Gender identity: A psychosocial primer for providing care to patients with a disorder/difference of sex development and their families [individualized care for patients with intersex (Disorders/differences of sex development): Part 2]

Abstract

Introduction/background: Many parents of infants born with a DSD describe the process of initial sex assignment at birth as highly stressful. Parents of children with a DSD also note high distress when their children engage in behaviors that are not considered typical for their gender.Objective: The goal of this article is to provide members of the health care team a brief overview of psychosocial facets of gender and gender identity particularly relevant to DSD for the purposes of enhancing shared decision-making and optimizing support for individuals with a DSD and their families.Discussion: Gender identity is a multidimensional construct involving related but distinct concepts such as gender typicality, gender contentedness and felt pressure for gender differentiation, and can be assessed via standardized measures. Gender dysphoria is associated with poor psychological adjustment, and is mitigated by family and peer support. Family influences on gender identity include parental modeling of gender behavior and family composition (e.g., same-sex children vs both sons and daughters in a family). Cultural factors that may influence sex assignment include societal views on gender, and gender-related differential resource allocation within a society. In addition, religious beliefs and the presence of a "third-sex" category within a culture may also influence parental gender ideology. Clinical application:Health care providers who work with patients with a DSD must have a strong grasp on the construct of gender identity, and must be able to clearly and consistently *

Congenital Adrenal Hyperplasia—Current Insights in Pathophysiology, Diagnostics, and Management

“…Families should be informed about surgical options including avoiding or delaying surgery. There should be a shared decision-making process including the family, endocrinologist, surgeon and mental health professionals, and the surgery should be performed by an experienced surgeon (134,581,618,619).…”

The Timing of Genital Surgery in Somatic Intersexuality: Surveys of Patients’ Preferences

“…As to guideline development, several considerations emerge from this review and from the status of the evidence generally as follows: (1) it is important to optimize initial gender assignment so that the risk of later severe gender dysphoria and patient-initiated gender reassignment is minimized; in this regard, the international conference on intersex management in 2005 has led to considerable progress [10]; see also [51,52]. (2) Given the diversity of intersex syndromes and their variations in severity, a one-fits-all approach to the timing of genital surgery is inappropriate; neither a total ban of early surgery nor early surgery for all are advisable.…”

Individualized care for patients with intersex (differences of sex development): part 4/5.Considering the Ifs, Whens, and Whats regarding sexual-reproductive system surgery

“…Adjustment to having a DSD involves on-going significant risk, life-long observation and, similar to the general population, the possibility that a percentage of these persons will have a poor quality of life because of a host of reasons. Earlier publications in this series addressed the psychosocial and psychosexual aspects in the management of DSD [7,9]. Related to these aspects and surgical choices is a report that suggests an impact of one's perception of their genitalia: a significant association between genital self-image, genital self-consciousness and better "sexual esteem" resulted in greater self-perceived sexual attractiveness [33].…”