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Fornander MJ, Egan AM, Robertson GC, Moser CN. Self-Reported Sexual Behavior of Transgender Youth. J Pediatr Adolesc Gynecol 2023:S1083-3188(23)00458-8. [PMID: 38122962 DOI: 10.1016/j.jpag.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Research indicates transgender/gender diverse (TGD) youth are more likely to engage in sexual behavior, have more sexual partners, and initiate sexual behavior earlier than their cisgender peers. However, no gender-inclusive self-report survey questionnaires (i.e., those that do not assume the gender of sexual partners or body parts used for sex) exist to assess sexual behavior of TGD youth. The current study illustrates a questionnaire with nuanced wording to more accurately portray the sexual behavior of TGD youth presenting for gender-affirming medical care compared to national adolescent norms. METHODS Retrospective chart review of 323 youth, ages 13-18, presenting to a pediatric gender clinic between 2015-2021. Youth self-reported their gender identity (i.e., masculine, feminine, gender queer, questioning/unsure), sexual behaviors, and partners via a REDCAP survey. RESULTS Rates of dating among TGD youth were significantly lower than national norms (33.7% v 68.3%; X2=172.644, p< 0.0001), as was sexual behavior (14.9% vs. 39.5% X2=80.419, p< 0.0001). Rates of self-reported involuntary sexual activity among TGD youth did not differ significantly from national norms (7.1% vs. 6.9%, ns). Body parts used for sex, the number of sexual partners, and the gender identity of sexual partners are reported. DISCUSSION Results suggest that rates of dating and sexual behavior among TGD youth are significantly lower than national norms, supporting a need for screening of sexual health among TGD youth utilizing gender-inclusive measures. A standardized gender-inclusive questionnaire of sexual behavior is needed to improve data accuracy and help develop inclusive programs to address the sexual health needs of TGD youth.
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Affiliation(s)
- Mirae J Fornander
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Anna M Egan
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, United States.
| | - Gail C Robertson
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Christine N Moser
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, United States
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2
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Moussaoui D, O'Connell MA, Elder CV, Grover SR, Pang KC. Characteristics of Menstrual Suppression and Its Association With Mental Health in Transgender Adolescents. Obstet Gynecol 2023; 142:1096-1104. [PMID: 37562053 DOI: 10.1097/aog.0000000000005317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To investigate the prevalence, nature, and effectiveness of menstrual suppression in transgender and gender-diverse (TGD) adolescents, and to explore whether there is an association between menstrual suppression and mental health in this population. METHODS A cross-sectional study was performed of TGD adolescents assigned female at birth attending their first appointment at a specialist pediatric gender service between February 2017 and December 2021. Demographic and mental health data were collected using a questionnaire at the time of first visit, and information regarding menstrual suppression at this time was retrieved from the medical record. RESULTS A total of 530 TGD individuals were included; 131 (24.7%) were on menstrual suppression at their initial visit, mainly to help alleviate gender dysphoria. Combined oral contraceptive pills were the most common agent used (n=61, 46.6%), followed by norethindrone (n=39, 29.8%) and intramuscular medroxyprogesterone (n=19, 14.5%). Rates of effectiveness (in stopping menstruation) and patient satisfaction were high. Among the 399 individuals not on menstrual suppression, there was strong interest in starting this treatment. No differences in the risk of gender dysphoria, depression, or anxiety were observed between those who were receiving menstrual suppression and those who were not. CONCLUSION Effectiveness of and satisfaction with menstrual suppression were high in TGD adolescents receiving this treatment. These findings support the routine exploration and management of menstrual health in TGD adolescents. However, menstrual suppression was not associated with any difference in gender dysphoria, depression, or anxiety symptoms in this cross-sectional study, and longitudinal studies are required to better investigate this.
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Affiliation(s)
- Dehlia Moussaoui
- Department of Pediatric and Adolescent Gynecology, the Department of Endocrinology and Diabetes, and the Department of Adolescent Medicine, the Royal Children's Hospital Melbourne, and the Murdoch Children's Research Institute, Parkville, and the Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
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3
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Daans CG, Hoornenborg E, de Haseth KB, Özer M, Bouman MB, Conemans E, Kreukels BP, den Heijer M, van der Sluis WB. HIV Prevalence and High-Risk Subgroup Identification in Transgender Women Who Undergo Primary Vaginoplasty in the Netherlands. Transgend Health 2023; 8:226-230. [PMID: 37342478 PMCID: PMC10277977 DOI: 10.1089/trgh.2021.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Purpose Worldwide, transgender women (TGW) bear a high HIV burden. Limited data are available on HIV prevalence and risk factors among TGW in western European countries. Our aim is to assess the prevalence of TGW living with HIV who underwent primary vaginoplasty in an academic reference hospital and to identify high-risk subgroups. Methods All TGW who underwent primary vaginoplasty between January 2000 and September 2019 at our institution were identified. A retrospective chart study was conducted, recording the medical history, age at vaginoplasty, region of birth, use of medication, injecting drug use, history of pubertal suppression, HIV status, and sexual preference at time of surgical intake. High-risk subgroups were identified using logistic regression analysis. Results Between January 2000 and September 2019, a total of 950 TGW underwent primary vaginoplasty, of whom 31 (3.3%) individuals were known to live with HIV. Prevalence of HIV was higher in TGW born outside of Europe (20/145, 13.8%) than among those born in Europe (11/805, 1.4%), p<0.001. In addition, having a sexual preference toward men was significantly associated with HIV. None of the TGW living with HIV had a history of puberty suppression. Conclusion The HIV prevalence in our study population is higher than the reported HIV prevalence in cisgender population in the Netherlands but lower than reported in previous studies in TGW. Further studies should investigate the need and feasibility of routine HIV testing of TGW in Western countries.
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Affiliation(s)
- Ceranza G. Daans
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Kristin B. de Haseth
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, and Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Müjde Özer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, and Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, and Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Elfi Conemans
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Baudewijntje P.C. Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Wouter B. van der Sluis
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, and Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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4
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Lampis J, De Simone S, Lasio D, Serri F. The Role of Family Support and Dyadic Adjustment on the Psychological Well-being of Transgender Individuals: An Exploratory Study. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-17. [PMID: 37363352 PMCID: PMC10166461 DOI: 10.1007/s13178-023-00817-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/28/2023]
Abstract
Introduction This study aimed to measure dyadic adjustment, social support, and psychological well-being. Methods A research protocol composed of the Dyadic Adjustment Scale, the Outcome Questionnaire 45.2, and the Multidimensional Scale of Perceived Social Support was administered to a sample of 109 Italian transgender individuals. Results Higher levels of global psychological distress, symptom severity, and interpersonal relationship distress were associated with lower levels of family support and dyadic adjustment. In addition, transgender women and younger transgender individuals reported higher levels of interpersonal relationship distress. Conclusions The results indicate that the support and acceptance of one's partner and family of origin play a crucial role in promoting well-being. It represents an important protective factor with respect to negative psychological health outcomes. Policy Implications The findings emphasize the need to develop specific clinical and social practices for transgender individuals and their families. Building family and partner-centered policies and programs is particularly important to enable transgender individuals to avoid paying the emotional and psychological costs associated with rejection and non-acceptance.
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Affiliation(s)
- Jessica Lampis
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
| | - Silvia De Simone
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
| | - Diego Lasio
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
| | - Francesco Serri
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
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Jung C, Hunter A, Saleh M, Quinn GP, Nippita S. Breaking the Binary: How Clinicians Can Ensure Everyone Receives High Quality Reproductive Health Services. Open Access J Contracept 2023; 14:23-39. [PMID: 36814801 PMCID: PMC9939798 DOI: 10.2147/oajc.s368621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
The gender binary has historically defined the study and practice of reproductive and sexual healthcare. However, the male and female binary categorization of sex does not adequately define patients seeking reproductive and sexual health. Comprehensive sexual healthcare should consider diverse gender identity and non-heteronormative sexual practices, family planning, sexually transmitted infections, cancer prevention, and sexual function. Recent research suggests clinicians do not feel prepared to provide care for sexual and gender minority (SGM) patients. In this narrative review, we focus on reproductive and sexual health within the scope of obstetric and gynecologic (OB/GYN) clinical practice. We used traditional medical subject headings to summarize data from publications in peer-reviewed journals published in the last 10 years and identified barriers, facilitators and best practices for de-gendering reproductive healthcare. Following a roughly chronological care path across the lifespan, we categorized findings into the following topics: Early Care for SGM, Sexual Health, Family Planning, and Care Later in Life for SGM. We include recommendations for creating a welcoming environment, SGM inclusive training for clinicians and staff, and best practices for individualized counseling. We review suggested practices related to service delivery and clinical considerations in the provision of sexual and reproductive health care for gender and sexual minority patients.
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Affiliation(s)
- Christina Jung
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Adam Hunter
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
| | - Mona Saleh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA,Correspondence: Gwendolyn P Quinn, Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 1st Ave NBV N91-F, New York, NY, 10016, USA, Tel +1-646-501-6878, Email
| | - Siripanth Nippita
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, NY, USA
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Kennis M, Kreukels BPC, Dewitte M. Sex & relationships in trans people. Best Pract Res Clin Obstet Gynaecol 2023; 86:102294. [PMID: 36635133 DOI: 10.1016/j.bpobgyn.2022.102294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Everyone has sexual rights and is entitled to enjoy sex, regardless of gender identity or expression. It is therefore encouraging to witness a recent growth in research on sexuality in transgender individuals. We provide a short overview of extant research on sex and relationships in this population and argue that current research has mostly been conducted from a medical and functional approach; there is a strong focus on negative experiences and prevention; and there is a lack of data regarding psychological and socio-relational variables. Furthermore, many studies have been conducted in a cis- and hetero-normative setting and have methodological shortcomings such as applying questionnaires that have not been validated in a transgender population. We encourage researchers to expand their focus to positive variables such as sexual pleasure and (in accordance with the biopsychosocial model) investigate subjective experiences and relationship variables when studying sexuality in transgender individuals.
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Affiliation(s)
- Mathilde Kennis
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands; Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands; Maastricht Brain Imaging Center, Maastricht, Netherlands.
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VU University, Amsterdam, Netherlands
| | - Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
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Clark AN, Lefkowitz ES, Zimmerman C. Sexual and Affectionate Behaviors in Asexual and Allosexual Adults. JOURNAL OF SEX RESEARCH 2023; 60:242-252. [PMID: 35316105 DOI: 10.1080/00224499.2022.2051161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Prior experience with physical behaviors - both sexual and affectionate - is common among adults in romantic relationships. However, less is known about differences in physical behaviors for asexual and allosexual adults, and these differences may explain how asexual adults navigate sexuality in romantic relationships. In this study we used sexual script theory to examine asexual (n = 109; 59% women; Mage = 27.7) and allosexual adults' (n = 403; 58% women; Mage = 29.0) prior experiences with and future likelihood to engage in sexual and affectionate behaviors in romantic relationships, and how these differences vary by gender. Asexual adults had less prior experience with and were less likely to intend to engage in future physical behaviors than allosexual adults. There were some gender differences in past experience and future likelihood. Prior experience with physical behaviors was associated with expected likelihood to engage in these behaviors for allosexual and asexual adults, although the association was stronger for asexual adults. These results have implications for how asexual adults engage in physical behaviors, and how differing interest in physical behaviors may cause conflict within asexual-allosexual couples.
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Affiliation(s)
- Alyssa N Clark
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Eva S Lefkowitz
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut
| | - Corinne Zimmerman
- Department of Psychology, Illinois State University Illinois, Normal, Illinois
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Coyne CA, Wongsomboon V, Korpak AK, Macapagal K. "We have to figure it out ourselves": Transfeminine adolescents' online sexual experiences and recommendations for supporting their sexual health and wellbeing. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 4:1034747. [PMID: 36726593 PMCID: PMC9884802 DOI: 10.3389/frph.2022.1034747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/05/2022] [Indexed: 01/18/2023] Open
Abstract
The internet plays a significant role in adolescent sexual development. Sexual and gender minority (SGM) adolescents are more likely than their cisgender, heterosexual peers to use online spaces for sexual and romantic purposes, as they may have a smaller pool of potential partners and more concerns about the risks of in-person partner seeking. Among SGM adolescents, gender identity may shape how youth navigate online spaces for sexual purposes but there is limited research focused on transgender and gender diverse (TGD) adolescents' online partner seeking. Previous research has focused on cisgender gay and bisexual boys' experiences with sexual networking applications designed for adult men who have sex with men. This perspective article integrates clinical expertise and survey data from transfeminine adolescents (N = 21) in the United States reporting their online sexual behavior and experiences. We use qualitative data to describe the sexual health, safety, and wellbeing of transfeminine adolescents and offer suggestions for clinical assessment of online versus offline sexual activity and call for inclusive sexual health resources for transfeminine adolescents.
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Affiliation(s)
- Claire A. Coyne
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, United States,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Correspondence: Claire A. Coyne
| | - Val Wongsomboon
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Aaron K. Korpak
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kathryn Macapagal
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Gieles NC, van de Grift TC, Elaut E, Heylens G, Becker-Hebly I, Nieder TO, Laan ETM, Kreukels BPC. Pleasure please! Sexual pleasure and influencing factors in transgender persons: An ENIGI follow-up study. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:212-224. [PMID: 37114112 PMCID: PMC10128378 DOI: 10.1080/26895269.2022.2028693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background: While the importance of sexual pleasure for physical and mental health becomes increasingly evident, research on sexual pleasure in transgender persons is lacking. Recently, the first version of the Amsterdam Sexual Pleasure Index (ASPI Vol. 0.1) was validated in cisgender persons. This questionnaire aims to assess the tendency to experience sexual pleasure independent of gender, sexual orientation or anatomy. Aim: The aims of this study were threefold. First, to perform exploratory scale validation analyses of the ASPI in transgender persons. Secondly, to compare transgender sexual pleasure scores to reference data in cisgender persons. Finally, to identify factors that are associated with sexual pleasure. Methods: In a follow-up study conducted within the European Network for the Investigation of Gender Incongruence (ENIGI), online questionnaires were distributed to persons who had a first clinical contact at gender clinics in Amsterdam, Ghent or Hamburg four to six years earlier. Internal consistency of the ASPI was assessed by calculating McDonald's omega (ωt). ASPI scores were compared to scores from the cisgender population using a one sample t-test, and linear regressions were conducted to study associations with clinical characteristics, psychological wellbeing, body satisfaction and self-reported happiness. Results: In total, 325 persons filled out the ASPI. The ASPI showed excellent internal consistency (ωt, all: 0.97; transfeminine: 0.97, transmasculine: 0.97). Compared to data from cisgender persons, transgender participants had significantly lower total ASPI scores (i.e., lower sexual pleasure; transgender vs. cisgender, mean(SD): 4.13(0.94) vs. 4.71(0.61)). Lower age, current happiness and genital body satisfaction were associated with a higher tendency to experience sexual pleasure. Conclusion & discussion: The ASPI can be used to assess the tendency to experience sexual pleasure and associated factors in transgender persons. Future studies are needed to understand interplaying biopsychosocial factors that promote sexual pleasure and hence transgender sexual health and wellbeing.
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Affiliation(s)
- Noor C. Gieles
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- CONTACT Noor C. Gieles Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam Medical Centers, location VUmc, PO box 7057, Amsterdam1007 MB, The Netherlands
| | - Tim C. van de Grift
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Els Elaut
- Center for Sexology and Gender, University Hospital Ghent, Ghent, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Gunter Heylens
- Center for Sexology and Gender, University Hospital Ghent, Ghent, Belgium
| | - Inga Becker-Hebly
- Interdisciplinary Transgender Health Care Center, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timo O. Nieder
- Interdisciplinary Transgender Health Care Center, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ellen T. M. Laan
- Department of Sexology and Psychosomatic Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Baudewijntje P. C. Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Nematollahi A, Gharibzadeh S, Damghanian M, Gholamzadeh S, Farnam F. Sexual behaviors and vulnerability to sexually transmitted infections among transgender women in Iran. BMC Womens Health 2022; 22:170. [PMID: 35568868 PMCID: PMC9107204 DOI: 10.1186/s12905-022-01753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Transgender people are at serious risk for HIV infection and other sexually transmitted infections (STIs), they are four times more likely to experience HIV infection than the general population. The aim of this study was to assess sexual behaviors and vulnerability of transgender women to STIs including HIV. Method A cross-sectional study was conducted using convenient sampling from August 2019 to March 2020 in Iran at “Support center for Iranian transgender” and “Shiraz Forensic Medicine” where transgender individuals refer to follow the steps of gender affirmation. 127 transgender women participated in this study. A researcher-made questionnaire was applied for evaluating sexual behaviors, STIs and HIV. Results The mean age of participants and their age of sexual debut were 27.6 and 16.9, respectively. 92.1% of participants were single with experience of sex and 59.3% had one sex partner in the last 2 years. 96.9% of the participants were heterosexual with 67.2% reporting experiencing orgasm in at least 50% of their sexual intercourse. However, 42.5% reported sexual pain and the same percentage reported low or very low sexual satisfaction. About half of the participants used condoms occasionally during sex (48.7%) and the most important reason for not using condoms in most cases was not having a condom (37.9%). Some of participants had little knowledge of the symptoms (33.9%) and complications (44.1%) of STIs. Although 87.4% and 72.4% of participants had never been tested for a STI and HIV, 1.6% were HIV positive and 18.1% had a history of STIs. Also, 26% of people had undergone vaginoplasty and a significant association was observed between vaginoplasty with sexual satisfaction (p < 0. 01(. Conclusion Some of transgender women in this study were involved in high-risk sexual behaviors while unaware of the signs and symptoms of STIs. Also, despite reaching orgasm in most of their sexual relationships, they had little sexual satisfaction that could probably be related to body dissatisfaction, and lack of vaginoplasty in the majority of them. The need for gender affirming surgeries and psychiatric interventions affecting body satisfaction was identified in this group.
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Affiliation(s)
- Azar Nematollahi
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Safoora Gharibzadeh
- Department of Epidemiology and Biostatistics, Pasteur Institute of Iran, Tehran, Iran
| | - Maryam Damghanian
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Gholamzadeh
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran.,Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnaz Farnam
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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11
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Lindley L, Anzani A, Galupo MP. Gender Dysphoria and Sexual Well-Being Among Trans Masculine and Nonbinary Individuals. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2049-2063. [PMID: 35449364 DOI: 10.1007/s10508-021-02242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
Prior qualitative research has noted that gender dysphoria impacts sexual engagement and satisfaction for many trans masculine and nonbinary individuals. As such, the current cross-sectional study aimed to investigate the exact relations between distinct aspects of gender dysphoria (i.e., genital, chest, other secondary sex characteristics, and social) and engagement in, and enjoyment of, specific sexual acts. To achieve this aim, a sample of 141 trans masculine and nonbinary participants who were assigned female at birth and whom had not undertaken a medical transition were recruited. Participants were identified as trans masculine (n = 52), nonbinary (n = 72), and agender (n = 17). Participants completed a survey rating both body and social gender dysphoria and their engagement and enjoyment of receptive and performative roles across six partnered sex act domains (i.e., insertion, oral sex, sex toys, manual stimulation, nipple stimulation, and anal stimulation), as well as masturbation and noncoital activities. The overall results demonstrated that gender dysphoria is more salient to sexual acts that involve receiving versus providing sexual pleasure. In addition, genital and chest dysphoria were often significantly related to lower ratings of engagement and enjoyment. These results support the understanding that trans masculine and nonbinary individuals are likely negotiating sexual encounters to avoid sexual acts that involve areas of their body they find most distressing and marks an important area for future interventions and research.
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Affiliation(s)
- Louis Lindley
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Annalisa Anzani
- Department of Psychology, University of Milano, Bicocca, Italy
| | - M Paz Galupo
- Department of Psychology, Towson University, 8000 York Road, Towson, MD, 21252, USA.
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12
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Arnoldussen M, van der Miesen AIR, Elzinga WS, Alberse AME, Popma A, Steensma TD, de Vries ALC. Self-Perception of Transgender Adolescents after Gender-Affirming Treatment: A Follow-Up Study into Young Adulthood. LGBT Health 2022; 9:238-246. [PMID: 35475663 DOI: 10.1089/lgbt.2020.0494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: Early medical treatment for transgender adolescents should contribute to healthy psychological development, including the development of positive self-perception. However, at present, there are no longitudinal studies that have examined whether current treatment approaches meet this expectation. Therefore, the aim of this single-arm retrospective study was to examine transgender adolescents' self-perception changes over the course of irreversible medical gender-affirming treatment. Method: The total study sample consisted of 70 adolescents (49 trans men and 21 trans women). Self-perception was assessed before the start of gender-affirming hormone treatment (mean age = 14.65, standard deviation (SD) = 2.08) and at least 6 months after gender-affirming surgeries (mean age = 20.70, SD = 1.49) by Self-Perception Profile for Adolescents (SPPA). The SPPA is a self-report measure that examines self-perception on seven different domains: Scholastic competence, social acceptance, athletic competence, physical appearance, behavioral conduct, close friendship, and global self-worth. Multilevel modeling (random intercepts model) was conducted to determine the effect of time for all domains of self-perception. Results: It was found that the domains of physical appearance and global self-worth improved significantly over the course of treatment. No domain worsened significantly over the course of treatment. The domains of scholastic competence, social acceptance, athletic competence, and close friendship remained stable over time. Conclusion: This study provides the first suggestive evidence that irreversible gender-affirming treatment for adolescents could contribute to the development of a more positive self-perception.
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Affiliation(s)
- Marijn Arnoldussen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
| | - Anna I R van der Miesen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
| | - Wieteke S Elzinga
- GGZ-Noord-Holland-Noord, Division Triversum, Centre for Child and Adolescent Psychiatry, Heiloo, the Netherlands
| | - Anne-Marie E Alberse
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
| | - Arne Popma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
| | - Thomas D Steensma
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annelou L C de Vries
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, de Boelelaan 1117, Amsterdam, Netherlands
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13
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Warwick RM, Araya AC, Shumer DE, Selkie EM. Transgender Youths' Sexual Health and Education: A Qualitative Analysis. J Pediatr Adolesc Gynecol 2022; 35:138-146. [PMID: 34619356 DOI: 10.1016/j.jpag.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE To characterize transgender adolescents' sexual behaviors, identities, and their perceived experiences with sex education. DESIGN Semi-structured interviews were conducted and addressed sexual experiences and perceptions of sex education received from family, school educators, and healthcare providers. Interviews were audio recorded, transcribed, and analyzed utilizing NVivo 12 software for thematic analysis. SETTING Child and adolescent gender services clinic at a Midwestern university-based medical center in the United States. PARTICIPANTS 30 transgender adolescents between the ages of 15 to 20. INTERVENTIONS AND MAIN OUTCOME MEASURES Themes generated during semi-structured interviews. RESULTS Sexual orientations were inclusive of attractions to a spectrum of gender identities. Libido was perceived to be impacted by gender-affirming hormone therapy, which was unanticipated for some adolescents. Family and school-based sex education was perceived to be relevant only for heterosexual and cisgender adolescents. Inclusive education for transgender adolescents was desired. Counseling provided by gender-affirming providers on sexual health was trusted and other healthcare providers were perceived to lack training on gender-inclusive care. CONCLUSION This study demonstrated that families and school educators did not provide sex education perceived to be applicable to transgender adolescents. Similarly, healthcare providers of transgender adolescents were perceived to not provide inclusive or comprehensive medical care in comparison to physicians who routinely provide gender-affirming care. Gaps in education and healthcare could be improved with sex education outreach or training for families and school educators as well as the development and implementation of professional competencies for pediatricians on transgender adolescent healthcare.
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Affiliation(s)
| | - Adrian C Araya
- Division of Pediatric Endocrinology, Michigan Medicine, Ann Arbor, MI
| | - Daniel E Shumer
- Division of Pediatric Endocrinology, Michigan Medicine, Ann Arbor, MI
| | - Ellen M Selkie
- Division of Adolescent Medicine, Michigan Medicine, Ann Arbor, MI
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14
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O’Connell MA, Nguyen TP, Ahler A, Skinner SR, Pang KC. Approach to the Patient: Pharmacological Management of Trans and Gender-Diverse Adolescents. J Clin Endocrinol Metab 2022; 107:241-257. [PMID: 34476487 PMCID: PMC8684462 DOI: 10.1210/clinem/dgab634] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/24/2022]
Abstract
Internationally, increasing numbers of children and adolescents with gender dysphoria are presenting for care. In response, gender-affirming therapeutic interventions that seek to align bodily characteristics with an individual's gender identity are more commonly being used. Depending on a young person's circumstances and goals, hormonal interventions may aim to achieve full pubertal suppression, modulation of endogenous pubertal sex hormone effects, and/or development of secondary sex characteristics congruent with their affirmed gender. This is a relatively novel therapeutic area and, although short-term outcomes are encouraging, longer term data from prospective longitudinal adolescent cohorts are still lacking, which may create clinical and ethical decision-making challenges. Here, we review current treatment options, reported outcomes, and clinical challenges in the pharmacological management of trans and gender-diverse adolescents.
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Affiliation(s)
- Michele A O’Connell
- Department of Endocrinology and Diabetes, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
- Department of Adolescent Medicine, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia
- Correspondence: Michele A. O’Connell, FRACP, MD, Department of Endocrinology and Diabetes, The Royal Children’s Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Thomas P Nguyen
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
| | - Astrid Ahler
- Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital Basel, Basel, Switzerland
| | - S Rachel Skinner
- Speciality of Child and Adolescent Health, Faculty of Medicine and Health, Sydney University, Children’s Hospital Westmead, NSW 2145, Australia
| | - Ken C Pang
- Department of Adolescent Medicine, The Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia
- Walter and Eliza Hall Institute for Medical Research, Parkville, VIC 3052, Australia
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15
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Maheux AJ, Zhou Y, Thoma BC, Salk RH, Choukas-Bradley S. Examining Sexual Behavior Among U.S. Transgender Adolescents. JOURNAL OF SEX RESEARCH 2021; 58:1050-1060. [PMID: 33356600 PMCID: PMC8236068 DOI: 10.1080/00224499.2020.1855408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The health of transgender adolescents (i.e., those identifying with a gender other than their sex assigned at birth) is gaining attention from researchers, yet little work has examined normative sexual behaviors among this population. Self-identified gender minority adolescents, including those identifying as trans boys, trans girls, nonbinary, and questioning their gender identity (age range 14-18, Mage = 16, n = 1,223) from all 50 U.S. states responded to anonymous online surveys. Participants reported on their age of initiation and number of sexual partners for four sexual behaviors ranging in intimacy (i.e., sexual touching, oral sex, vaginal sex, and anal sex). Participants also indicated the gender of their sexual partners and experiences with sexually transmitted infections (STIs), STI tests, and pregnancy. Overall, transgender adolescents' age of initiating sexual behaviors and number of sexual partners are similar to those observed in prior studies of cisgender adolescents. No differences were found between gender identity subgroups on ever engaging, age of initiation, number of partners, and gender of partners across the four sexual behaviors, with some exceptions for anal sex. Participants reported low rates of STIs and pregnancy, but also low rates of STI testing. Implications for sex education and health care are discussed.
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Affiliation(s)
- Anne J. Maheux
- University of Pittsburgh, Department of Psychology
- University of Delaware, Department of Psychological and Brain Sciences
| | - Yiyao Zhou
- University of Pittsburgh, Department of Psychology
- Indiana University Bloomington, Department of Counseling and Educational Psychology
| | | | | | - Sophia Choukas-Bradley
- University of Pittsburgh, Department of Psychology
- University of Delaware, Department of Psychological and Brain Sciences
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16
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Siboni L, Rucco D, Prunas A, Anzani A. "We Faced Every Change Together". Couple's Intimacy and Sexuality Experiences from the Perspectives of Transgender and Non-Binary Individuals' Partners. JOURNAL OF SEX & MARITAL THERAPY 2021; 48:23-46. [PMID: 34357858 DOI: 10.1080/0092623x.2021.1957733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In recent years, there has been a growing interest in the study of transgender and non-binary (TGNB) individuals' romantic and sexual relationships. The present study explored, from TGNB people's partners' perspective, how the couple experiences sexuality and intimacy, the effects from gender dysphoria in these relational domains, and how dysphoria is managed. For this purpose, 99 partners of TGNB individuals were recruited for an online study. Participants were asked to answer the following open-ended questions: "In the intimacy and sexuality with your partner, are there any parts of your or your partner's body that are/were off-limits?" "How did you manage this before, during, and after transition?" The data were analyzed through thematic analysis, and four overarching themes emerged: 1) Positive Aspects of the Relationship; (2) Challenges; (3) Strategies to Manage Dysphoria; and (4) Expected Improvement through Access to Medical Affirmation. The results suggest that gender dysphoria is one of the main challenges in experiencing intimacy and sexuality, but TGNB individuals and their partners can rely on several relational and practical resources to navigate it and enjoy positive experiences with intimacy and sexuality. The findings provide valuable information about how TGNB individuals and their partners build healthy and fulfilling relationships, and they can help clinicians better understand both members' perspectives in these romantic couples in the context of couples' therapy and sexual counseling.
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Affiliation(s)
- Laura Siboni
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Daniele Rucco
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Antonio Prunas
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Annalisa Anzani
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
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17
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Sexual habits among Italian transgender adolescents: a cross-sectional study. Int J Impot Res 2021; 33:687-693. [PMID: 33727693 DOI: 10.1038/s41443-021-00427-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 11/08/2022]
Abstract
Recent studies showed that transgender (TGN) adolescents are more at risk of negative sexual outcomes than their peers. However, little is known about the psychopathological and sociodemographic correlates of sexual-related experiences in TGN adolescents. This cross-sectional study aimed at overcoming this limitation describing this association in a sample of 18 transgirls and 32 transboys recruited at the Gender Clinic of the University of Florence between 2015 and 2020. Clinical, sociodemographic, and sexual-related features were collected through a face-to-face interview and anamnestic forms. Self-report questionnaires were administered to evaluate gender dysphoria (Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults), emotional and behavioral problems (Youth Self Report), and body uneasiness (Body Uneasiness Test). The percentage of subjects reporting to have had at least one romantic relationship in life was 62.5% among transboys and 16.7% in transgirls (ORsex = 8.65, p < 0.01), whereas 28.1% of transboys and 5.6% of transgirls were sexually active (ORsex = 6.63, p > 0.05). A worse psychological functioning and risk-taking behaviors were associated with being sexually active (p < 0.05). These results underline the deep interconnection between psychological vulnerability and sexual-related features in TGN adolescents, confirming the importance of developing gender inclusive sex education programs to prevent negative sexual outcomes in this population.
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18
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Araya AC, Warwick R, Shumer D, Selkie E. Romantic Relationships in Transgender Adolescents: A Qualitative Study. Pediatrics 2021; 147:peds.2020-007906. [PMID: 33468600 DOI: 10.1542/peds.2020-007906] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Identity formation and exploration of interpersonal relationships are important tasks that occur during adolescence. Transgender, gender diverse, and gender-nonconforming (TGNC) individuals must face these developmental milestones in the context of their transgender identity. Our aim with this article is to describe adolescents' history and experiences with romantic partners. METHODS We conducted phenomenological, qualitative semistructured interviews with transgender adolescents. Questions were focused on romantic experiences, thoughts, and perceptions. All interviews were coded by 2 members of the research team, with disagreements resolved by discussion and, if needed, with a third member of the research team. Thematic analysis was used to analyze the data, as well as descriptive categorization. RESULTS In total, 30 adolescents (18 transmasculine and 12 transfeminine) between the ages of 15 and 20 years were interviewed. Themes included (1) engagement in romantic relationships, (2) disclosure of gender identity and romantic relationships, (3) experience with abusive relationships, and (4) perceived impact of gender-affirming hormone care on romantic experiences. CONCLUSIONS TGNC adolescents are engaged in romantic experiences before and during social and/or medical transitioning and are cultivating relationships through both proximal peers and online connections. There is perceived benefit of gender-affirming hormone care on romantic experiences. Risk of transphobia in romantic relationships impacts the approach that transgender adolescents take toward romance and influences decisions of identity disclosure. TGNC adolescents have experience with relationship abuse in different forms. Providers can incorporate these findings in their approach to counseling and screening when caring for TGNC youth.
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Affiliation(s)
| | - Rebecca Warwick
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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19
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Lindley L, Anzani A, Prunas A, Galupo MP. Sexual Satisfaction in Trans Masculine and Nonbinary Individuals: A Qualitative Investigation. JOURNAL OF SEX RESEARCH 2021; 58:222-234. [PMID: 32787679 DOI: 10.1080/00224499.2020.1799317] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The present study investigated the ways trans masculine and nonbinary individuals describe aspects of their sexual satisfaction. Sexual satisfaction refers to an individual's subjective evaluation of their sexual experiences, and is influenced by relational, contextual, and personal experiences. Prior research with sexual satisfaction among trans individuals utilized quantitative measures, restricting the ability for respondents to describe trans-related aspects. Further, the pervasive focus on the effects of medical transition on binary trans individuals' experiences in prior research limits our understanding of those who do not desire a medical transition or live outside of the gender binary. Participants represented a community sample of 358 trans masculine and nonbinary individuals who responded to the question: "In what ways are you satisfied with your sex life?" Thematic analysis revealed eight overarching themes that represented two categories: universal and trans-related. Discussion focuses on the ways in which clinicians and researchers can utilize the current findings to improve the sexual satisfaction of trans masculine and nonbinary individuals.
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Affiliation(s)
- Louis Lindley
- Department of Counseling Psychology, University of Wisconsin-Madison , Madison, MI, USA
| | - Annalisa Anzani
- Department of Psychology, University of Milano , Bicocca, Italy
| | - Antonio Prunas
- Department of Psychology, University of Milano , Bicocca, Italy
| | - M Paz Galupo
- Department of Psychology, Towson University , Towson, MD, USA
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20
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Anzani A, Lindley L, Prunas A, Galupo P. " I Use All the Parts I'm Given": A Qualitative Investigation of Trans Masculine and Nonbinary Individuals' Use of Body during Sex. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2020; 33:58-75. [PMID: 38596469 PMCID: PMC10807806 DOI: 10.1080/19317611.2020.1853300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 04/11/2024]
Abstract
Objectives: The study investigates how trans masculine and nonbinary individuals describe the use of their bodies during sexual activities. Methods: Three hundred and sixty-one trans masculine and nonbinary individuals were asked to describe their use of body during sex through an online survey. Data were analyzed through thematic analysis. Results: Eleven subthemes emerged that were organized in 4 overarching themes: Relational Factors; Behavioral Factors; Sexual Roles; and Transgender Related Factors. Some differences emerged between trans masculine and nonbinary participants. Conclusions: Although some of our participants described a lack of sexual activity, our participants overall described a wide range of activities.
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Affiliation(s)
- Annalisa Anzani
- Department of Psychology, University of Milano – Bicocca, Milano, Italy
| | - Louis Lindley
- Department of Psychology, Towson University, Towson, Maryland, USA
| | - Antonio Prunas
- Department of Psychology, University of Milano – Bicocca, Milano, Italy
| | - Paz Galupo
- Department of Psychology, Towson University, Towson, Maryland, USA
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21
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Heino E, Fröjd S, Marttunen M, Kaltiala R. Normative and negative sexual experiences of transgender identifying adolescents in the community. Scand J Child Adolesc Psychiatr Psychol 2020; 8:166-175. [PMID: 33564633 PMCID: PMC7866780 DOI: 10.21307/sjcapp-2020-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Sexuality is a major facet of development during adolescence. Apace with normal sexual development, sexual experiences become more common and intimate. Recent research reports mixed results as to whether this is the case among transgender identifying adolescents. Recent research also suggests that trans youth experience negative sexual experiences (such as dating violence and sexual harassment) more often than their cisgender identifying peers. However, most studies have had clinical or selected samples. OBJECTIVE The aim of this study is to compare the normative as well as negative sexual experiences of trans youth with their cisgender peers in the general population. METHOD Our study included 1386 pupils of the ninth year of comprehensive school in Finland, mean age (SD) 15.59 (0.41) years. We compared sexual experiences, sexual harassment and dating violence among trans youth and their cisgender identifying peers. Distributions of the outcome variables were calculated among the whole sample and by sex. Next, multivariate associations were studied using logistic regression adjusting for age, sex, honesty of responding and depression. Odds Ratios (OR) with 95% confidence intervals (CI) are given. RESULTS After adjusting for age, sex, honesty of responding and ultimately for depression, normative sexual experiences of trans youth did not differ systematically from those of the mainstream, cisgender identifying youth. After adjusting for sex, age and honesty, transgender youth had increased Odds Ratios for experiences of sexual coercion and dating violence perpetration. In the final models however, no statistically significant differences were detected in the negative sexual experiences between transgender and cisgender youth. CONCLUSIONS Transgender identifying adolescents presented neither with delayed nor with excessively advanced sexual experiences. However, transgender youth seem to be more susceptible to subjection to sexual coercion and, unexpectedly, dating violence perpetration than their cisgender peers. However, these associations may in fact relate more closely to depression, a prevalent phenomenon among trans youth, than transgender identity itself.
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Affiliation(s)
- Elias Heino
- University of Tampere, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Sari Fröjd
- University of Tampere, Faculty of Social Sciences, Tampere, Finland
| | - Mauri Marttunen
- University of Helsinki and Helsinki University Hospital, Adolescent Psychiatry, Helsinki, Finland
| | - Riittakerttu Kaltiala
- University of Tampere, Faculty of Medicine and Health Technology, Tampere, Finland
- Tampere University Hospital, Department of Adolescent Psychiatry, Tampere, Finland
- anha Vaasa Hospital, Vaasa, Finland
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22
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Brik T, Vrouenraets LJJJ, de Vries MC, Hannema SE. Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2611-2618. [PMID: 32152785 PMCID: PMC7497424 DOI: 10.1007/s10508-020-01660-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 05/12/2023]
Abstract
Gonadotropin-releasing hormone analogues (GnRHa) are recommended as initial treatment for adolescents diagnosed with gender dysphoria, providing time to follow gender identity development and consider further treatment wishes without distress caused by unwanted pubertal changes. This has been described as an extended diagnostic phase. However, there are also concerns about the physical, neurocognitive, and psychosocial effects of this treatment. In this retrospective study, we document trajectories after the initiation of GnRHa and explore reasons for extended use and discontinuation of GnRHa. Treatment was considered appropriate in 143 (67%) of the 214 adolescents eligible for GnRHa treatment by virtue of their age/pubertal status, and all started GnRHa (38 transgirls, 105 transboys; median age, 15.0 years [range, 11.1-18.6] and 16.1 years [range, 10.1-17.9]). After a median duration of 0.8 years (0.3-3.8) on GnRHa, 125 (87%) started gender-affirming hormones (GAH). Nine (6%) discontinued GnRHa, five of whom no longer wished gender-affirming treatment. Thirteen had used GnRHa for longer than required by protocol for reasons other than logistics and regularly met with a mental health professional during this time, supporting the use of GnRHa treatment as an extended diagnostic phase. In conclusion, the vast majority who started GnRHa proceeded to GAH, possibly due to eligibility criteria that select those highly likely to pursue further gender-affirming treatment. Due to the observational character of the study, it is not possible to say if GnRHa treatment itself influenced the outcome. Few individuals discontinued GnRHa, and only 3.5% no longer wished gender-affirming treatment.
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Affiliation(s)
- Tessa Brik
- Department of Pediatrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Lieke J J J Vrouenraets
- Department of Pediatric and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine C de Vries
- Department of Pediatrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sabine E Hannema
- Department of Pediatrics, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of Paediatric Endocrinology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands.
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23
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Marshall E, Glazebrook C, Robbins-Cherry S, Nicholson S, Thorne N, Arcelus J. The quality and satisfaction of romantic relationships in transgender people: A systematic review of the literature. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:373-390. [PMID: 34993516 PMCID: PMC8726697 DOI: 10.1080/26895269.2020.1765446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Romantic relationships are often a significant area of individuals' lives and can have a positive impact on wellbeing. There is often a belief within society of romantic relationships ending upon the start of gender affirming transition, however this is often not reflected within clinical work or research studies. Despite this, currently not enough is known about romantic relationships for transgender individuals and their partners, and the impact gender affirming transition can have on the quality and satisfaction of these relationships. AIM To critically and systematically review the available literature examining quality and satisfaction of romantic relationships for transgender individuals and their partners. METHODS Using PRISMA guidelines, major databases (Pubmed, PsycINFO and Web of Science) and relevant reference lists were searched for suitable articles up to January 2020. Each included article was assessed for methodological quality and the demographic data, methods and findings linked to relationship quality and satisfaction was extracted for analysis. RESULTS From 151 potentially relevant articles, 14 studies (six quantitative, eight qualitative) were included within the review. Most studies displayed moderate risk of bias due to cross-sectional designs and lack of reflexivity. Findings from quantitative studies suggest a bi-directional relationship between transition, relationship quality and satisfaction and wellbeing. Qualitative studies suggest transition can cause personal challenges for both transgender individuals and partners. Maintenance activities help buffer the impact of these challenges on relationship satisfaction and ensure positives are possible from relationships. DISCUSSION Gender affirming transition can impact on the quality and satisfaction of romantic relationships. Due to additional challenges transgender individuals and their partners may face, adequate support is required at personal, community and clinical level. There is a paucity of research in this area and current studies lack methodological rigor. Future research is essential to gain a further understanding of transgender relationships and the support required.
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Affiliation(s)
- Ellen Marshall
- Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Cris Glazebrook
- Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sally Robbins-Cherry
- Nottingham Centre for Transgender Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Nat Thorne
- Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham Centre for Transgender Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
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24
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Baetens L, Dhondt K. Psychosocial challenges and hormonal treatment in gender diverse children and adolescents. A narrative review. Int J Impot Res 2020; 33:217-227. [PMID: 32366985 DOI: 10.1038/s41443-020-0291-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
Gender dysphoria (GD) in children and adolescents is a condition that is characterized by an incongruence between the assigned and experienced gender. Despite the diversity in clinical presentation, literature demonstrates that GD might lead to poor mental health and high rates of co-occurring psychopathology. Due to the overlap of physical aspects as well as psychological needs in these children, a multidisciplinary approach is highly desirable. The aim of this narrative review is to give an overview of recent literature on several topics relevant in this domain. Guidelines on psychological counseling and hormonal treatment are given and challenging topics subject to controversy are explained. Furthermore, attention is drawn to the risks and protective factors in psychological functioning, including the growing evidence of a frequent co-occurrence with Autism Spectrum Disorder. Finally the psycho-sexual development in these children, the impact on fertility and fertility preservation are discussed.
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Affiliation(s)
- Laura Baetens
- General Psychiatry Department, Sint-Lucas, Bruges, Belgium, Ghent University, Ghent, Belgium
| | - Karlien Dhondt
- Dept Child & Adolescent psychiatry, Center for Gender and Sexuology, Pediatric Gender Clinic, Ghent University Hospital, Ghent, Belgium.
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Kaltiala R, Heino E, Työläjärvi M, Suomalainen L. Adolescent development and psychosocial functioning after starting cross-sex hormones for gender dysphoria. Nord J Psychiatry 2020; 74:213-219. [PMID: 31762394 DOI: 10.1080/08039488.2019.1691260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To assess how adolescent development progresses and psychiatric symptoms develop among transsexual adolescents after starting cross-sex hormone treatment.Materials and methods: Retrospective chart review among 52 adolescents who came into gender identity assessment before age 18, were diagnosed with transsexualism and started hormonal gender reassignment. The subjects were followed over the so-called real-life phase of gender reassignment.Results: Those who did well in terms of psychiatric symptoms and functioning before cross-sex hormones mainly did well during real-life. Those who had psychiatric treatment needs or problems in school, peer relationships and managing everyday matters outside of home continued to have problems during real-life.Conclusion: Medical gender reassignment is not enough to improve functioning and relieve psychiatric comorbidities among adolescents with gender dysphoria. Appropriate interventions are warranted for psychiatric comorbidities and problems in adolescent development.
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Affiliation(s)
- Riittakerttu Kaltiala
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Vanha Vaasa Hospital, Vaasa, Finland
| | - Elias Heino
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marja Työläjärvi
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Laura Suomalainen
- Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
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T'Sjoen G, Arcelus J, De Vries ALC, Fisher AD, Nieder TO, Özer M, Motmans J. European Society for Sexual Medicine Position Statement "Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction". J Sex Med 2020; 17:570-584. [PMID: 32111534 DOI: 10.1016/j.jsxm.2020.01.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a general lack of recommendations for and basic information tailored at sexologists and other health-care professionals for when they encounter trans people in their practice. AIM We present to clinicians an up-to-date overview of clinical consensus statements on trans health care with attention for sexual function and satisfaction. METHODS The task force consisted of 7 clinicians experienced in trans health care, selected among European Society for Sexual Medicine (ESSM) scientific committee. The consensus was guided by clinical experience and a review of the available literature and by interactive discussions on trans health, with attention for sexual function and satisfaction where available. OUTCOMES The foci of the study are assessment and hormonal aspects of trans health care. RESULTS As the available literature for direct recommendations was limited, most of the literature was used as background or indirect evidence. Clinical consensus statements were developed based on clinical experiences and the available literature. With the multiple barriers to care that many trans people experience, basic care principles still need to be stressed. We recommend that health-care professionals (HCPs) working with trans people recognize the diversity of genders, including male, female, and nonbinary individuals. In addition, HCPs assessing gender diverse children and adolescents should take a developmental approach that acknowledges the difference between prepubescent gender diverse children and pubescent gender diverse adolescents and trans adults. Furthermore, trans people seeking gender-affirming medical interventions should be assessed by HCPs with expertise in trans health care and gender-affirming psychological practice. If masculinization is desired, testosterone therapy with monitoring of serum sex steroid levels and signs of virilization is recommended. Similarly, if feminization is desired, we recommend estrogens and/or antiandrogen therapy with monitoring of serum sex steroid levels and signs of feminization. HCPs should be aware of the influence of hormonal therapy on sexual functioning and satisfaction. We recommend HCPs be aware of potential sexual problems during all surgical phases of treatment. CLINICAL IMPLICATIONS This is an up-to-date ESSM position statement. STRENGTHS & LIMITATIONS These statements are based on the data that are currently available; however, it is vital to recognize that this is a rapidly changing field and that the literature, particularly in the field of sexual functioning and satisfaction, is limited. CONCLUSION This ESSM position statement provides relevant information and references to existing clinical guidelines with the aim of informing relevant HCPs on best practices when working with transgender people. T'Sjoen G, Arcelus J, De Vries ALC, et al. European Society for Sexual Medicine Position Statement "Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction". J Sex Med 2020;17:570-584.
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Affiliation(s)
- Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University and Ghent University Hospital, Gent, Belgium.
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Annelou L C De Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology, Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joz Motmans
- Transgender Infopunt, Ghent University Hospital, Ghent, Belgium
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Macdonald DW, Grossoehme DH, Mazzola A, Pestian T, Schwartz SB. Oral Sex Knowledge and Experience of Transgender Youth: An Opportunity for Dental Education. J Dent Educ 2020; 84:473-477. [PMID: 32314385 DOI: 10.21815/jde.019.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/06/2019] [Indexed: 01/07/2023]
Abstract
Recent evidence suggests that, when compared to their cisgender counterparts, transgender youth exhibit more unsafe sexual behavior that may elevate their risk for sexually transmitted infections. The aim of this study was to better understand what transgender youth know about oral sex, related consequences, and mechanisms of protection and where they obtained this information. The findings can be helpful in preparing oral health providers to play a role in meeting this public health need. The study took place at a U.S. academic pediatric medical center in 2017. Participants were recruited at a Transgender Research Day and during Transgender Clinic sessions. English-speaking transgender adolescents ages 14 to 24 were invited to participate in a previously validated survey about their knowledge and behaviors related to oral sex. Of the 138 transgender youth invited to participate, 57 completed the surveys, for a 41% response rate. Most respondents reported feeling they understood the necessity of protection and consequences of oral sex but did not use protection. Over half of the participants (58%) said they had not had a physician, dentist, or parent speak to them about oral sex. Given the lack of standardized, evidence-based sex education, it is imperative that adolescents, particularly in highly vulnerable populations like transgender youth, receive accurate information about oral sexual contact. Dental schools should prepare future practitioners to address these issues with youth using a culturally competent, evidence-based approach.
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28
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Staples JM, Bird ER, Gregg JJ, George W. Improving the Gender-Affirmation Process for Transgender and Gender-Nonconforming Individuals: Associations Among Time Since Transition Began, Body Satisfaction, and Sexual Distress. JOURNAL OF SEX RESEARCH 2020; 57:375-383. [PMID: 31140876 DOI: 10.1080/00224499.2019.1617829] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Sexual distress is associated with a variety of negative outcomes. Unique contributors to sexual distress exist among transgender individuals. The current study examined the impacts of gender-affirming interventions (i.e., hormone therapy [HT], gender-affirmation surgery [GAS]) and body satisfaction on sexual distress among 317 transgender adults recruited nationally to participate in an anonymous online survey. As expected, individuals who had received HT and/or GAS reported better body satisfaction compared to those who wanted these interventions but had not yet received them. Sexual distress did not differ by transition status. As hypothesized, time since transition began was positively associated with body satisfaction, and there was an indirect relationship between time since transition began and sexual distress through body satisfaction. These results replicated findings in the extant literature suggesting that body satisfaction is improved by GAS. Furthermore, this was the first study of which we are aware to examine the role of time since transition began with respect to body satisfaction and the resulting impact on sexual distress. Results from this study may have clinical implications that could help improve the gender-affirmation experience for transgender individuals.
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29
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Beckmeyer JJ, Herbenick D, Fu TCJ, Dodge B, Fortenberry JD. Prevalence of Romantic Experiences and Competencies Among 14 to 17 Year Olds: Implications for the Primary Care Setting. Clin Pediatr (Phila) 2020; 59:116-126. [PMID: 31690094 DOI: 10.1177/0009922819885659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Using data from 600 adolescents (14-17 years old) from the 2015 National Survey of Sexual Health and Behavior, we examined the prevalence and demographic correlates of adolescents' romantic activities (ie, group dating, dyadic dating, and relationship involvement) and their confidence in avoiding unwanted romantic experiences. Overall, 55.8% of adolescents had engaged in at least one romantic activity. More adolescents reported having gone on dyadic (42.1%) and group (37.3%) dates than had been involved in romantic relationships (32.9%). Age and gender were the most consistent correlates of each romantic activity. Each type of romantic activity becomes more common as adolescents mature. Female adolescents were less likely to report romantic activities. Approximately 25.7% of adolescents were not confident that they could turn down unwanted dates, and 34.3% were not confident that they could end a relationship they no longer wanted to be in. Clinicians can draw on our results when discussing romantic development with their adolescent patients.
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Affiliation(s)
- Jonathon J Beckmeyer
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,Center for Sexual Heath Promotion, Bloomington, IN, USA
| | - Debby Herbenick
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,Center for Sexual Heath Promotion, Bloomington, IN, USA
| | - Tsung-Chieh Jane Fu
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,Center for Sexual Heath Promotion, Bloomington, IN, USA
| | - Brian Dodge
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.,Center for Sexual Heath Promotion, Bloomington, IN, USA
| | - J Dennis Fortenberry
- Center for Sexual Heath Promotion, Bloomington, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
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30
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Haley SG, Tordoff DM, Kantor AZ, Crouch JM, Ahrens KR. Sex Education for Transgender and Non-Binary Youth: Previous Experiences and Recommended Content. J Sex Med 2019; 16:1834-1848. [PMID: 31585806 DOI: 10.1016/j.jsxm.2019.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/16/2019] [Accepted: 08/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transgender and non-binary (TNB) youth face disparities in sexual health risks compared with cisgender peers. Comprehensive sex education programs have the potential to result in delayed sexual debut, increased condom and contraceptive use, and reduced sexual risk-taking; however, little research has explored the specific sex education needs of TNB youth. AIM To use insights from TNB youth, parents of TNB youth, and healthcare affiliates to understand deficits in sex education experienced by TNB youth, and to elicit recommended content for a comprehensive and trans-inclusive sex education curriculum. METHODS We conducted 21 in-depth interviews with non-minor TNB youth (n = 11) and with parents (n = 5) and healthcare affiliates (n = 5) of TNB youth recruited from Seattle Children's Gender Clinic and local TNB community listerv readerships. Data was analyzed using theoretical thematic analysis. OUTCOMES Participants described prior sex education experiences and content needs of TNB youth. RESULTS Participants described 5 key sources where TNB youth received sexual health information: school curricula, medical practitioners, peers, romantic partners, and online media. Inapplicability of school curricula and variable interactions with medical practitioners led youth to favor the latter sources. 8 content areas were recommended as important in sex education for TNB youth: puberty-related gender dysphoria, non-medical gender-affirming interventions, medical gender-affirming interventions, consent and relationships, sex and desire, sexually transmitted infection prevention, fertility and contraception, and healthcare access. CLINICAL IMPLICATIONS Dependence on potentially inaccurate sex education sources leaves TNB youth vulnerable to negative outcomes, including sexually transmitted infections, pregnancy, unsanitary/unsafe sex toy use, and shame about their body or sexual desires. STRENGTHS & LIMITATIONS Strengths included capturing perspectives of an underserved population using open-ended interview questions, which allowed topics of greatest importance to participants to arise organically. Limitations included a sample size of 21 participants, and racial and geographic homogeneity of youth and parent participants. Only 1 author identifies as TNB. One-on-one interview methods may have omitted participants who would otherwise have been willing to share their perspective in a more impersonal format. CONCLUSION This study demonstrates that TNB youth have unique sex education needs that are not well covered in most sexual health curricula. Recommended content for this population includes standard sex education topics that require trans-inclusive framing (eg, contraception), topics specific to TNB youth (eg, gender-affirming medical interventions), and topics absent from standard curricula that warrant universal teaching (eg, information on consent as it relates to sex acts aside from penile-vaginal sex). Haley SG, Tordoff DM, Kantor AZ, et al. Sex Education for Transgender and Non-Binary Youth: Previous Experiences and Recommended Content. J Sex Med 2019;16:1834-1848.
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Affiliation(s)
- Samantha G Haley
- University of Washington, School of Medicine, Department of Pediatrics, Seattle, WA, USA.
| | - Diana M Tordoff
- University of Washington, Department of Epidemiology, Seattle, WA, USA
| | - Alena Z Kantor
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Julia M Crouch
- Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA
| | - Kym R Ahrens
- University of Washington, School of Medicine, Department of Pediatrics, Seattle, WA, USA; Seattle Children's Research Institute, Center for Child Health, Behavior and Development, Seattle, WA, USA
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31
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The pathologization of trans-sexuality: Historical roots and implications for sex counselling with transgender clients. SEXOLOGIES 2019. [DOI: 10.1016/j.sexol.2019.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Zucker KJ. Epidemiology of gender dysphoria and transgender identity. Sex Health 2019; 14:404-411. [PMID: 28838353 DOI: 10.1071/sh17067] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/22/2017] [Indexed: 01/11/2023]
Abstract
This review provides an update on the epidemiology of gender dysphoria and transgender identity in children, adolescents and adults. Although the prevalence of gender dysphoria, as it is operationalised in the fifth edtion of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), remains a relatively 'rare' or 'uncommon' diagnosis, there is evidence that it has increased in the past couple of decades, perhaps reflected in the large increase in referral rates to specialised gender identity clinics. In childhood, the sex ratio continues to favour birth-assigned males, but in adolescents, there has been a recent inversion in the sex ratio from one favouring birth-assigned males to one favouring birth-assigned females. In both adolescents and adults, patterns of sexual orientation vary as a function of birth-assigned sex. Recent studies suggest that the prevalence of a self-reported transgender identity in children, adolescents and adults ranges from 0.5 to 1.3%, markedly higher than prevalence rates based on clinic-referred samples of adults. The stability of a self-reported transgender identity or a gender identity that departs from the traditional male-female binary among non-clinic-based populations remains unknown and requires further study.
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33
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Prunas A. La pathologisation de la sexualité des personnes trans : racines historiques et implications pour la consultation sexologique avec des clients transgenres. SEXOLOGIES 2019. [DOI: 10.1016/j.sexol.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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34
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Kaltiala-Heino R, Työläjärvi M, Lindberg N. Sexual experiences of clinically referred adolescents with features of gender dysphoria. Clin Child Psychol Psychiatry 2019; 24:365-378. [PMID: 30968725 DOI: 10.1177/1359104519827069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gender dysphoria in adolescence could be expected to be associated with delayed sexual development because of the distress related to the sexual characteristics of the body. However, identity challenges may also increase early and risk-taking sexual behaviours among adolescents with gender dysphoria. We studied sexual experiences among 101 adolescents, attending an adolescent gender identity service, desiring gender reassignment. Their experiences were compared to the sexual experiences of the same-aged population, evaluated in a large adolescent survey. A majority of adolescents with gender dysphoria had been in love or had a crush on somebody. Birth assigned females had experiences of romantic relationships twice as commonly as birth assigned males. Otherwise, there was no statistically significant difference in the adolescents' sexual experiences. About half of the subjects had experiences of kissing, and about 40% had intimate (genital) sexual experiences with a partner. Compared to the general adolescent population, adolescents with gender dysphoria were less experienced. Autism spectrum disorder was associated with more delayed sexual development.
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Affiliation(s)
- Riittakerttu Kaltiala-Heino
- 1 Department of Adolescent Psychiatry, Tampere University Hospital, Finland.,2 Vanha Vaasa Hospital, Finland.,3 Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Marja Työläjärvi
- 1 Department of Adolescent Psychiatry, Tampere University Hospital, Finland
| | - Nina Lindberg
- 4 Helsinki University and Helsinki University Hospital, Forensic Psychiatry, HUS, Finland
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35
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Khorashad BS, Roshan GM, Talaei A, Arezoomandan S, Sadr M. Views of individuals with gender dysphoria and disorders of sex development on sexism: An Iranian study. Int J Transgend 2018; 20:459-470. [PMID: 32999630 DOI: 10.1080/15532739.2018.1445573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Ambivalent sexist attitudes have been previously measured regarding several factors such as sex, race and religion. Aims: In this study, we evaluated the ambivalent sexism among Iranian individuals with gender dysphoria with or without disorders of sex development (DSD). Methods: Attitudes towards gender stereotypes were investigated using Ambivalent Sexism Inventory (ASI) among three groups of participants with varying psychosexual outcome. These groups were transpeople (N = 152, M = 25.44, SD = 6.52), people with DSD (N = 40, M = 21.2, SD = 2.24) and cisgender people (N = 195, M = 25.9, SD = 5.59). Results: Significant differences in both types of sexism, benevolent (F (2,383) = 134.217, p < .001) and hostile (F (2,383) = 93.765, p < .001), were found between transpeople, participants with DSD and controls. While scores of transpeople and people with DSD were not significantly different from each other (p = 0.191, Cohen's d = 0.38), both groups were significantly more sexist than controls on hostile sexism (p < 0.001, Cohen's d = 1.4 and 1.1). In benevolent sexism, there were significant differences between the scores of the trans, DSD and control groups, with individuals with DSD being most sexist followed by transgender people (p < 0.001) and controls showing the least degree of sexism (p < 0.001). Conclusion: Using the Gender Self-Socialization Model (GSSM), we propose that increased scores of ASI among individuals whose gender identity is incongruent with all or some of their physical features are attempts to attain gender typicality. This may lead to a higher degree of sexist beliefs than when all sex and gender characteristics are congruent.
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Affiliation(s)
- Behzad S Khorashad
- Transgender Studies Center, Psychiatry and Behavioral Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghasem M Roshan
- Transgender Studies Center, Psychiatry and Behavioral Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Talaei
- Transgender Studies Center, Psychiatry and Behavioral Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sanaz Arezoomandan
- Transgender Studies Center, Psychiatry and Behavioral Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Sadr
- Transgender Studies Center, Psychiatry and Behavioral Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
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36
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Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L. Gender dysphoria in adolescence: current perspectives. Adolesc Health Med Ther 2018; 9:31-41. [PMID: 29535563 PMCID: PMC5841333 DOI: 10.2147/ahmt.s135432] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Riittakerttu Kaltiala-Heino
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
| | - Hannah Bergman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marja Työläjärvi
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Louise Frisén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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