Hertha Richter-Appelt

University Medical Center Hamburg - Eppendorf · Department of Sexual Research and Forensic Psychiatry

Zusammenfassung Einführung Körperliche Geschlechtsentwicklungen, die auf chromosomaler, gonadaler und/oder anatomischer Ebene untypisch verlaufen, werden als Intergeschlechtlichkeit, Varianten der Geschlechtsentwicklung, Intersex, Intersexualität, Variationen der körpergeschlechtlichen Merkmale und Störungen der Geschlechtsentwicklung bezeichnet. S...

The term variations of sex development subsumes a large number of congenital conditions including chromosomal mosaics and variations of chromosomal, gonadal and phenotypic sex. A situation of this nature may cause severe distress to both, parents and affected persons. One of the reasons for this is the binary form of gender classification in our so...

Inge, eine über 60-jährige verheiratete Frau, verliebt sich in den noch älteren Karl und entschließt sich, ihren Mann Werner zu verlassen und zu Karl zu ziehen. Der Film beschäftigt sich mit Sehnsüchten und sexuellen Wünschen im Alter und soll an Hand von Nacktszenen deutlich machen, dass sexuelles Verlangen auch noch im Alter bestehen und wie in j...

Percy und Felix Adlon wollten einen Film über Gustav Mahler gestalten, um diesen einem breiteren Publikum näher zu bringen. Anlass war Mahlers 150. Geburtstag am 7. Juli 2010 und sein 100.Todestag am 18. Mai 2011 (so Felix Adlon in dem Beiheft zum Film, S.10). Das ist ihnen zweifelsfrei gelungen.

In den letzten Jahrzehnten wurden zahlreiche Studien zur Behandlung der Dissoziativen Identitätsstörung durchgeführt. Die individuellen Erfahrungen und das Wissen von Betroffenen aus Bewältigungs­ und Heilungsprozessen wurden dabei bisher nur unzureichend erfasst und ausgewertet. Im Zentrum der vorliegenden Studie stehen daher Gespräche mit zwölf F...

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...

Hinsichtlich Klassifikation, Diagnostik, Begriffsbestimmungen und Behandlungsansätzen im Zusammenhang mit Transsexualität und Intersexualität hat ein Paradigmenwechsel stattgefunden: Es wird akzeptiert, dass es viele Varianten des körperlichen Geschlechts und viele unterschiedliche Erlebensweisen der Geschlechtsidentität gibt. Die Entwicklung der G...

The study aimed to compare pornography use of students in two culturally different European countries – Poland and Germany, and to investigate associations with religiosity, sexual myths, and sex taboos. Data were collected in an online survey among German (n = 1303) and Polish (n = 1135) university students aged 18-26 years. Polish students were m...

The purpose of this study was to explore the relationship between pornography use and sexual behavior in young adults from two culturally different countries. Data were collected in an online survey among German (n=1303; G) and Polish (n=1135; P) university students aged 18-26 years. Pornography use was associated with engaging in a greater variety...

The perception of gender development of individuals with complete androgen insensitivity syndrome (CAIS) as unambiguously female has recently been challenged in both qualitative data and case reports of male gender identity. The aim of the mixed-method study presented was to examine the self-perception of CAIS individuals regarding different aspect...

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...

In Germany, the situation of health care services for children and adolescents with gender dysphoria is insufficient. In 2006 a specialized multiprofessional outpatient clinic was founded at the University Medical Center Hamburg-Eppendorf. Goals were improvement of health services for gender dysphoric children, development of treatment concepts, an...

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...

Purpose: This study examines quality of life and psychological distress in individuals with Mayer- Rokitansky-Küster-Hauser Syndrome (MRKHS) and Complete Androgen Insensitivity Syndrome (CAIS), two syndromes belonging to the field of “disorders of sex development”. Methods: Fifty women with MRKHS and eleven individuals with CAIS participated. The G...

Purpose: This study examines quality of life and psychological distress in individuals with Mayer-Rokitansky-Küster-Hauser Syndrome (MRKHS) and Complete Androgen Insensitivity Syndrome (CAIS), two syndromes belonging to the field of “disorders of sex development”. Methods: Fifty women with MRKHS and eleven individuals with CAIS participated. The Ge...

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...

The aims of this mixed-methods study were to: (1) describe the gender experience and level of satisfaction with gender allocation of intersex persons and (2) explore the spectrum of their gender identities. Of the 69 participants with a number of divergences of sex development (DSD), gender allocation at birth was female in 83% and male in 17%. Sev...

Sexual wellness depends on a person's physical and psychological constitution. Complete Androgen Insensitivity Syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser Syndrome (MRKHS) can compromise sexual well-being. To compare sexual well-being in CAIS and MRKHS using multiple measures: To assess sexual problems and perceived distress. To gain insight...

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...

Sexual delinquency in juveniles is insufficiently explored in regard to the specificity of offender characteristics. The aim is to investigate relevant areas for juvenile sexual offending in a precourt, pretreatment group. Thirty-two alleged juvenile sexual offenders (ASO) referred to by police were compared with 32 juvenile nonsexual violent offen...

To date no instrument for the assessment of parenting styles is available in the German -language area that has been validated in patients with addictive disorders. Therefore the aim of this study was the confirmatory evaluation of the factor structure of the Questionnaire on Parental Attitudes and Rearing Practices (FEPS) in 186 alcohol dependent...

Women with Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) or polycystic ovary syndrome (PCOS) experience substantial changes in female body characteristics. It was investigated how this is associated with changes concerning the experience of one's own femininity. A questionnaire was developed to measure the experience of one's own femininity. The...

Physical and psychosocial aspects of intersexuality (disorders of sex development, DSD) are described here. Differences between intersexuality and transsexuality are elaborated upon, especially in terms of coping with the diagnosis and treatment recommendations when dealing with an “ambiguous” or “false” body and with the disclosure of the physical...

Persons with different sex characteristics may suffer from a feeling of being “different” or “not normal”. In this study, persons with one of 3 diagnoses (complete androgen insensitivity syndrome [CAIS]; Mayer-Rokitansky-Küster-Hauser syndrome [MRKHS], polycystic ovary syndrome [PCOS]) were asked whether they had contact to other affected persons a...

Diverse partner relationship constellations of gender dysphoric women and men with different sexual orientations are explored in a sample of 93 persons before gender-confirming interventions in persons with female gender identity and male body characteristics (MF) and persons with male gender identity and female body characteristics (FM). While in...

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...

Der Artikel hinterfragt kritisch die in der Medizin verbreitete Vorstellung, dass Personen mit Intersexualität nur dann eine befriedigende Sexualität leben können, wenn ihre Geschlechtsorgane chirurgisch möglichst dem weiblichen oder männlichen Geschlecht angepasst werden, sodass »heterosexueller« Geschlechtsverkehr möglich wird. Ergebnisse der Ham...

Die Suche nach den neurobiologischen Grundlagen sexueller und transsexueller Entwicklungen beschäftigt die Wissenschaft seit mehr als fünf Jahrzehnten. Das Wissen um die Sexualdifferenzierung neuronaler Strukturen konnte seitdem erheblich erweitert werden. Die vorliegende Arbeit stellt exemplarisch genetische, neuroendokrinologische, neurostrukture...

According to the principle of the excluded third (tertium non datur) the gender binary divides our social life into two options only: male or female. Similarly, either/or reactions also seem to be applied by people dealing professionally with issues of transsexualism, transgenderism or related statuses. For instance, the history of transsexualism i...

In recent years the topic of intersexuality/Disorders of Sex Development (DSD) has gained more attention in medical and psychological research. Intersexuality refers to a variety of conditions in which an individual is born with a reproductive or sexual anatomy that does not seem to fit the typical definitions of male or female individuals. Althoug...

In recent years the topic of intersexuality/Disorders of Sex Development (DSD) has gained more attention in medical and psychological research. Intersexuality refers to a variety of conditions in which an individual is born with a reproductive or sexual anatomy that does not seem to fit the typical definitions of male or female individuals. Althoug...

Einleitung: Die Diagnose des Mayer-Rokitansky-Kuster-Hauser Syndrom (MRKHS) wird gestellt bei Frauen mit XX-Karyotyp, bei denen aufgrund von Veranderungen in der Embryonalentwicklung eine Aplasie von Vagina und Uterus vorliegt, funktionsfahigen Ovarien und ansonsten unauffalligen weiblichen Geschlechtsmerkmalen. Erste Studien weisen auf eine erhoht...

MRKHS (Pravalenz 1: 5000) beschreibt eine angeborene Uterus- und Vaginalaplasie. Masgebliche Merkmale sind, dass die Patientinnen steril sind und dass ein Koitus nicht ohne medizinische Eingriffe moglich ist. Beim PCOS ist durch erhohte Androgenspiegel die Fruchtbarkeit eingeschrankt, das ausere Erscheinungsbild ist durch die Androgenwirkung beeinf...

Der Verdacht auf Intersexualität wird geäußert, wenn bei Personen entweder geschlechtstypische Merkmale fehlen, zu stark ausgeprägt sind oder Merkmale beider Geschlechter mehr oder minder gleichzeitig vorkommen. Intersexualität ist ein Überbegriff für eine Vielzahl von Diagnosen mit unterschiedlichen Ursachen, Erscheinungsbildern und Entwicklungsve...

In recent years the topic of intersexuality/Dlsorders of Sex Development (DSD) has gained more attention in medical and psychological research. Intersexuality refers to a variety of conditions in which an individual is born with a reproductive or sexual anatomy that does not seem to fit the typical definitions of male or female individuals. Althoug...

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...

Diese Arbeit thematisiert mögliche Einflussfaktoren auf die sexuelle Lebensqualität (SLQ) bei Männern und Frauen mit unterschiedlichen Formen von Epilepsie. Es werden physiologische, pharmakologische, psychologische und soziale Faktoren erläutert und Zusammenhänge zwischen diesen diskutiert. Die bei Epilepsie häufig gefundenen Einschränkungen der s...

We prospectively investigated the effect of personality on sexual quality of life (SQOL) in 49 epilepsy patients (23 women). Fifteen patients had generalised epilepsy and 34 had focal epilepsy. SQOL was determined using the Derogatis Interview for Sexual Function - Self Report Inventory (DISF-SR) and personality was studied using the NEO five-facto...

This article summarizes the current state of research on Sexual Quality of Life (SexQoL) of adults with 46,XY Disorders of Sex Development (DSD)/Intersexuality. An extensive literature search yield 21 studies published between 1974-2007, examining sexual aspects in individuals with 46,XY DSD. However, many of them lack methodological quality. The r...

The DSM-IV-TR category of Gender Identity Disorder (GID; American Psychiatric Association, 2000) is limited to persons with typical somatosexual development who experience “strong and persistent cross-gender identification” as well as a “persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex.” The pre...

Introduction. There has recently been a growing acceptance that it is not only heterosexual functioning of surgically adjusted genitalia which should be considered when measuring the treatment outcome of persons with disorders of sex development (DSD) but also their overall sexual quality of life (SexQoL). Aim. A comprehensive cross-sectional inves...

Beeinträchtigungen und Auff älligkeiten der sexuellen Funktion, der sexuellen Präferenz und der Geschlechtsidentität werden unter Störungen der Sexualität zusammengefasst. Die ▸ Fallbeispiele 1–3 sollen die Vielfalt an möglichen Problemen deutlich machen.

Die Diagnose des Mayer-Rokitansky-Kuster-Hauser-Syndroms (MRKH) wird bei folgender Symptomatik gestellt: Nichtausbildung (Aplasie) von Vagina und Gebarmutter bei Frauen mit weiblichem XX-Chromosomensatz, funktionsfahigen Eierstocken und ansonsten auserlich unauffalligen weiblichen Geschlechtsmerkmalen. Das Syndrom hat fur betroffene Frauen Unfrucht...

Since the beginning of institutionalized treatment of transsexualism in the USA in the mid-1960s and somewhat later in Europe, the focal point was centered on the biological sex of the person affected. The term “transsexual woman” was used to refer to a biological woman, identifying herself as a man and aiming at living as a man supported by hormon...

The paper summarizes results from a prospective study regarding psychological characteristics of females undergoing infertility treatment. For 91 patients out of an initial sample of 191 women, it was possible to determine whether the patients had achieved pregnancy (n == 52) or not (n == 39) after an average of 28 months. The remaining patients ei...

Neurobiologische Zusammenhange bei Storungen der Geschlechtsidentitat (Gender Identity Disorder: GID bzw. Transsexualitat) beschaftigen die klinische Forschung seit mehr als drei Jahrzehnten. Durch bildgebende Verfahren liegen hinsichtlich der sexuellen Differenzierung neuronaler Strukturen und Funktionen mittlerweile hochinteressante Forschungsbef...

Das Phänomen der Intersexualität ist in der psychotherapeutischen Praxis und Ausbildung kaum thematisiert. Dabei ist von einer erhöhten Indikation zur Psychotherapie bei Betroffenen auszugehen. Im Rahmen des Hamburger Forschungsprojekts am Institut für Sexualforschung wurden erstmals in Deutschland Erwachsene mit verschiedenen Formen der Intersexua...

Seventy-nine consecutive inpatients of an epilepsy center (34 women, 45 men) who had either generalized epilepsy, temporal lobe epilepsy, focal epilepsy of other origin, or no epilepsy completed the Derogatis Interview for Sexual Function—Self-Report Inventory. Quantitative assessments of blood levels were performed for prolactin, total testosteron...

Individuals living with an intersex condition have not received much attention in counseling psychology, although a high need for psychosocial care is obvious. Using a mixed-methods multiple case study with qualitative and quantitative data, the authors explore coping and gender experiences in seven 46, XY intersexual persons with deficiencies of a...

Background Disorders resp. Divergencies of Sex Development (DSD) comprise various forms of untypical sex development in which chromosomal, gonadal and/or anatomical sex characteristics do not all correspond to one sex. Up to now the common medical practice has included an immediate gender assignment after birth and sex-correcting medical interventi...

Data on associations between the parent-child relationship, eating behavior, and body weight in a community-based sample of preadolescent children are presented. The aim of our study was to replicate the finding from clinical samples that families of overweight children demonstrate adverse characteristics of the parent-child relationship. A communi...

Dieser Artikel fasst den Forschungsstand zur sexuellen Lebensqualitat von Personen mit Intersexualitat und 46,XY Karyotyp zusammen. 21 internationale Studien aus den Jahren 1974 bis 2007 uber sexuelles Verhalten und sexuelle Erfahrungen dieser Personengruppe werden ausfuhrlich dargestellt und kritisiert. Die Ergebnisse sind sehr widerspruchlich, de...

Our knowledge of the treatment options and long-term outcomes with different forms of intersexuality is insufficient. The demand for life long follow-up studies asks for more than surgical outcomes data. The objective of the Hamburg follow-up study is not only to gather information about physical development and treatment experiences of individuals...

Background As long-term outcome data on treatment experiences and treatment satisfaction of German subjects with intersexuality (disorders of sex development) are lacking, a comprehensive study project on intersexuality was conducted at the Institute for Sex Research at the University Hospital Hamburg Eppendorf. Material und methods The treatment e...

Evaluation of psychological distress has received relatively little attention in research on persons with disorders of sex development (DSD). Results of previous studies varied considerably, but most studies did not find increased levels of psychological distress. We conducted a pilot study based on a sample of 37 persons with diverse forms of DSD...

Until now, there are only few studies that focus on the specific treatment experiences of people with intersexuality and evaluate their outcome in terms of psychological, physical, and social well-being. Further, the presentation of the patients' perspective is often neglected in research. Overview of preliminary results of the Hamburg-Intersex-Stu...

In der vorliegenden Studie wird ein Fragebogen zur Erfassung der Repräsentation der Eltern-Kind-Beziehung von vorpubertären Kindern vorgestellt. Bislang fehlt für diese Altersgruppe ein standardisiertes Messinstrument, das ökonomisch und dennoch differenziert erfasst, wie Kinder die Beziehung zu ihren Eltern erleben. Die ursprüngliche Fragebogenver...

Different forms of intersexuality (Disorders of Sex Development, DSD) are described (congenital adrenal hyperplasia, androgen insensitivity, disorders of androgen biosynthesis, gonadal dysgenesis). Treatment interventions for individuals with ambiguous genitalia and untypical sex development are discussed with respect to medical and psychosocial as...

Im vorliegenden Beitrag werden verschiedene Formen der Intersexualität (Disorders of Sex Development; DSD) beschrieben (Adrenogenitales Syndrom, Androgeninsensitivtat, Störungen der Androgenbiosynthese und Gonadendysgenesien). Die Behandlung von Personen mit nicht eindeutigem Genital bzw. nicht eindeutigem Geschlecht wird aus medizinischer und psyc...

A questionnaire on representations of the parent-child relationship in preadolescent children is presented. At present, no standardised measure is available for this age group which assesses economically but still differentiated how younger children perceive the relationship with their parents. The original version of the Parent-Child Relationship...

A questionnaire on psychological dimensions of eating behavior in children is presented. Existing questionnaires for children specifically focus on symptoms of eating disorders only, whereas for adults, questionnaires assessing general psychological dimensions of eating behavior are also available. The development of the Eating Pattern Inventory fo...

With a prevalence of around 20%, childhood sexual abuse (CSA) is a relevant problem in obstetric care. The aim of our systematic review was to present the current knowledge on the influence of CSA on pregnancy, delivery, and early parenthood. All English, French, or German primary and secondary literature from the reference lists found after screen...