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„Ich wäre lieber ein Junge …““I would rather have been a boy…”: Körper- und Genderdysphorie junger Mädchen – ein aktuelles Plädoyer für frauenärztliches präventives EngagementBody and gender dysphoria of young girls—A contemporary plea for gynecological preventive engagement
Abstract
The Self-determination Law passed by the German Bundestag on April 12 2024 has the intention that in the future every person over 14 years old, whose subjective feeling of identification deviates from their objectively given biological gender, can once per year explain to the registry office that the information should be altered or deleted, without presuppositions, as long as there is consent by their legal representative. An assessment or medical certification is no longer necessary and a mandatory expert counselling is also not required for minors. Exactly this part of the draft of the law is the subject of criticism. For some it goes too far and for others not far enough: a topic that misleads to polemics, but which in view of the exponentially increased number of young girls with gender-related identity conflicts deserves to be differentially considered and to be illuminated from different perspectives in the best interests of the child.
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Persons who have renounced a prior transgender identification, often after some degree of social and medical transition, are increasingly visible. We recruited 78 US individuals ages 18–33 years who previously identified as transgender and had stopped identifying as transgender at least six months prior. On average, participants first identified as transgender at 17.1 years of age and had done so for 5.4 years at the time of their participation. Most (83%) participants had taken several steps toward social transition and 68% had taken at least one medical step. By retrospective reports, fewer than 17% of participants met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. In contrast, 53% of participants believed that “rapid-onset gender dysphoria” applied to them. Participants reported a high rate of psychiatric diagnoses, with many of these prior to trans-identification. Most participants ( N = 71, 91%) were natal females. Females (43%) were more likely than males (0%) to be exclusively homosexual. Participants reported that their psychological health had improved dramatically since detransition/desistance, with marked decreases in self-harm and gender dysphoria and marked increases in flourishing. The most common reason given for initial trans-identification was confusing mental health issues or reactions to trauma for gender dysphoria. Reasons for detransition were more likely to reflect internal changes (e.g., the participants’ own thought processes) than external pressures (e.g., pressure from family). Results suggest that, for some transgender individuals, detransition is both possible and beneficial.
Media's Stranglehold on Storm and Stress - The Sorrows of Generation Z about Sex and Gender Abstract: The feeling of not belonging to one's birth sex is not new; one can trace this phenomenon back even to ancient mythology. Although it has always been rare, there has recently been a sharp increase in gender identity deviations among adolescents. This text addresses this problem by asking to what extent this development also results from upheavals in the cultural landscape and, above all, in media technology. Do they cause young people to believe they are in the "wrong gender" and, in extreme cases, to strive for transition? We present the most salient cornerstones of the planned German self-determination law (Self-ID), most of which, however, are unlikely to do justice to the underlying problem. The text concludes by describing several unanswered questions concerning this matter and by attempting to propose first answers. The advantages of a gender-exploratory over the trans affirmative therapy approach are summarized.
Background
Twenty years ago, the Dutch Protocol—consisting of a gonadotropin-releasing hormone agonist (GnRHa) to halt puberty and subsequent gender-affirming hormones (GAHs)—was implemented to treat adolescents with gender dysphoria.
Aim
To study trends in trajectories in children and adolescents who were referred for evaluation of gender dysphoria and/or treated following the Dutch Protocol.
Methods
The current study is based on a retrospective cohort of 1766 children and adolescents in the Amsterdam Cohort of Gender Dysphoria.
Outcomes
Outcomes included trends in number of intakes, ratio of assigned sex at birth, age at intake, age at start of GnRHa and GAH, puberty stage at start of GnRHa, proportions of adolescents starting and stopping GnRHa, reasons for refraining from GnRHa, and proportions of people undergoing gender-affirming surgery.
Results
A steep increase in referrals was observed over the years. A change in the AMAB:AFAB ratio (assigned male at birth to assigned female at birth) was seen over time, tipping the balance toward AFAB. Age at intake and at start of GnRHa has increased over time. Of possibly eligible adolescents who had their first visit before age 10 years, nearly half started GnRHa vs around two-thirds who had their first visit at or after age 10 years. The proportion starting GnRHa rose only for those first visiting before age 10. Puberty stage at start of GnRHa fluctuated over time. Absence of gender dysphoria diagnosis was the main reason for not starting GnRHa. Very few stopped GnRHa (1.4%), mostly because of remission of gender dysphoria. Age at start of GAH has increased mainly in the most recent years. When a change in law was made in July 2014 no longer requiring gonadectomy to change legal sex, percentages of people undergoing gonadectomy decreased in AMAB and AFAB.
Clinical Implications
A substantial number of adolescents did not start medical treatment. In the ones who did, risk for retransitioning was very low, providing ongoing support for medical interventions in comprehensively assessed gender diverse adolescents.
Strengths and Limitations
Important topics on transgender health care for children and adolescents were studied in a large cohort over an unprecedented time span, limited by the retrospective design.
Conclusion
Trajectories in diagnostic evaluation and medical treatment in children and adolescents referred for gender dysphoria are diverse. Initiating medical treatment and need for surgical procedures depends on not only personal characteristics but societal and legal factors as well.
It is unclear whether the research literature on adolescent gender dysphoria (GD) provides sufficient evidence to adequately inform clinical decision making. In the first of a series of three papers, this study sought to systematically review published evidence regarding: the prevalence of GD in adolescence; the proportions of natal males/females with GD in adolescence and whether this changed over time; and the pattern of age at (a) onset (b) referral and (c) assessment. Having searched PROSPERO and the Cochrane library for existing systematic reviews (and finding none), we searched Ovid Medline 1946 –October week 4 2020, Embase 1947–present (updated daily), CINAHL 1983–2020, and PsycInfo 1914–2020. The final search was carried out on the 2nd November 2020 using a core strategy including search terms for ‘adolescence’ and ‘gender dysphoria’ which was adapted according to the structure of each database. Papers were excluded if they did not clearly report on clinically-verified gender dysphoria, if they were focused on adult populations, if they did not include original data (epidemiological, clinical, or survey) on adolescents (aged at least 12 and under 18 years), or if they were not peer-reviewed journal publications. From 6202 potentially relevant articles (post de-duplication), 38 papers from 11 countries representing between 3000 and 4000 participants were included in our final sample. Most studies were observational cohort studies, usually using retrospective record review (26). A few compared to normative or population datasets; most (31) were published in the past 5 years. There was significant overlap of study samples (accounted for in our quantitative synthesis). No population studies are available, so prevalence is not possible to ascertain. There is evidence of an increase in frequency of presentation to services, and of a shift in the natal sex of referred cases: those assigned female at birth are now in the majority. No data were available on age of onset. Within the included samples the average age was 13 years at referral, 15 years at assessment. All papers were rated by two reviewers using the Crowe Critical Appraisal Tool v1·4 (CCAT). The CCAT quality ratings ranged from 45% to 96%, with a mean of 78%. Almost half the included studies emerged from two treatment centres: there was considerable sample overlap and it is unclear how representative these are of the adolescent GD community more broadly. The increase in clinical presentations of GD, particularly among natal female adolescents, warrants further investigation. Whole population studies using administrative datasets reporting on GD / gender non-conformity may be necessary, along with inter-disciplinary research evaluating the lived experience of adolescents with GD.
The study’s purpose was to describe a population of individuals who experienced gender dysphoria, chose to undergo medical and/or surgical transition and then detransitioned by discontinuing medications, having surgery to reverse the effects of transition, or both. Recruitment information with a link to an anonymous survey was shared on social media, professional listservs, and via snowball sampling. Sixty-nine percent of the 100 participants were natal female and 31.0% were natal male. Reasons for detransitioning were varied and included: experiencing discrimination (23.0%); becoming more comfortable identifying as their natal sex (60.0%); having concerns about potential medical complications from transitioning (49.0%); and coming to the view that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition (38.0%). Homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition. The majority (55.0%) felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition and only 24.0% of respondents informed their clinicians that they had detransitioned. There are many different reasons and experiences leading to detransition. More research is needed to understand this population, determine the prevalence of detransition as an outcome of transition, meet the medical and psychological needs of this population, and better inform the process of evaluation and counseling prior to transition.
Background
UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently ‘detransition’.
Aims
To describe service users’ access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify ‘detransitioning’.
Method
A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and ‘accessing care’ or ‘other outcome’.
Results
The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7–19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1–1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1–17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1–4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning.
Conclusions
Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.
The aim of this study is to analyze the specific needs of detransitioners from online detrans communities and discover to what extent they are being met. For this purpose, a cross-sectional online survey was conducted and gathered a sample of 237 male and female detransitioners. The results showed important psychological needs in relation to gender dysphoria, comorbid conditions, feelings of regret and internalized homophobic and sexist prejudices. It was also found that many detransitioners need medical support notably in relation to stopping/changing hormone therapy, surgery/treatment complications and reversal interventions. Additionally, the results indicated the need for hearing about other detransitioners' experiences and meeting each other. A major lack of support was reported by the respondents overall, with a lot of negative experiences coming from medical and mental health systems and from the LGBT+ community. The study highlights the importance of increasing awareness and support given to detransitioners.
Background
Transgender/ gender non-binary (TGNB) people are an understudied population that appears to have undergone changes in both its size and demographic composition; however, population-level data on the magnitude of these changes are sparse.
Methods
Electronic health records from Kaiser Permanente health plans in Georgia and Northern and Southern California were used to identify TGNB individuals who sought care from January 2006 through December 2014, and the data were analyzed by year, site and age, and by sex assigned at birth.
Results
In 2006 the number of TGNB people (and corresponding 95% confidence intervals) per 100,000 population were 3.5 (1.9, 6.3) in Georgia, 5.5 (4.8, 6.4) in Southern California and 17 (16, 19) in Northern California. In 2014, these frequencies increased to 38 (32, 45), 44 (42, 46) and 75 (72, 78) per 100,000 population, respectively. When analyzed by age, the most rapid increase was observed among persons 18 to 25 years old, and this increase accelerated after 2010. The ratio of transmasculine to transfeminine persons also changed from 1:1.7 in 2006 to 1:1 in 2014 overall, and from 1:1 in 2006 to 1.8:1 in 2014 among persons under the age of 18 years.
Conclusions
This analysis confirms previous observations that the proportion of TGNB people is growing especially among young adults. The composition of TGNB population is also changing from predominantly transfeminine to roughly 1:1 overall, and predominantly transmasculine in children and adolescents.
Purpose: To explore whether the increase observed in referrals to child and adolescent gender identity services (GIDSs) has been similar in four Nordic countries and in the UK.
Materials and methods: Numbers of referrals per year in 2011–2017 were obtained from all GIDS in Denmark, Finland, Norway, Sweden and the UK and related to population aged <18.
Results: A similar pattern of increase in referral rates was observed across countries, resulting in comparable population adjusted rates in 2017. In children, male:female birth sex ratio was even; in adolescents, a preponderance of females (birth sex) was observed, particularly in Finland.
Conclusions: The demand for GIDSs has evolved similarly across Nordic countries and the UK. The reasons for the increase are not known but increased awareness of gender identity issues, service availability, destigmatization as well as social and media influences may play a role.
Purpose
In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing for the first time during puberty or even after its completion. Parents describe that the onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity. Recently, clinicians have reported that post-puberty presentations of gender dysphoria in natal females that appear to be rapid in onset is a phenomenon that they are seeing more and more in their clinic. Academics have raised questions about the role of social media in the development of gender dysphoria. The purpose of this study was to collect data about parents’ observations, experiences, and perspectives about their adolescent and young adult (AYA) children showing signs of an apparent sudden or rapid onset of gender dysphoria that began during or after puberty, and develop hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among this demographic group.
Methods
For this descriptive, exploratory study, recruitment information with a link to a 90-question survey, consisting of multiple-choice, Likert-type and open-ended questions was placed on three websites where parents had reported sudden or rapid onsets of gender dysphoria occurring in their teen or young adult children. The study’s eligibility criteria included parental response that their child had a sudden or rapid onset of gender dysphoria and parental indication that their child’s gender dysphoria began during or after puberty. To maximize the chances of finding cases meeting eligibility criteria, the three websites (4thwavenow, transgender trend, and youthtranscriticalprofessionals) were selected for targeted recruitment. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques. Data were collected anonymously via SurveyMonkey. Quantitative findings are presented as frequencies, percentages, ranges, means and/or medians. Open-ended responses from two questions were targeted for qualitative analysis of themes.
Results
There were 256 parent-completed surveys that met study criteria. The AYA children described were predominantly natal female (82.8%) with a mean age of 16.4 years at the time of survey completion and a mean age of 15.2 when they announced a transgender-identification. Per parent report, 41% of the AYAs had expressed a non-heterosexual sexual orientation before identifying as transgender. Many (62.5%) of the AYAs had reportedly been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset of their gender dysphoria (range of the number of pre-existing diagnoses 0–7). In 36.8% of the friendship groups described, parent participants indicated that the majority of the members became transgender-identified. Parents reported subjective declines in their AYAs’ mental health (47.2%) and in parent-child relationships (57.3%) since the AYA “came out” and that AYAs expressed a range of behaviors that included: expressing distrust of non-transgender people (22.7%); stopping spending time with non-transgender friends (25.0%); trying to isolate themselves from their families (49.4%), and only trusting information about gender dysphoria from transgender sources (46.6%). Most (86.7%) of the parents reported that, along with the sudden or rapid onset of gender dysphoria, their child either had an increase in their social media/internet use, belonged to a friend group in which one or multiple friends became transgender-identified during a similar timeframe, or both
Conclusion
This descriptive, exploratory study of parent reports provides valuable detailed information that allows for the generation of hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among AYAs. Emerging hypotheses include the possibility of a potential new subcategory of gender dysphoria (referred to as rapid-onset gender dysphoria) that has not yet been clinically validated and the possibility of social influences and maladaptive coping mechanisms. Parent-child conflict may also explain some of the findings. More research that includes data collection from AYAs, parents, clinicians and third party informants is needed to further explore the roles of social influence, maladaptive coping mechanisms, parental approaches, and family dynamics in the development and duration of gender dysphoria in adolescents and young adults.
Increasing numbers of adolescents are seeking treatment at gender identity services in Western countries. An increasingly accepted treatment model that includes puberty suppression with gonadotropin-releasing hormone analogs starting during the early stages of puberty, cross-sex hormonal treatment starting at ~16 years of age and possibly surgical treatments in legal adulthood, is often indicated for adolescents with childhood gender dysphoria (GD) that intensifies during puberty. However, virtually nothing is known regarding adolescent-onset GD, its progression and factors that influence the completion of the developmental tasks of adolescence among young people with GD and/or transgender identity. Consolidation of identity development is a central developmental goal of adolescence, but we still do not know enough about how gender identity and gender variance actually evolve. Treatment-seeking adolescents with GD present with considerable psychiatric comorbidity. There is little research on how GD and/or transgender identity are associated with completion of developmental tasks of adolescence.
Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development.
Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013.
The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.
The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.
This article presents the findings from a cross-sectional study on demographic variables and associated difficulties in 218 children and adolescents (Mean age = 14 years, SD = 3.08, range = 5-17 years), with features of gender dysphoria, referred to the Gender Identity Development Service (GIDS) in London during a 1-year period (1 January 2012-31 December 2012). Data were extracted from patient files (i.e. referral letters, clinical notes and clinician reports). The most commonly reported associated difficulties were bullying, low mood/depression and self-harming. There was a gender difference on some of the associated difficulties with reports of self-harm being significantly more common in the natal females and autism spectrum conditions being significantly more common in the natal males. The findings also showed that many of the difficulties increased with age. Findings regarding demographic variables, gender dysphoria, sexual orientation and family features are reported, and limitations and implications of the cross-sectional study are discussed. In conclusion, young people with gender dysphoria often present with a wide range of associated difficulties which clinicians need to take into account, and our article highlights the often complex presentations of these young people.
© The Author(s) 2014.
Improvements in neuroimaging technologies, and greater access to their use, have generated a plethora of data regarding male/female differences in the developing brain. Examination of these differences may shed light on the pathophysiology of the many illnesses that differ between the sexes and ultimately lead to more effective interventions. In this review, we attempt to synthesize the anatomic magnetic resonance imaging (MRI) literature of male/female brain differences with emphasis on studies encompassing adolescence - a time of divergence in physical and behavioral characteristics. Across all ages total brain size is consistently reported to be about 10% larger in males. Structures commonly reported to be different between sexes include the caudate nucleus, amygdala, hippocampus, and cerebellum - all noted to have a relatively high density of sex steroid receptors. The direction and magnitude of reported brain differences depends on the methodology of data acquisition and analysis, whether and how the subcomponents are adjusted for the total brain volume difference, and the age of the participants in the studies. Longitudinal studies indicate regional cortical gray matter volumes follow inverted U shaped developmental trajectories with peak size occurring one to three years earlier in females. Cortical gray matter differences are modulated by androgen receptor genotyope and by circulating levels of hormones. White matter volumes increase throughout childhood and adolescence in both sexes but more rapidly in adolescent males resulting in an expanding magnitude of sex differences from childhood to adulthood.
Background:
There are over 150,000 transgender adolescents in the United States, yet research on outcomes following gender-affirming mastectomy in this age group is limited. We evaluated gender-affirming mastectomy incidence, as well as postoperative complications, including regret, in adolescents within our integrated health care system.
Methods:
Gender-affirming mastectomies performed from January 1, 2013 - July 31, 2020 in adolescents 12-17 years of age at the time of referral were identified. The incidence of gender-affirming mastectomy was calculated by dividing the number of patients undergoing these procedures by the number of adolescents assigned female at birth ages 12-17 within our system at the beginning of each year and amount of follow-up time within that year. Demographic information, clinical characteristics (comorbidities, mental health history, testosterone use), surgical technique, and complications, including mention of regret, of patients who underwent surgery were summarized. Patients with and without complications were compared to evaluate for differences in demographic or clinical characteristics using chi-squared tests.
Results:
The incidence of gender-affirming mastectomy increased 13-fold (3.7 to 47.7 per 100,000 person-years) during the study period. Of the 209 patients who underwent surgery, the median age at referral was 16 years (range 12-17) and the most common technique was double-incision (85%). For patients with greater than 1-year follow-up (n=137, 65.6%), at least one complication was found in 7.3% (n=10), which included hematoma (3.6%), infection (2.9%), hypertrophic scars requiring steroid injection (2.9%), seroma (0.7%), and suture granuloma (0.7%); 10.9 % underwent revision (n=15). There were no statistically significant differences in patient demographics and clinical characteristics between those with and without complications (p>0.05). Two patients (0.95%) had documented postoperative regret but neither underwent reversal surgery at follow-up of 3 and 7 years postoperatively.
Conclusion:
Between 2013-2020, we observed a marked increase in gender-affirming mastectomies in adolescents. The prevalence of surgical complications was low and of over 200 adolescents who underwent surgery, only two expressed regret, neither of which underwent a reversal operation. Our study provides useful and positive guidance for adolescent patients, their families, and providers regarding favorable outcomes with gender-affirming mastectomy.
Introduction:
Concerns about future regret and treatment discontinuation have led to restricted access to gender-affirming medical treatment for transgender and gender-diverse (TGD) minors in some jurisdictions. However, these concerns are merely speculative as few studies have examined gender-affirming hormone continuation rates among TGD individuals.
Methods:
We performed a secondary analysis of 2009-2018 medical and pharmacy records from the U.S. Military Healthcare System. We identified TGD patients who were children and spouses of active-duty, retired, or deceased military members using ICD-9/10 codes. We assessed initiation and continuation of gender-affirming hormones using pharmacy records. Kaplan-Meier and Cox proportional hazard analyses estimated continuation rates.
Results:
The study sample included 627 transmasculine and 325 transfeminine individuals with an average age of 19.2 ± 5.3 years. The 4-year gender-affirming hormone continuation rate was 70.2% (95%CI 63.9-76.5). Transfeminine individuals had a higher continuation rate than transmasculine individuals 81.0% (72.0-90.0%) vs 64.4% (56.0-72.8). People who started hormones as minors had higher continuation rate than people who started as adults 74.4% (66.0-82.8) vs 64.4% (56.0-72.8). Continuation was not associated with household income or family member type. In Cox Regression, both transmasculine gender identity (Hazard Ratio 2.40 (95%CI 1.50-3.86) and starting hormones as an adult (HR 1.69 (1.14-2.52) were independently associated with increased discontinuation rates.
Discussion:
Our results suggest that >70% of TGD individuals who start gender-affirming hormones will continue use beyond 4-years, with higher continuation rates in transfeminine individuals. Patients who start hormones, with their parents' assistance, prior to age 18 have higher continuation rates than adults.
The physical restructuring processes in puberty activate even now reactions, such as worry, self-doubt, anxiety and shyness. The nervous irritations of sexual awakening are still associated with many uncertainties and feelings of shame. The psychosexual processing of pubertal changes requires a period of grace of a few years for the psychosocial reorganization but that is no longer conceded to adolescents. In general, people in periods of upheaval in life are extremely receptive for information that makes the internal and also external alterations explainable, structurable and predictable and promises an increase in coping competence. This is particularly true for adolescents in puberty, in whom nowadays a mental catching up is demanded due to the physical jump start. Medical prevention is initiated here by clarification and sexual education. With the preventive offer of a personal consultation for young girls, gynecologists can support young girls in the sense of female empowerment before they discover maladaptive solutions (e.g. eating disorders) for themselves.
The perception of menstruation is currently changing—it is no longer viewed as an imposition, but rather increasingly as a symbol of female potency. Outdated tabus are questioned by young women, not rarely provocatively, and menstrual hygiene products are displayed on brightly lit supermarket shelves. This change in menstruationʼs image should be actively encouraged by gynecologists, who should see consultations for menstrual complaints—the most frequent reason for young girls seeking a consultation—as a valuable opportunity to inform patients about the fascinating processes in the female body in the sense of primary prevention. Moreover, gynecologists should have substantiated scientific knowhow regarding the sometimes-confusing information of competitors in the hygiene industry regarding the correct use and alleged infection-promoting attributes of their products.
There has been a recent rise in the number of people who hold a non-binary gender identity. However, the proportion of young people attending gender services who identify as non-binary has not yet been investigated. This article presents the findings from a pilot study of newly designed questionnaire, the Gender Diversity Questionnaire, which included questions about gender identity and gender expression. Responses from 251 adolescents attending the United Kingdom's National Gender Identity Development Service between June 2016 and February 2017 are reported here. The majority, 56.9%, of young people identified as trans, 29.3% identified as a binary gender (male or female), 11% identified as non-binary and 1.2% as agender. There were no significant differences in self-defined identities based on assigned gender or age. However, once young people were separated into these groups, some of them were very small; thus, a larger sample is required. In terms of aspects of gender expression that were important to the young people, the data formed five themes - name and pronouns, external appearance, the body, intrinsic factors and 'other'. Strengths and weaknesses of the research are discussed as well as future work that will be conducted.
Laut Kinder- und Jugendgesundheitssurvey (KiGGS) des Robert-Koch-Instituts geben 54,5 % der normgewichtigen Mädchen an, sich für zu dick zu halten, und bei jedem dritten Mädchen zwischen 14 und 17 Jahren gibt es Hinweise auf eine Essstörung. Die Disziplinleistung des Hungerns ersetzt die Kontrolle über das eigene Leben, der Körper kann zum Austragungsort innerer Konflikte mit einem hohen Maß an bizarrer Ritualisierung werden. Gynäkologische Probleme wie die Amenorrhö führen essgestörte Mädchen nicht selten relativ früh in die Frauenarztpraxis. Beratungsambivalenz der betroffenen Mädchen und konsekutive Ratlosigkeit des Arztes lassen diese Konsultationen nicht selten unbefriedigend verlaufen. Vermittelt werden sollen die für einen kompetenten Umgang mit diesen jungen Patientinnen relevanten psychosomatischen Grundlagen, die gynäkologisch wichtigen Fragestellungen und die Möglichkeiten der Prävention von Essstörungen.
The complex developmental functions of puberty involve a multitude of external as well internal risk factors for the emergence of eating disorders. In particular a strict ideal of beauty as androgynous slenderness and the prepubertal structural design imperative for the external female genitalia prevent young girls from being able to accept the alterations to their developing body and the symbolic significance with respect to fertility. Furthermore, due to a lack of competent and trustworthy information many young girls do not succeed in accepting menstruation as being a principally vital process of their body. The association of a false body image with eating disorders is obvious. Because of the severity, the tendency to become chronic and protracted therapy of clinically manifested eating disorders effective concepts for prevention should be made available. It is a rewarding task in gynecology, e.g. within the framework of consultations with young girls, to make offers of advice and solutions, such as sport, so that a young girl can develop an informed and consensual access to her body.
Few studies have focused on the prevalence and extent of childhood trauma in the transsexual population. In our study of 42 transsexual people (34 = natal males, 8 = natal females), 55% (n = 23) reported experiencing an unwanted sexual event before the age of 18, with the average age of initial sexual contact being 13. This sexual event differs from other clinical populations in that the unwanted sexual experiences in this sample were the consequence of adolescents satisfying their curiosity about the gender of the transsexual rather than for their own sexual gratification. Consequently, the sequalae of the unwanted sexual touches in our sample did not lead to sexualised behaviours described in the sexual abuse literature of clinical samples. Our sample also reported being: verbally abused (77%), insulted (81%), embarrassed in front of others (55%), made to feel guilty by their parents (58%) before their fifteenth birthday.
Zusammenfassung Menarche und Menstruation waren über Jahrhunderte nicht erklärbar. Inadäquate Verhaltensreglementierungen wurden in der weiblichen
Linie tradiert. Die Entkleidung der Menstruation von ihrem magisch-metaphysischen Umfeld ist überhaupt erst seit dem letzten
Jahrhundert möglich. Aber wie erleben junge Mädchen in der Pubertät aktuell ihre Menstruation? Können immer noch nur wenige
Mädchen die Menstruation mit Stolz statt mit Scham- und Ohnmachtsgefühlen erleben? Eine anonyme Umfrage unter 659 Mädchen
von 12 bis 14 Jahren ergab, dass die Identität von Mädchen durch die Menstruation auch heute noch in Fluss gerät – im wahrsten
Sinne des Wortes. Sie brauchen kompetente Unterstützung, frauenärztliches präventives Engagement ist gefragt.
Transition bei Genderdysphorie: Wenn die Pubertas gestoppt wird
- M Lenzen-Schulte
Intimmodifikationen: Spielarten und ihre psychosozialen Bedeutungen
- A Borkenhagen
- E Brähler
Warum es toll ist, ein Mädchen zu sein! Den eigenen Körper schätzen und schützen lernen
- G Gille