (GID) may deal with various forms of psychopathology. Until now, a limited number of publications focus on the effect of the different phases of treatment on this comorbidity and other psychosocial factors. The aim of this study was to investigate how gender reassi...

Sex steroids and genital surgery are known to affect sexual desire, but little research has focused on the effects of cross-sex hormone therapy and sex reassignment surgery on sexual desire in trans persons. This study aims to explore associations between sex reassignment therapy (SRT) and sexual desire in a large cohort of trans persons. A cross-s...

Data on self-perceived genital anatomy and sensitivity should be part of the long-term follow-up of genitoplasty procedures. However, no normative data, based on a large sample, exist to date. Validation of the Self-Assessment of Genital Anatomy and Sexual Function, Female version (SAGAS-F) questionnaire within a Belgian, Dutch-speaking female popu...

The term micropenis encompasses a range of congenital and acquired conditions that result in an abnormally short penis. Small penis size may persist into adulthood, becoming a major cause of dissatisfaction. To review the literature pertaining to the effects of hormonal and surgical treatment on psychosexual functioning and quality of life (QoL) in...

This study evaluates the short- and long-term cardiovascular- and cancer-related morbidities during cross-sex hormone therapy in a large sample of trans persons. A specialist centre cross-sectional study compared 214 trans women (male-to-female transsexual persons) and 138 trans men (female-to-male trans persons) to an age- and gender-matched contr...

Research into the relationship between gender identity disorder and psychiatric problems has shown contradictory results. To investigate psychiatric problems in adults fulfilling DSM-IV-TR criteria for a diagnosis of gender identity disorder. Data were collected within the European Network for the Investigation of Gender Incongruence using the Mini...

Introduction: Hormonal therapy is part of an established treatment of gender identity disorder, however outcome data regarding mortality and morbidity are scant. Methods: A specialist center cross-sectional study in 193 transsexual women and 128 transsexual men (mean age 42.5 years) assessing physical health and incidence of possible treatment rel...

ntroduction: Quality of life in transsexual persons after transition is among the most important outcome factors. Methods: A specialist center cross-sectional study in 193 transsexual women and 128 transsexual men (mean age 42.5 years) after on average 7.4 years of cross-sex hormone therapy and 6.6 years since sex reassignment surgery (SRS), compa...

Since very little research in this field is available, this study aims to assess the role of psychosexual, relationship, hormonal and genetic measures in the sexual desire of users of three hormonal contraceptive products [low-dose combined oral contraceptive (20 mcg ethinylestradiol/150 mcg desogestrel), progestin-only pill (75 mcg desogestrel) an...

Disorders of sex development specifically requiring vaginal reconstruction because of vaginal hypoor aplasia are complex and diverse in their presentation. Although healthcare providers agree on the importance of the construction of a good and functional vaginal substitute which is durable, requires a minimum of postoperative maintenance manipulati...

The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with s...

In patients with disorders of sex development requiring creation of a neovagina, a number of techniques are available, including surgical vaginoplasty and self-dilation therapy. Vaginal dilation therapy has been recommended as a first-line treatment because of its less invasive character and high success rate. However, no data exist on long-term ps...

Since its introduction, there has been a debate about the validity of the factorial structure of the SCL-90-R. In this study we investigate whether the lack of agreement with respect to the dimensionality can be partly explained by important variables that might differ between samples such as level of psychological distress, the variance of the SCL...

The etiology of gender identity disorder (GID) remains largely unknown. In recent literature, increased attention has been attributed to possible biological factors in addition to psychological variables. To review the current literature on case studies of twins concordant or discordant for GID. A systematic, comprehensive literature review. Of 23...

Although sexual health after genital surgery is an important outcome factor for many transsexual persons, little attention has been attributed to this subject. To provide data on quality of life and sexual health after sex reassignment surgery (SRS) in transsexual men. A single-center, cross-sectional study in 49 transsexual men (mean age 37 years)...

Introduction. Karyotyping is often performed in transsexual individuals. Aim. Quantification and characterization of karyotype findings and abnormalities in transsexual persons. Main Outcome Measures. Karyotypes were listed both in male-to-female and in female-to-male transsexual persons. Methods. The data were collected through a retrospective stu...

Kanker kan ingrijpende gevolgen hebben op verschillende domeinen van het leven, ook op het vlak van seksualiteit en intimiteit. Wanneer de diagnose „kanker” wordt gesteld, denkt men eerst en vooral aan overleven. De gevolgen die kanker voor het seksuele leven zal hebben, zijn op dat moment nog niet aan de orde. Toch zal men vaak ervaren dat het sek...

With regard to transsexual developments, onset age (OA) appears to be the starting point of different psychosexual pathways. To explore differences between transsexual adults with an early vs. late OA. Data were collected within the European Network for the Investigation of Gender Incongruence using the Dutch Biographic Questionnaire on Transsexual...

Studies involving patients with gender identity disorder (GID) are inconsistent with regard to outcomes and often difficult to compare because of the vague descriptions of the diagnostic process. A multisite study is needed to scrutinize the utility and generality of different aspects of the diagnostic criteria for GID. To investigate the way in wh...

Studies on diagnostic subtypes of gender identity disorder (GID) or gender incongruence (GI), comorbidity and treatment outcome show considerable variability in results. Clinic/country specific factors may account for the contradictory results, but these factors have never been studied. This article is the first of a series reporting on a unique co...

The World Professional Association for Transgender Health (WPATH) is recognized as the leading authority in the field of transgender health, through a membership that encompasses experts in this field and transgender community representatives. WPATH therefore is in an excellent position to give input on the DSM 5 section on gender identity disorder...

This consensus statement is an executive summary of several papers resulting from a 2009 consensus process comprising nine work groups and 37 members of the World Professional Association for Transgender Health (WPATH). The purpose of this group was to put forth recommendations for the upcoming revision of the DSM with respect to the Gender Identit...

Purpose In congenital vaginal hypo- or aplasia, seen in Complete Androgen Insensitivity Syndrome (CAIS) or Mayer Rokitansky Syndrome (MRS), an absent or blind ending vagina makes sexual intercourse impossible. Operative vaginoplasty and vaginal dilation are both valid vaginal substitution treatments. The ACOG recommends vaginal dilation as a first...

Women and girls with complete androgen insensitivity syndrome (CAIS) invariably have a female typical core gender identity. In this case report, we describe the first case of male gender identity in a CAIS individual raised female leading to complete sex reassignment involving both androgen treatment and phalloplasty. CAIS was diagnosed at age 17,...

Transseksualiteit heeft weinig te maken met seksualiteit en is ook geen seksuele afwijking, maar heeft te maken met de genderidentiteit. Psychotherapeutische behandeling is echter vrijwel nooit succesvol, waar een geslachtsaanpassende behandeling wél positieve resultaten geeft. Men kiest daarom tegenwoordig steeds voor deze zogeheten gender reassig...

The ideal goals in penile reconstruction are well described, but the multitude of flaps used for phalloplasty only demonstrates that none of these techniques is considered ideal. Still, the radial forearm flap is the most frequently used flap and universally considered as the standard technique. In this article, the authors describe the largest ser...

In a review of the literature on follow-up studies of sex reassignment surgery (SRS) with regard to regret, suicide, and prognosis, this article evaluates the eligibility and readiness criteria of the WPATH Standards of Care—Sixth Version. Because the literature shows a lack of high-quality follow-up studies on large numbers of operated transsexual...

Low sexual desire is present in 1/3 of male-to-female transsexuals (post-operative male-to-female transsexual persons on estrogen replacement). Several studies report lower endogenous testosterone (T) levels in this group compared to community dwelling women. However, no relationship between T and sexual desire has been found in male-to-female tran...

In a review of the literature on follow-up studies of sex reassignment surgery (SRS), or gender reassignment surgery (GRS), this paper evaluates the levels of evidence-based medicine in relation to the surgical therapy of patients with transsexualism or with a severe gender identity disorder (GID). The specific questions that are addressed in this...

One of the goals of genital construction in female-to-male transsexuals is the creation of an aesthetically acceptable result, both for phallus and scrotum, leaving minimal morbidity and recreating function. In the last 15 years, transsexuals have become more demanding, and scrotoplasty has received more attention than before. Traditional flaps for...

Genderproblemen verwijzen naar moeilijkheden die personen kunnen ervaren ten gevolge van een discrepantie tussen hun biologische geslacht en genderidentiteit. ‘Gender’, een Engels leenwoord, duidt niet zozeer het biologische geslacht aan, maar refereert eerder aan de psychosociale aspecten daarvan. In de psychologie en psychiatrie wordt een ondersc...

Gender assignment in newborns with ambiguous genitalia remains a delicate decision, beset with difficulties. Until recently, those newborns often received a female gender assignment based on the existing surgical possibilities and limitations, as well as on the assumption that children are "psychosexual neutral" at birth. In the last decade the pre...

Transsexualism is the most extreme form of gender identity disorder and most transsexuals eventually pursue sex reassignment surgery (SRS). In transsexual women, this comprises removal of the male reproductive organs, creation of a neovagina and clitoris, and often implantation of breast prostheses. Studies have shown good sexual satisfaction after...

The objective of this paper was to report on a large series of laparoscopic hysterectomy in female-to-male (FTM) transsexual patients. A retrospective study was carried out by the gender team of Ghent University Hospital, Ghent, Belgium. The patient files of 83 consecutive cases of laparoscopic hysterectomy between April 2003 and August 2007 were r...

A number of studies have evaluated the effectiveness of a cricothyroid approximation (CA) in creating a more female voice in male-to-female transsexuals (MFTs) from an acoustic perspective. An increase in pitch is of little value, however, unless it accurately indicates listeners' perceptions of gender. The purpose of this study was to further inve...

In female-to-male transsexuals, the first surgical procedure in their reassignment surgery consists of the subcutaneous mastectomy. The goals of subcutaneous mastectomy are removal of breast tissue, removal of excess skin, reduction and proper positioning of the nipple and areola, and ideally, minimization of chest-wall scars. The authors present t...

An unknown proportion of transsexual women (defined as post-operative male-to-female transsexuals on oestrogen replacement) experience hypoactive sexual desire disorder (HSDD). It has been suggested that the absence of ovarian androgen production together with oestrogen treatment-related increase in sex hormone-binding globulin (SHBG) levels could...

The study aims to investigate if a similar interaction between physical appearance and voice could be found in female-to-male transsexuals as had been observed in male-to-female transsexuals. A panel of judges rated "maleness" of seven female-to-male transsexuals from video-recorded speech samples using three modes of presentation: auditory-only pr...

To apply a phalloplasty technique used in female-to-male transsexual surgery in male patients with penile insufficiency. Seven male patients (aged 15 to 42 years) were treated with phalloplasty (6 with radial forearm free flap and one with anterolateral thigh flap) between March 2004 and April 2006 (follow-up, 9 to 34 months). All patients suffered...

In this explorative study, nine stable relationships between female-to-male transsexuals and their biologically female partners were compared to an equal number of "traditional" heterosexual couples. The aim was to investigate any differences between these two groups on three aspects: satisfaction about the partner relationship, sexual satisfaction...

Tactile and erogenous sensitivity in reconstructed genitals is one of the goals in sex reassignment surgery. Since November 1993 until April 2003, a total of 105 phalloplasties with the radial forearm free flap and 127 vaginoclitoridoplasties with the inverted penoscrotal skin flap and the dorsal glans pedicled flap have been performed at Ghent Uni...

The Belgian medical world has acknowledged the diagnosis of transsexualism and accepted Sex Reassignment Surgery (SRS) as one of the steps in the treatment of choice since 1985. This prevalence and demographic study analyses data on all Belgian individuals who have undergone SRS since that year. All (188) plastic surgeons as well as all gender team...