Psychosexual development, sexual functioning and sexual satisfaction in long-term childhood cancer survivors: DCCSS-LATER 2 sexuality substudy

OBJECTIVES

Childhood cancer may negatively impact childhood cancer survivors' (CCS) sexuality. However, this is an understudied research area. We aimed to describe the psychosexual development, sexual functioning and sexual satisfaction of CCS, and identify determinants for these outcomes. Secondarily, we compared the outcomes of a subsample of emerging adult CCS to the Dutch general population.

METHODS

From the Dutch Childhood Cancer Survivor Study LATER cohort (diagnosed 1963-2001), 1912 CCS (18-71 years, 50.8% male) completed questions on sexuality, psychosocial development, body perception, mental and physical health. Multivariable linear regressions were used to identify determinants. Sexuality of CCS age 18-24 (N = 243) was compared to same-aged references using binomial tests and t-tests.

RESULTS

One third of all CCS reported hindered sexuality due to childhood cancer, with insecure body the most often reported reason (44.8%). Older age at study, lower education, surviving central nervous system cancer, poorer mental health and negative body perception were identified as determinants for later sexual debut, worse sexual functioning and/or sexual satisfaction. CCS age 18-24 showed significantly less experience with kissing (p = 0.014), petting under clothes (p = 0.002), oral (p = 0.016) and anal sex (p = 0.032) when compared to references. No significant differences with references were found for sexual functioning and sexual satisfaction, neither among female CCS nor male CCS age 18-24.

CONCLUSIONS

Emerging adult CCS reported less experience with psychosexual development, but similar sexual functioning and sexual satisfaction compared to references. We identified determinants for sexuality, which could be integrated in clinical interventions for CCS at risk for reduced sexuality.

Psychosexual Development and Sexual Functioning in Young Adult Survivors of Childhood Cancer

BACKGROUND

Childhood cancer and its treatment can impair survivors' development throughout life, particularly psychosexual development, which can be affected in complex ways and is crucial for survivors' well-being. Yet, research is scarce.

AIM

This study assessed psychosexual development (milestone attainment, age at attainment, perceived timing) in young adult survivors of childhood cancer. It further examined sexual satisfaction and sexual functioning, and whether survivors' perceived timing of sexual debut was related to satisfaction or functioning.

METHODS

A registry-based nationwide survey was completed by N = 492 German survivors of childhood cancer (age 21-26 years, 6-26 years postdiagnosis). They completed standardized measures of psychosexual milestones (eg, first kiss, sexual debut), sexual satisfaction, and sexual functioning. Psychosexual development was compared to normative data (N = 1,533).

OUTCOMES

Psychosexual development, sexual satisfaction, and sexual functioning were the primary outcome measures. Psychosexual development was characterized in three ways: milestone attainment (yes/no), age at attainment, perceived timing ("right" time, too early/late).

RESULTS

Milestone attainment was comparable to normative data, except for sexual debut: Survivors were less often experienced (82.5% vs 88%; P = .002) and older at sexual debut (17.4 vs 16.2 years; g = 0.55), but most survivors (58.3%) perceived their timing as "right." Survivors of brain tumors were least likely to have had their sexual debut, but if experienced age at sexual debut was similar to other survivors. Female survivors were somewhat more experienced than males (eg, first kiss, first relationship; <10% difference), but they were somewhat older when they first kissed (g = 0.26). Age at diagnosis was unrelated to milestone attainment. Perceived early/late sexual debut was related to lower satisfaction in female survivors (P = .026), but unrelated to sexual dysfunction. Instead, partnered men reported particularly low dysfunction whereas women reported similar levels of sexual dysfunction irrespective of their relationship status (P = .049). Overall, sexual functioning was favorable (60.2%: not/barely problematic).

CLINICAL IMPLICATIONS

Most survivors reported favorable sexual satisfaction and functioning, but a minority of survivors may need supportive services.

STRENGTHS & LIMITATIONS

This project represents one of few large-scale studies on psychosexual development in childhood cancer survivors relative to normative data, and is the first to link development to sexual satisfaction/functioning. Assessing satisfaction/functioning with validated, but brief measures limits detailed insights, but was inclusive of any sexual orientation. Medical background information based on registry data was limited.

CONCLUSION

Results showed normative psychosexual development (except for sexual debut) in most survivors. A self-determined attitude toward sexuality (ie, engaging in sexual activities at the "right" time) may generally determine positive sexual experiences.

[The role of socialisation in psychosexual development]

INTRODUCTION

In the recent research and interpretation of the genetical-biological and environmental-social factors shaping psychosexual development, in addition to scientific arguments, more and more ideological and political aspect have received unfortunate emphasis.

OBJECTIVE

Since the literature investigating the development of gender identity and gender orientation has not only increased, but also polarized, it is timely to look at the scientific exchange of ideas and debates among the differing positions.

METHOD

Exploring the significance of genetic, biological and social factors involved in the development of gender identity and gender orientation based on international literature data.

RESULTS

Based on the current state of science it can be concluded that, in addition to the indisputably marked genetic-biological factors, education and social patterns, as well as the extremely complex environmental and media-related influence with its variable intensity and diverse emotional content also play a significant role in the psychosexual development. This is supported, among other observations, by the data indicating that homoerotic behavior is more common in people raised by same-sex couples.

CONCLUSION

As psychosexual development is determined jointly by both genetic-biological and social factors (like education, media etc), belonging to a sexual minority group is not a choice, not the result of a personal decision. Therefore, any kind of discrimination in this regard is unacceptable. Further scientific studies are necessary to answer a large number of questions that still remain open.

Sexuality in Adults with Differences/Disorders of Sex Development (DSD): Findings from the dsd-LIFE Study

For various reasons, sexuality of individuals with differences/disorders of sex development (DSD) may be affected. The aim of the study was to describe sexual activity, satisfaction with sex life, satisfaction with genital function, and sexual problems in people with different DSD conditions. Data were collected from 1,040 participants in Europe. Many people with a variety of DSD conditions do not appear to be satisfied with their sex life, experience a variety of sexual problems, and are less sexually active than the general population; therefore sexuality should be explicitly addressed in the care of people with DSD.

Barriers between mothers and their adolescent daughters with regards to sexual and reproductive health communication in Taunggyi Township, Myanmar: What factors play important roles?

BACKGROUND

Parents play critical roles in adolescents' sexual and reproductive health (SRH) and discussions between parents and adolescents on this topic are fundamental in reducing adolescents' risky sexual behaviors. However, SRH communication is a challenging issue in Myanmar due to socio-cultural taboos. This study assessed the communication barriers towards SRH issues among mothers and their adolescent girls.

METHODS

A community-based, cross-sectional study was conducted from January to December 2017 in Taunggyi Township, Southern Shan State, Myanmar. In total, 112 pairs of mothers and adolescent daughters were recruited using a face-to-face interview method with semi-structured questionnaires. Logistic regression analysis was applied to examine communication barriers on SRH issues between mothers and their adolescent girls.

RESULTS

More than half of both mother and adolescent girls had negative perceptions of communication on SRH issues. Only 2.7% of girls discussed SRH issues with their mothers more than four times in the last six months. The factors found to create SRH communication barriers were higher family incomes (adjusted odd ration [AOR] 2.5, 95% confidence interval [CI] 1.0, 6.2), good knowledge of puberty (AOR 4.5, 95% CI 1.6, 12.5), good knowledge of sexual and reproductive health issues (AOR 4.5, 95% CI 1.8, 11.5), and positive perception of communication (AOR 6.7, 95% CI 2.5, 17.9) among mothers, and good knowledge of contraception (AOR 5.7, 95% CI 1.5, 21.4) and good knowledge of sexually transmitted infections (AOR 2.5, 95% CI 1.0, 6.4) among adolescent girls.

CONCLUSION

Mothers and adolescent girls communicated on SRHs was narrow, occurring infrequently and late, with only limited topics discussed. Having higher levels of SRH knowledge were more likely to create communication barriers among mother and adolescent girls. Policy makers need to consider targeted sexual and reproductive health education programs that can be implemented at the school and community levels to increase parent-adolescent communication.

Gender and Cortisone: Clinical Practice and Transatlantic Exchange in the Medical Management of Intersex in the 1950s

This article complicates the history of the standardization of intersex case management developed at the Johns Hopkins Hospital in the 1950s by focusing on clinical practices and logics and the transatlantic circulation of knowledge. Using patient records and published studies, I follow the exchanges between pediatric endocrinologists Lawson Wilkins (Pediatric Endocrinology Clinic, Baltimore) and Andrea Prader (University Children's Hospital, Zürich) on cortisone treatment for children with congenital adrenal hyperplasia (CAH), on psychosexuality and gender role, on choosing and changing the sex of intersex children, and on genital surgery. I argue that a focus on the transatlantic exchanges between these two clinics illuminates a more complex genealogy of modern intersex case management. It also provides insight into how physicians understood their clinical practice and sheds light on the messiness and pragmatic contingencies of what only in retrospect appears to have been a consistent treatment regime.

Father Hunger and Narcissistic Deformation

The author advances the hypothesis that paternal availability and the relationship between the mother and father are crucial components of evolving character structure in children. He proposes that a kind of narcissistic pathology featuring perverse sexuality may eventuate in the absence of paternal availability and in the presence of a disordered relationship between the parents. He also suggests that the ways in which aggression is or is not modulated and organized are crucial components of this evolving disorder, and that boys are more susceptible to its full manifestation and expression than are girls.

The Prevalence of Only-Child Status Among Children and Adolescents Referred to a Gender Identity Service Versus a Clinical Comparison Group

Several studies indicate that homosexual males have a high proportion of older brothers compared to heterosexual males. Natal males with gender dysphoria who are likely to be homosexual also display this sibship pattern. Until recently, there was little evidence linking homosexuality and/or gender dysphoria in females to unique sibship characteristics. Two studies have indicated that natal female youth clinically referred for gender dysphoria are more likely to be only children (Schagen, Delemarre-van de Waal, Blanchard, & Cohen-Kettenis, 2012; VanderLaan, Blanchard, Wood, & Zucker, 2014). However, these studies did not include control groups of youth clinically referred for other reasons. Thus, it is unclear whether the increased likelihood of only-child status is specific to gender-referred natal females. This study compared only-child status among youth referred to a mental health service for gender dysphoria (778 males, 245 females) versus other reasons (783 males, 281 females). Prehomosexual gender-referred males were less likely to be only children than clinical controls. Contrary to previous findings, gender-referred females were not more likely to be only children, indicating that increased likelihood of only-child status is not specific to gender-referred females, but is characteristic of clinic-referred females more generally.

Treating Youths in the Juvenile Justice System

Adolescents involved with the juvenile justice system have higher rates of risky sexual behaviors, resulting in high rates of sexually transmitted infections and increased risk of human immunodeficiency virus, early or complicated pregnancy, and parenting issues. Comorbid substance abuse, gang association, mental health issues, and history of having been abused as children result in further elevated rates. Girls and lesbian, gay, bisexual, and transgender youths represent growing subpopulations with special risks. Increasingly diverted to community-based alternatives, juvenile justice-involved teens obtain most of their medical care from community providers, who need to understand their risks to provide appropriate, optimal care.

Recalled Gendered Behavior in Childhood: A Comparison of Androphilic Men, Gynephilic Men, and Androphilic Women in Japan

The current study tested the hypothesis that men who are androphilic (sexually attracted to adult men) in a non-Western, developed country-Japan-would recall engaging in more female-typical behavior, and less male-typical behavior, in childhood, compared to men who are gynephilic (sexually attracted to adult women). Androphilic men, androphilic women, and gynephilic men (N = 302) responded to the Female-Typical Behavior Subscale and the Male-Typical Behavior Subscale of the Childhood Gender Identity Scale, which asked participants to recall their childhood behavior. Results indicated that gynephilic men scored highest on the Male-Typical Behavior Subscale and lowest on the Female-Typical Behavior Subscale. Androphilic women scored the highest on the Female-Typical Behavior Subscale and lowest on the Male-Typical Behavior Subscale. Androphilic men scored intermediately for both the Male- and Female-Typical Behavior Subscales. The results supported the hypothesis that Japanese androphilic men would recall greater gender-nonconforming childhood behavior compared to gynephilic men. These results further reinforce the conclusion that childhood gender-nonconforming behavior is a cross-culturally universal aspect of psychosexual life course development in androphilic men. We discuss why this may be the case, as well as why cross-cultural variation occurs in the magnitude with which recalled childhood gender nonconformity is reported by androphilic males.

Working with Nonheterosexual Youth to Understand Sexual Identity Development, At-Risk Behaviors, and Implications for Health Care Professionals

This article outlines special issues related to being a nonheterosexual youth. Information is presented on the sexual development of homosexual youth and their unique challenges. Included are data about the average age of initial awareness and self-identification of gay, lesbian, bisexual, transgendered, and questioning youth. The average age of awareness of homosexual orientation is between 10 or 11 years, while the average for identifying or self-labeling is ages 13–15. This age range is consistent across studies. The special issues related to a unique sexual development, prejudices associated with being a nonheterosexually oriented youth, typical behavioral outcomes of dealing with discrimination, and major health concerns for this at-risk population are identified. Finally, implications for health care professionals working with these adolescents are outlined.

A Qualitative Exploration of the "Coming Out" Process for Asexual Individuals

"Coming out" is an important process not only for identity formation in sexual minorities, but also for increasing access to romantic partners of similar identities (Vaughan & Waehler, 2010). It is unclear how asexuality and the variations within the asexual community are revealed and communicated in the coming out process. Some asexual individuals may find no practical value in coming out, as they do not seek romantic partnerships, while others pursue romantic relationships that are devoid of sexual activity. To date, virtually no psychological research has explored the "coming out" experience for those with an asexual identity. The current research analyzed the "coming out" narratives of 169 self-identified asexual individuals recruited from three online asexual communities using a phenomenological approach. Salient themes were extracted from narratives about the experience of developing an asexual identity. Themes included skepticism from family and friends, lack of acceptance and misunderstanding, non-disclosure of the asexual identity, relief upon discovering the asexual community, and the role of the internet in asexual identity discovery and expression. A theoretical model of asexual identity development is proposed based on these findings.

The Relation of Familiarity With Sexual Abusers to Subsequent Developmental Adaptation in Youths Who Have Sexually Offended

The present study explored the effects of child sexual abuse (CSA) on the adaptation of male juveniles who subsequently sexually offended (JSOs; n = 178; age, M = 16.05 years, SD = 0.27, range = 12-22). It examined multiple levels of interpersonal closeness between the perpetrators of sexual abuse and their JSO victims. JSOs who were sexually abused by older children or adults who cohabitated with them for at least 3 months reported higher levels of emotional dysregulation, callousness/manipulativeness, and sexualization than did both JSOs who were sexually abused by someone they had never lived with and JSOs who reported no experiences of sexual abuse. Implications of these findings are discussed.

Psychosexual Correlates of Sexual Double Standard Endorsement in Adolescent Sexuality

Endorsement and enactment of the (hetero)sexual double standard (SDS), prescribing sexual modesty for girls and sexual prowess for boys, has been shown to be negatively related to sexual and mental health. To be able to challenge the SDS, more insight is needed into the conditions that shape gendered sexual attitudes. A survey was conducted among 465 heterosexual adolescents (aged 16-20 years), examining the relationship between a number of relevant demographic and psychosexual variables and SDS endorsement. SDS endorsement was assessed using a newly developed instrument, the Scale for the Assessment of Sexual Standards Among Youth (SASSY). Gender (being male) and religiousness were significantly associated with increased SDS endorsement. For both boys and girls, increased feelings of entitlement to self-induced sexual pleasure (e.g., masturbation) were significantly associated with reduced SDS endorsement, whereas higher gender investment was significantly associated with increased SDS endorsement. Furthermore, increased feelings of entitlement to partner-induced sexual pleasure and more frequent talking about sexuality with peers were associated with increased SDS endorsement among boys but not among girls. We conclude that future research should explore peer influence processes through peer communication about sex, gender investment, and feelings of entitlement to both self and partner-induced sexual pleasure.

Increased Cross-Gender Identification Independent of Gender Role Behavior in Girls with Congenital Adrenal Hyperplasia: Results from a Standardized Assessment of 4- to 11-Year-Old Children

While reports showing a link between prenatal androgen exposure and human gender role behavior are consistent and the effects are robust, associations to gender identity or cross-gender identification are less clear. The aim of the current study was to investigate potential cross-gender identification in girls exposed prenatally to high concentrations of androgens due to classical congenital adrenal hyperplasia (CAH). Assessment included two standardized measures and a short parent interview assessing frequency of behavioral features of cross-gender identification as conceptualized in Part A of the diagnostic criteria for gender identity disorder (GID) in the DSM-IV-TR. Next, because existing measures may have conflated gender role behavior with gender identity and because the distinction is potentially informative, we factor analyzed items from the measures which included both gender identity and gender role items to establish the independence of the two constructs. Participants were 43 girls and 38 boys with CAH and 41 unaffected female and 31 unaffected male relatives, aged 4- to 11-years. Girls with CAH had more cross-gender responses than female controls on all three measures of cross-gender identification as well as on a composite measure of gender identity independent of gender role behavior. Furthermore, parent report indicated that 5/39 (12.8 %) of the girls with CAH exhibited cross-gender behavior in all five behavioral domains which comprise the cross-gender identification component of GID compared to 0/105 (0.0 %) of the children in the other three groups combined. These data suggest that girls exposed to high concentrations of androgens prenatally are more likely to show cross-gender identification than girls without CAH or boys with and without CAH. Our findings suggest that prenatal androgen exposure could play a role in gender identity development in healthy children, and may be relevant to gender assignment in cases of prenatal hormone disruption, including, in particular, cases of severely virilized 46, XX CAH.

Gender Development in Indonesian Children, Adolescents, and Adults with Disorders of Sex Development

In most Western countries, clinical management of disorders of sex development (DSD), including ambiguous genitalia, begins at diagnosis soon after birth. For many Indonesian patients born with ambiguous genitalia, limited medical treatment is available. Consequently, affected individuals are raised with ambiguous genitalia and atypical secondary sex characteristics. We investigated gender identity and gender role behavior in 118 Indonesian subjects (77 males, 41 females) with different types of DSD in comparison with 118 healthy controls matched for gender, age, and residential setting (rural, suburban, or urban). In Study 1, we report on methodological aspects of the investigation, including scale adaptation, pilot testing, and determining reliability and validity of measures. In Study 2, we report on gender development in 60 children (42 boys, 18 girls), 24 adolescents (15 boys, 9 girls), and 34 adults (19 men, 15 women) with DSD. The majority of participants with DSD never received any medical or surgical treatment prior to this study. We observed a gender change in all age groups, with the greatest incidence in adults. Among patients who changed, most changed from female to male, possessed a 46,XY karyotype, and had experienced significant masculinization during life. Gender identity confusion and cross-gender behavior was more frequently observed in children with DSD raised as girls compared to boys. Puberty and associated masculinization were related to gender problems in individuals with 46,XY DSD raised female. An integrated clinical and psychological follow-up on gender outcome is necessary prior to puberty and adulthood.

How children learn about sex: a cross-species and cross-cultural analysis

Scattered and not widely disseminated evidence from primatology, anthropology, and history of childhood sexuality support the hypothesis that throughout much of human behavioral evolution that human children have learned about sex through observing parental sexuality and then imitating it in sexual rehearsal play with peers. Contemporary theories of psychosexual development have not considered the possibility that young children are predisposed to learn about sex through observational learning and sexual rehearsal play during early childhood, a primate-wide trait that is conserved in humans but suppressed in contemporary contexts.

Patterns and trends in sources of information about sex among young people in Britain: evidence from three National Surveys of Sexual Attitudes and Lifestyles

OBJECTIVE

To assess progress in meeting young people's sex education needs in Britain by examining the current situation and changes over the past 20 years in sources of information about sexual matters and unmet information needs.

DESIGN

Cross-sectional probability sample surveys.

SETTING

British general population.

PARTICIPANTS

3869 men and women aged 16-24 years, interviewed 2010-2012 for the third National Survey of Sexual Attitudes & Lifestyles (Natsal-3), compared with 16-24 year-olds in Natsal-1 (1990-1991; 792 men and women) and Natsal-2 (1999-2001; 2673 men and women).

MAIN OUTCOME MEASURES

Reported source of information about sexual matters, unmet information needs and preferred source of additional information.

RESULTS

Between 1990 and 2012, the proportion citing school lessons as their main source of information about sexual matters increased from 28.2% (95% CI 24.6 to 32.1) to 40.3% (95% CI 38.6 to 42.1). In 2010-2012, parents were reported as a main source by only 7.1% (95% CI 5.8 to 8.7) of men and 14.1% (95% CI 12.6 to 15.7) of women and, for women, were less commonly reported than in 1999-2001 (21.7%; 95% CI 19.6 to 24.0). Most young people reported not knowing enough when they first felt ready for sexual experience (68.1% men, 70.6% women), and this did not change substantially over time. They wanted more information about psychosexual matters (41.6% men, 46.8% women), as well as sexually transmitted infections (27.8% men, 29.8% women) and, for women, contraception (27.5%). Young people primarily wanted this information from school, parents or health professionals.

CONCLUSIONS

Over the past 20 years, young people have increasingly identified school lessons as their main source of information about sex, although they continue to report needing more information on a broad range of topics. The findings support the expressed need for improved sex and relationships education in schools alongside greater involvement of parents and health professionals.

Eyes, ears, lips, fingertips, secrets: Dora, psychoanalysis, and the body

The topic of secrets will be expanded here to apply to complex secrets of the body, sex, and gender kept by both patients and analysts. Their detection is made harder by our field's current lack of interest in them compared to Freud's curiosity. We tend to ignore body narratives these days, with both men and women, keeping secret from ourselves daily challenges to theory that do indeed exist. Dora's case will be used to examine her own, her father's, and Freud's expectations of what constitutes a sexed and gendered portrait of grown-up males and females, and how they behave together. Contemporary embodied questions will emerge in discussion of Dora and her mother(s), the men in the story, and some male case vignettes. Ordinary secrets, hidden in broad daylight in both 1905 and in 2014, will be "revealed."

Gender assignment in patients with disorder of sex development

PURPOSE OF REVIEW

To examine the sex assignment in patients with atypical external genitalia, a particularly challenging situation, especially when the genital appearance is not compatible with the sex chromosome.

RECENT FINDINGS

The most important factors that influence sex assignment include the definite diagnosis, genital appearance, surgical options, potential for fertility, risks of gonadal malignancy and, finally, the perception of the patients and their parents. Full disclosure and complete involvement of the parents in making decisions concerning gender assignment and/or genital surgery must be part of the basic medical care for children with disorder of sex development.

SUMMARY

Patients with disorder of sex development should receive long-term care provided by multidisciplinary teams in centers of excellence with ample experience in the management of this disorder.

Place and sexual partnership transition among young American Indian and Alaska native women

Multiple challenges expose American Indian and Alaska Native (AIAN) women to high-risk sexual partnerships and increased risk for HIV/STI. Using a unique sample of sexually-active young AIAN women (n = 129), we examined characteristics of last three partners and whether transitional partnerships were associated with different risk profiles, including where partners met, lived, and had sex. Respondents were more likely to have met their previous or current secondary partner (P2) at a friend's or family setting (versus work or social setting) (AOR = 3.92; 95 % CI 1.31, 11.70). Condom use was less likely when meeting a partner at friend's or family settings (AOR = 0.17; 95 % CI 0.05, 0.59). Sexual intercourse with P2 (compared to P1) usually took place in "riskier" settings such as a car, bar, or outside (AOR = 4.15; 95 % CI 1.59, 10.68). Perceived "safe" places, e.g., friend's or family's house, were identified with risky behaviors; thus, homogeneous messaging campaigns may promote a false sense of safety.

LGB-parent families: the current state of the research and directions for the future

Over the past several decades, lesbian, gay, and bisexual (LGB) parenting has grown more visible. Alongside this enhanced visibility, research on the experiences of LGB parents and their children has proliferated. The current chapter addresses this research, focusing on several main content areas: family building by LGB people, the transition to parenthood for LGB parents, and functioning and experiences of LGB parents and their children. In the context of discussing what we know about LGB-parent families, we highlight gaps in our knowledge and point to key areas that future research should aim to answer, including how race, ethnicity, social class, and geographic factors shape the experiences of LGB-parent families.

Biological markers of asexuality: Handedness, birth order, and finger length ratios in self-identified asexual men and women

Human asexuality is defined as a lack of sexual attraction to anyone or anything and it has been suggested that it may be best conceptualized as a sexual orientation. Non-right-handedness, fraternal birth order, and finger length ratio (2D:4D) are early neurodevelopmental markers associated with sexual orientation. We conducted an Internet study investigating the relationship between self-identification as asexual, handedness, number of older siblings, and self-measured finger-lengths in comparison to individuals of other sexual orientation groups. A total of 325 asexuals (60 men and 265 women; M age, 24.8 years), 690 heterosexuals (190 men and 500 women; M age, 23.5 years), and 268 non-heterosexuals (homosexual and bisexual; 64 men and 204 women; M age, 29.0 years) completed online questionnaires. Asexual men and women were 2.4 and 2.5 times, respectively, more likely to be non-right-handed than their heterosexual counterparts and there were significant differences between sexual orientation groups in number of older brothers and older sisters, and this depended on handedness. Asexual and non-heterosexual men were more likely to be later-born than heterosexual men, and asexual women were more likely to be earlier-born than non-heterosexual women. We found no significant differences between sexual orientation groups on measurements of 2D:4D ratio. This is one of the first studies to test and provide preliminary empirical support for an underlying neurodevelopmental basis to account for the lack of sexual attraction characteristic of asexuality.

Sexual differentiation of childhood play: a contemporary psychoanalytic perspective

Freud (1905/1953) anchored his theories of unconscious psychological functioning in observations and inferences about childhood sexuality. These ideas remain influential among psychoanalysts today. Much progress subsequently occurred in extra-psychoanalytic research in human sexuality. This included the discovery in 1959 of an entirely new area of psychology: the sexual differentiation of behavior (Phoenix, Goy, Gerall, & Young, 1959; Wallen, 2009). The observations that led to this new field originally concerned the effects of androgen administered prenatally to non-human animals. This early research was compatible with later studies of humans as well. Prenatal androgen influences both erotic and non-erotic behavior, including childhood rough-and-tumble play (RTP). We have previously emphasized the need to integrate this psychoneuroendocrine knowledge with psychoanalytic theory and practice (Friedman, 1988; Friedman & Downey, 2002, 2008a, 2008b). In this article, we discuss additional aspects of the relationship between sexually differentiated childhood play, particularly RTP, and gender differences in psychosexual development and functioning. These topics and other aspects of the sexual differentiation of behavior have been under-emphasized in psychoanalytic thought.

[The development of gender identity beyond rigid dichotomy]

The conflicts individuals with ambiguous sexual characteristics suffer from are not the result of genetic features but of the rigid and dichotomous gender order, which is currently undergoing a renaissance. This also applies to individuals with an uncertain gender identity. In the best interests of the child a concept of gender seems necessary, that goes beyond a binary separation and allows gender-specific intermediary stages in the personal development of identity. Such a gender concept can be developed following psychoanalytic theories. The present discourse contains a scale of connecting factors for a differentiated and less normative conceptualization of gender development. Starting from Freud's concept of constitutional bisexuality, Robert Stoller's theory, which has been firmly rooted in the mainstream of psychoanalysis for more than 40 years, will be critically reviewed. By involving Reimut Reiche's and Jean Laplanche's arguments, a continuative psychological gender theory will be drafted, which does not normatively and reductively claim the demarcation of gender, but rather opens up a space for gender diversity.

Sexual behavior of gender-dysphoric individuals before gender-confirming interventions: a European multicenter study

A transsexual course of development that starts before puberty (early onset) or during or after puberty, respectively (late onset), may lead to diverse challenges in coping with sexual activity. The authors explored the sexual behavior of 380 adult male-to-female and female-to-male individuals diagnosed according to DSM-IV-TR criteria who had not yet undergone gender-confirming interventions. Data originated from the European Network for the Investigation of Gender Incongruence Initiative, conducted in Belgium, Germany, The Netherlands, and Norway. Information on outcome variables was collected using self-administered questionnaires at first clinical presentation. Compared with late-onset male-to-females, early-onset individuals tended to show sexual attraction toward males more frequently (50.5%), involve genitals less frequently in partner-related sexual activity, and consider penile sensations and orgasm as more negative. Early-onset female-to-males predominantly reported sexual attraction toward females (84.0%), whereas those with a late-onset more frequently showed other sexual attractions (41.7%). The study (a) shows that early- and late-onset male-to-females differ considerably with regard to coping strategies involving their body during sexual relations and (b) reveals initial insights into developmental pathways of late-onset female-to-males.

[On the road to a new humanity: the reception of psychoanalysis in the early Kinderladen movement]

In the late 1960s a group of students in West Germany founded the so-called Kinderläden (day care centers) in order to experiment with new forms of early childhood education. Members of the early Kinderladen movement in particular pursued a radically utopian approach that, they hoped, would engender new human beings. With the aid of psychoanalytic writings, especially those of Wilhelm Reich, they sought to create subjects that would overcome repressive bourgeois norms and live out their sexuality freely. This reliance on Reich entailed a new interpretation of the "base", as psychoanalytic drive theory supplanted Marxist theory. As such, the early Kinderladen ac- tivists regarded the "basis" of society in biological, psychological, and pedagogic rather than economic terms.

[Psychoanalysis and the "Kinderladen" movement. A view on four projects]

Along with the reception of Critical Theory in the student movement of the 1960s, psychoanalytically influenced social criticism was spread by the SDS and the Argument-Club. This had prac tical consequences, especially for the development of antiauthoritarian education, often practiced by psychoanalytical autodidacts. The public outrage caused by antiauthoritarian education was overwhelming. Throughout the media excited reactions to "wild analysis" and "pedagogic experiments" were expressed. Conservative psychoanalysts, politicians and educationalists condemned each new approach to education and alleged oedipal acting-out and danger to the safety of the state and democracy. The emancipatory educational reform on the ground broke under the pressure of conservatism. Now is the time to draw a reasonable balance of the four year alliance between psychoanalysis and the student movement, especially as it seems that this alliance has not only a past but also a future.

[Gender dysphoria in children and adolescents]

Despite rising demand for treatment, far too few specialist services for gender dysphoric children and adolescents exist. Due to complex issues related to indication of physical treatment with lifelong consequences a thorough interdisciplinary treatment service with development-related evaluation is necessary. The aim of this paper is to outline the professional and social tension, in which the practitioner works, as well as to provide insight into the diversity of developmental trajectories and difficult decisions or dilemmas.

[Clinical treatment of children and adolescents with gender dysphoria from international experts' point of view]

The clinical treatment of children and adolescents with gender dysphoria is still a controversial issue. The aim of this study was to get an overview of the knowledge and experience of international experts and to highlight shared views as well as differences in theoretical convictions and treatment approaches. Half-structured, guide-line based interviews were carried out with international experts in the field. The interviews were analyzed using qualitative content analysis (Mayring, 2010).

Roman Catholic Clergy who have sexually abused children: their perceptions of their developmental experience

OBJECTIVES

There is a growing consensus in the research and theoretical literature that vulnerability to the perpetration of child sexual abuse appears to involve the offenders' early developmental experience. This study explored the perceptions of nine clerical child sex offenders in relation to their developmental experience.

METHODS

Nine participants were selected on the basis of being priests or brothers who had sexually abused children. Participants were identified from a larger group of clergy who were currently attending or had previously attended an institution that provides therapeutic intervention for sex offenders and aged between 38 and 75 years. Interpretative Phenomenological Analysis was used to identify common themes in the participants' accounts.

CONCLUSIONS

Many of these themes are reflected in the existing literature but what appears to distinguish the participants in the present study is their experience of an ideology within clerical training that prevented remediation and compounded earlier psychosocial and psychosexual difficulties.

Psychosexual outcomes in three siblings with partial androgen insensitivity syndrome: impact of nature versus nurture

There are few reports of adults with disorders of sexual development (DSD). Here we describe the clinical profile and results of psychological assessment of three siblings with 46, XY DSD caused by partial androgen insensitivity syndrome (PAIS). The elder sibling (aged 22 years) was reared as female, while the middle and youngest siblings (17 and 18 years of age), were reared as males. The gender identity was concordant with the sex of rearing. There was no gender dysphoria. The psychological distress that our patients experienced was due to the limitations placed on them by their medical condition. It did not permit them to experience various facets of being either male or female completely. The younger siblings reared as males had additional problems of gynecomastia and lack of male secondary sexual development.

Sexual attraction, sexual identity, and psychosocial wellbeing in a national sample of young women during emerging adulthood

Identity-based conceptualizations of sexual orientation may not account adequately for variation in young women's sexuality. Sexual minorities fare worse in psychosocial markers of wellbeing (i.e., depressive symptoms, anxiety, self esteem, social support) than heterosexual youth; however, it remains unclear whether these health disparities exclusively affect individuals who adopt a sexual minority identity or if they also may be present among heterosexually-identified youth who report same-sex attractions. We examined the relationship between sexual attraction, sexual identity, and psychosocial wellbeing in the female only subsample (weighted, n = 391) of a national sample of emerging adults (age 18-24). Women in this study rated on a scale from 1 (not at all) to 5 (extremely) their degree of sexual attraction to males and females, respectively. From these scores, women were divided into 4 groups (low female/low male attraction, low female/high male attraction, high female/low male attraction, or high female/high male attraction). We explored the relationship between experiences of attraction, reported sexual identity, and psychosocial outcomes using ordinary least squares regression. The results indicated sexual attraction to be predictive of women's psychosocial wellbeing as much as or more than sexual identity measures. We discuss these findings in terms of the diversity found in young women's sexuality, and how sexual minority status may be experienced by this group.

An ecological analysis of the effects of deviant peer clustering on sexual promiscuity, problem behavior, and childbearing from early adolescence to adulthood: an enhancement of the life history framework

The authors propose that peer relationships should be included in a life history perspective on adolescent problem behavior. Longitudinal analyses were used to examine deviant peer clustering as the mediating link between attenuated family ties, peer marginalization, and social disadvantage in early adolescence and sexual promiscuity in middle adolescence and childbearing by early adulthood. Specifically, 998 youths, along with their families, were assessed at age 11 years and periodically through age 24 years. Structural equation modeling revealed that the peer-enhanced life history model provided a good fit to the longitudinal data, with deviant peer clustering strongly predicting adolescent sexual promiscuity and other correlated problem behaviors. Sexual promiscuity, as expected, also strongly predicted the number of children by ages 22-24 years. Consistent with a life history perspective, family social disadvantage directly predicted deviant peer clustering and number of children in early adulthood, controlling for all other variables in the model. These data suggest that deviant peer clustering is a core dimension of a fast life history strategy, with strong links to sexual activity and childbearing. The implications of these findings are discussed with respect to the need to integrate an evolutionary-based model of self-organized peer groups in developmental and intervention science.

Update on disorders of sex development

PURPOSE OF REVIEW

To review the recent information regarding disorders of sex development (DSD) which contribute to, as well as highlight, the need for greater understanding of genetic mutations and the dire need for specific outcome information.

RECENT FINDINGS

New information is primarily related to the identification of genetic mutations and other gene variations that impact reproductive system development. These new data add to the increasingly complex list of genes and the multigenetic effects involved in DSD. Several reviews outline the approach to diagnosis and management of the patient with DSD and the importance of a multidisciplinary team. These reviews continue to demonstrate the lack of specific guidelines for complex DSD patients for whom sex assignment is problematic.

SUMMARY

Although genetic research continues to define new and multigenetic factors involved in the development of DSD, this review of the medical literature also underscores the fact that scientific understanding remains inadequate in many areas of DSD to provide solid guidelines for approaching the more controversial questions in the DSD patient. Accordingly, the need for larger, outcome studies using subjects with verified diagnoses are needed. Optimally, these studies would account for potentially confounding differences in genetic, social, and psychological factors to help answer the pressing question facing every clinician dealing with DSD patients - what is the relationship between medical decision-making (such as sex assignment and genital surgery) and future quality of life and adaptation.

Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism

This study provided a descriptive and quantitative comparative analysis of data from an assessment protocol for adolescents referred clinically for gender identity disorder (n = 192; 105 boys, 87 girls) or transvestic fetishism (n = 137, all boys). The protocol included information on demographics, behavior problems, and psychosexual measures. Gender identity disorder and transvestic fetishism youth had high rates of general behavior problems and poor peer relations. On the psychosexual measures, gender identity disorder patients had considerably greater cross-gender behavior and gender dysphoria than did transvestic fetishism youth and other control youth. Male gender identity disorder patients classified as having a nonhomosexual sexual orientation (in relation to birth sex) reported more indicators of transvestic fetishism than did male gender identity disorder patients classified as having a homosexual sexual orientation (in relation to birth sex). The percentage of transvestic fetishism youth and male gender identity disorder patients with a nonhomosexual sexual orientation self-reported similar degrees of behaviors pertaining to transvestic fetishism. Last, male and female gender identity disorder patients with a homosexual sexual orientation had more recalled cross-gender behavior during childhood and more concurrent cross-gender behavior and gender dysphoria than did patients with a nonhomosexual sexual orientation. The authors discuss the clinical utility of their assessment protocol.

Sexual attraction and trajectories of mental health and substance use during the transition from adolescence to adulthood

Previous research suggests that sexual minority youth have poorer health-related outcomes than their heterosexual peers. The purpose of this study is to determine whether sexual orientation disparities in mental health and substance use increase, decrease, or remain the same during the transition from adolescence to adulthood. Data are from Waves 1-4 of the National Longitudinal Study of Adolescent Health (n = 8,322; 55% female). Respondents were in grades 7-12 at Wave 1 and aged 24-32 at Wave 4. Latent growth curve modeling is used to compare the mental health and substance use trajectories of youth who consistently report heterosexual attraction versus those who consistently report lesbian, gay, or bisexual (LGB) attraction, those who report a transition to LGB attraction, and those who report a transition to heterosexual attraction. Among women and men, sexual orientation disparities in depressive symptoms and suicidal thoughts persist, but do not increase, during the transition from adolescence to adulthood. The same pattern is observed for disparities in smoking, heavy drinking, and marijuana use among women. Among men, disparities in substance use are only observed between those who report consistent heterosexual attraction and those who transition to heterosexual attraction. Disparities between these groups persist over time for heavy drinking and marijuana use but decrease over time for smoking. While this study finds evidence of numerous disparities in mental health and substance use outcomes during adolescence and young adulthood, particularly among young women, there is no indication that these disparities get larger over time.

A prospective study of young females' sexual subjectivity: associations with age, sexual behavior, and dating

Sexual self-perceptions are important aspects of sexuality, which can undergo significant change during adolescence and early adulthood. The purpose of this study was to describe these changes among girls (N = 251; ages 16-25) over one year, and to examine associations of sexual self-perceptions (sexual subjectivity) with age, sexual behavior, and romantic status. Sexual body-esteem, perceptions of entitlement to desire and pleasure, sexual efficacy, and sexual self-reflection were investigated as elements of sexual subjectivity. All sexual subjectivity elements were higher among girls who had more sexual experience and/or had steady romantic partners during the study. Perception of entitlement to desire and pleasure increased over time, whereas sexual body-esteem showed the most stability and had minimal associations with sexual or romantic experiences. The greatest increases in sexual subjectivity were found among girls who began the study with the least sociosexual experience and self-reflection also increased for girls who had first coitus after the start of the study. Overall, girls who had sexual intercourse the earliest (before age 16) had the highest sexual subjectivity, but sexual subjectivity increased the most among girls without coital experience or who had more recent first coitus.

The role of masturbation in healthy sexual development: perceptions of young adults

Despite efforts to identify masturbation as a strategy to improve sexual health, promote relational intimacy, and reduce unwanted pregnancy, STIs, and HIV transmission, masturbation as a context for healthy sexual development has been met with silence or trepidation in the scientific and educational communities. Relegated to the realm of commercial media, rather than rational discourse in families, schools, and the general public, young people receive mixed messages about this non-reproductive sexual behavior. In order to explore how young adults have learned about masturbation and currently perceive masturbation, we conducted a grounded theory study of 72 college students (56 females; 16 males) enrolled in a human sexuality class. Findings revealed that a young adult's perceptions of and feelings toward masturbation were the result of a developmental process that included: (1) learning about the act of masturbation and how to do it, (2) learning and internalizing the social contradiction of stigma and taboo surrounding this pleasurable act, and (3) coming to terms with this tension between stigma and pleasure. Although nearly all participants learned about masturbation through the media and peers (not parents or teachers), gender was salient in coming to terms with the contradiction of stigma and pleasure. Most of the women reported either still struggling with the contradiction or accepting it as normal. Most of the men recognized the beneficial aspects for healthy sexual development that result from masturbation. Both male and female participants identified differential sexual scripts as contributing to the double standard.

The use of sexually explicit internet material and its antecedents: a longitudinal comparison of adolescents and adults

An implicit assumption in research on adolescents' use of sexually explicit internet material (SEIM) is that they may feel more attracted to such material than adults, given the "forbidden" character of SEIM for minors. However, systematic comparisons between adolescents' and adults' SEIM use and of its antecedents are missing. We conducted a two-wave panel survey among a nationally representative sample of 1,445 Dutch adolescents and a nationally representative sample of 833 Dutch adults. Adolescents' and adults' SEIM use was similar. When significant differences in the SEIM use occurred, they indicated that adults used SEIM more often than adolescents. Male adults were the most frequent users of SEIM. No difference in the antecedent structure of SEIM use emerged between adolescents and adults. In both groups, males, sensation seekers, as well as people with a not exclusively heterosexual orientation used SEIM more often. Among adolescents and adults, lower life satisfaction increased SEIM use. Our findings suggest that the frequency of SEIM use and its antecedents are largely the same among adolescents and adults.

Associations between online pornography and sexual behavior among adolescents: myth or reality?

This study aimed to compare the sexual behavior of adolescents who were or were not exposed to online pornography, to assess to what extent the willingness of exposure changed these possible associations, and to determine the profiles of youths who were exposed to online pornography. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a self-administered cross-sectional, paper and pencil questionnaire. From the 7529 adolescents aged 16-20 years, 6054 (3283 males) used the Internet during the previous month and were eligible for our study. Males were divided into three groups (wanted exposure, 29.2%; unwanted exposure, 46.7%; no exposure, 24.1%) whereas females were divided into two groups (exposure, 35.9%; no exposure, 64.1%). The principal outcome measures were demographic characteristics, Internet use parameters and risky sexual behaviors. Risky sexual behaviors were not associated with online pornography exposure in any of the groups, except that males who were exposed (deliberately or not) had higher odds of not having used a condom at last intercourse. Bi/homosexual orientation and Internet use parameters were not associated either. Additionally, males in the wanted exposure group were more likely to be sensation-seekers. On the other hand, exposed girls were more likely to be students, higher sensation-seekers, early maturers, and to have a highly educated father. We conclude that pornography exposure is not associated with risky sexual behaviors and that the willingness of exposure does not seem to have an impact on risky sexual behaviors among adolescents.