性别认同障碍:人格、心理病理及社会适应水平的术前术后变化的比较研究

简介:性别认同障碍是一复杂的症状,目前对其认识还很匮乏.在过去的几十年内,易性症不是单独出现的症状这一认识得到广泛的讨论,而易性症研究的经验也揭示了易性症是遗传性并存疾病的可能性.伴随变性手术(SRS)的心理病理、临床症状水平和社会适应水平的变化已逐渐明确,但目前尚没有关于人格特性改变的充分证据.本研究的进行正是基于这一重要主题的科学数据的空白,目的是为增进该领域的临床护理的认识作出贡献.目标:确定受试者为确诊进行的临床评估时刻的人格档案与结构、临床心理病理症状和社会适应水平的特征,基于这些结果的分析,将其与变性手术后的相应结果进行比较,从而为术前术后人格档案水平、心理病理和社会适应水平的变化提供证据支持.材料和方法:受试者为22名确诊为性别认同障碍的个体的非随机样本.在临床评估时刻对其进行前瞻性和描述性研究,变性手术后再次进行比较性的研究.除了半结构式访谈,还应用了其他自我评估工具:症状自评量表(SCL - 90),社会家庭生活问卷,Million临床多轴问卷- Ⅱ(MCMI - Ⅱ),明尼苏达多项人格问卷-2(MMPI -2).数据分析通过SPSS -预测统计分析软件(PASW) 18进行.结果和结论:在临床评估时刻,性别认同障碍不是单独存在的.在变性手术后,我们观察到多水平的显著变化;心理病理症状、临床和人格障碍以及社会适应(积极演变,即多维度的平衡和稳定).变性手术后,在人格档案水平也观察到了变化.因此,和变性手术初始阶段相比,在心理病理水平之外,受试者在人格结构和基本人格模式水平也出现了显著性的变化.我们还发现当根据性别认同对个体进行评估时,个体各水平之间的平衡更好,并且与性别认同一致的性别角色表现为总体一致性.     

性别异位症的临床治疗

目的探讨性别异位症的临床特点及其手术变性治疗.方法变性手术均分期施行.男性变女性采用一期睾丸切除及阴蒂、阴道、外阴再造,采用阴茎阴囊皮瓣法再造阴道及外阴,再二期行隆胸手术以及乳头、乳晕整形.女性变男性先行子宫及双附件切除,阴道切除闭合,后行乳房整形,再行阴茎再造术.阴茎再造采用腹壁及旋髂浅动脉为蒂的皮瓣与腹直肌肌瓣瓦合成形法.结果自1989年至2007年共诊治性别异位症患者78例,行变性手术治疗21例,其中男性变为女性者15例,女性变男性6例.术后随访1～11年,无严重并发症.受术者社会性别转变后,生活状态良好.结论对于性别异位症患者,手术行性别改变是安全、有效的治疗方法.     

易性癖患者男变女手术的护理

目的：探讨易性癖男-女变性手术前后的护理方法,提高护理质量.方法：对我院男科中心病区9例男变女手术患者实施精心有效的护理.结果：经过护理,无并发症,效果满意,康复出院.结论：针对变性手术,开展有效的护理,对术后患者康复至关重要.     

变性人私法问题研究(二)

5 变性后的人身权与财产权调整 5.1 变性对财产权的影响 5.1.1 变性后对物权的影响①变性不影响物权的归属与利用.自然人手术变性改变的只是权利主体的性别,权利本身并未发生变动,权利主体对物的支配性地位未受任何影响,权利主体也未发生任何变更.知识产权中的财产权与此相同.②对物权登记的影响.首先,变性后,权利人可以要求以新的性别身份登记物权.其次,对于变性前的物权登记如果涉及性别身份的,权利人可以享有选择权,要么选择不变更原有物权登记内容,以变性的身份证明佐证权利的归属,要么出示变性前后的身份证明,请求相关部门对原有物权登记的性别内容作出变更.     

变性人私法问题研究(一)

简要介绍了变性症或称易性病以及人类目前应对这种疾病两种做法的基本认识,分析研究了两种变性实践的私权利根据与自然人进行变性的法律条件,详细讨论了变性对自然人私权产生的各种影响.     

真皮弹力纤维疾病

20130854光线性弹性组织变性形成机制的研究进展(综述)/许庆芳(中山大学附三院皮肤科),赖维,郑跃∥国际皮肤性病学杂志.-2013,38(1).-45～47光老化皮肤最具特征性的病理改变是变性弹性纤维在真皮中上层的堆积,即光线性弹性组织变性。光线性弹性组织变性的病理表现为在光老化的真皮中上     

淀粉样变性的研究现状

淀粉样变性是一组由淀粉样蛋白沉积引起、涉及多系统的代谢性疾病,其病因与多种因素有关,淀粉样蛋白也有多种来源,临床表现十分复杂。按沉积的淀粉样蛋白种类对淀粉样变性进行了分类,并对淀粉样变性发病机制及治疗学方面的进展作一概述。     

原发性系统性淀粉样变性并发多发性骨髓瘤

报告1例原发性系统性淀粉样变性并发多发性骨髓瘤.患者男,68岁.表现为紫癜、瘀斑、斑块的原发性系统性淀粉样变性,患者曾被多次误诊,最终确诊为原发性系统性淀粉样变性并发多发性骨髓瘤.     

皮肤异色病样淀粉样变3例

皮肤淀粉样变性是一组由淀粉样物质沉积于皮肤组织中引起的皮肤疾病.根据发病的原因,该病分为原发性皮肤淀粉样变性和继发性皮肤淀粉样变性.临床上原发性皮肤淀粉样变性皮损表现为苔藓样、斑状、结节样、大疱及皮肤异色病样损害等,其中苔藓样、斑状损害比较常见,而结节样、大疱及皮肤异色病样损害十分少见.本文报道3例皮肤异色病样淀粉样变性如下.     

穿通性环状肉芽肿2例

报告２例穿通性环状肉芽肿均为丘疹型，１例临床皮损类似寻常疣。组织病理示真皮上部栅状肉芽肿和穿通管道，从表皮排出真皮内变性物质。电镜观察见大量组织细胞、变性的胶原纤维和弹力纤维，坏死区组织细胞呈现变性，未见吞噬弹力纤维，但在其周围见变性弹力纤维与质膜密切接触     

HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia

OBJECTIVES: To establish the prevalence of HIV, syphilis, and sexual risk behaviour among three groups of men who have sex with men in Jakarta, Indonesia, and to investigate sexual links between these men and broader heterosexual populations. METHODS: Anonymous, cross sectional surveys among community recruited transgender and male sex workers and self recognised men who have sex with men (MSM) were undertaken in mid-2002 in Jakarta, Indonesia. Places where transgender and male sex workers sell sex and where men go to meet non-commercial male sex partners were mapped. Probability samples were selected for the sex worker populations, while a mixed probability and convenience sample was drawn for self recognised MSM. Blood was drawn for HIV and syphilis serology and community interviewers administered a standardised questionnaire. RESULTS: HIV prevalence was 22% among transgender sex workers, 3.6% among male sex workers, and 2.5% among self recognised MSM, and syphilis prevalence was 19.3%, 2.0% and 1.1% respectively. 59.3% of transgender sex workers and 64.8% of male sex workers reported recent unprotected anal intercourse with clients, and 53.1% of other MSM reported unprotected anal sex with male partners. Some 54.4% of male sex workers and 18.3% of other MSM reported female partners in the preceding year. CONCLUSION: HIV has reached substantial levels among transgender sex workers, and is not negligible in other MSM groups. Risk behaviour is high in all subpopulations, and bisexual behaviour is common, meaning the threat of a wider epidemic is substantial. Prevention programmes targeting male-male sex are needed to reduce this threat.     

日本性别认同障碍的发展现状综述

性别认同障碍(gender identity disorder,GID),指对于自己的性别认同与生物解剖学上的性别不一致的情况,并且常伴随内心痛苦想要改变生物学上的性别,心理治疗对性别认同障碍的干预,即想要使患者的性别认同与生物性别一致的情况早已被证实无效,性别认同障碍的患者往往会选择荷尔蒙治疗甚至手术来使自己的生物性别与性别认同趋向一致。2013年5月美国《精神疾病诊断及统计手册》第五版(DSM-Ⅴ)将性别认同障碍修改为性别烦恼(gender dysphoria),不再认为性别认同问题是障碍或疾病,承认性别多样性的存在。本文从对日本性别认同障碍患者的一般调查研究数据,包括荷尔蒙疗法及性别转变手术在内的性别认同障碍的治疗以及生殖医疗三个方面来描述日本性别认同障碍目前的发展状况。     

Preoperative and Postoperative Considerations in Gender-Affirming Surgery

Purpose of Review

The review is aimed at determining critical factors in the preoperative and postoperative care of transgender patients undergoing gender-affirming surgery. General and procedure-specific considerations are summarized to improve the longitudinal perioperative care of transgender patients.

Recent Findings

Surgical providers should follow World Professional Association for Transgender Health (WPATH) guidelines regarding eligibility for surgery. Important elements in preoperative evaluation include mental health screening, fertility discussion, and adjustment of hormone replacement therapy. Postoperative considerations include proper cancer screening, mental health support, appropriate outcomes assessment, and awareness of potential procedure specific complications.

Summary

Proper perioperative care for transgender patients undergoing gender-affirming surgery involves a multidisciplinary approach to healthcare to create a comprehensive treatment environment at an institutional level.

     

Acquired smooth‐muscle hamartoma of the scrotum: a histological simulator?

BACKGROUND: In three cases of chronic scrotal lymphedema, histological and immunohistochemical changes were observed that were strikingly similar to an exceedingly rare lesion reported previously under the name of acquired smooth-muscle hamartoma (ASMH) of the scrotum. The clinical context indicated that the cases were reactive rather than hamartomatous in nature. MATERIALS AND METHODS: The histological and immunohistochemical findings of the three cases were compared to macroscopically normal scrotal specimens obtained during sex reassignment surgery in seven male-to-female transsexuals. RESULTS: Compared to the seven controls, the three cases of chronic scrotal edema revealed a marked increase of dartos smooth-muscle tissue and of connective tissue of the scrotal skin and underlying soft tissues. Still, even the normal amount of scrotal smooth-muscle tissue may easily be misinterpreted as smooth-muscle hyperplasia. CONCLUSIONS: Chronic scrotal lymphedema may induce hyperplasia of the dartos muscle, resulting in a histological appearance previously described as ASMH. This indicates that ASMH may not always represent a later onset of abnormality similar to congenital smooth-muscle hamartoma but, rather, may constitute a histological simulator.     

Acne: a side-effect of masculinizing hormonal therapy in transgender patients

Acne is a known side effect of masculinizing hormonal therapy used in transgender men. In all people with acne, it can contribute to depression, body image issues and even suicidal ideation. Hormones, particularly testosterone, are often the first treatment for gender dysphoria - the distress that can be caused by feeling and living a different gender to one's assigned gender - in transgender men. These hormones can exacerbate acne, among other hair and skin issues. The aim of this article, from the USA, is to promote understanding for advising and treating transgender men who have acne as a result of masculinizing hormonal therapy. Studies suggest that the severity of acne peaks within the first 4 months of treatment. Although gradual improvement is noted within the first year, acne can be persistent, lasting years after testosterone therapy is started. Severity of acne is variable, with most patients experiencing milder lesions (spots). Acne tends to be most prominent on the back and chest, an area that may already be one of the greatest sources of dissatisfaction among transgender men. Standard acne treatments such as topical medications (creams) and antibiotics can be used, but hormonal therapy is likely to interact with the desired effects of testosterone in transgender men, which requires careful consideration and discussion. In cases that don't improve after these first-line treatments, a powerful drug called isotretinoin is effective in patients on masculinizing therapy, though multiple courses of treatment may be needed. This drug can have unwanted side-effects and doctors have to closely monitor patients on this drug. The study discusses other important considerations for doctors. Although the options for treating acne are similar to those used in cis-gender patients (i.e. whose sense of personal identity and gender corresponds with their birth sex), several medical, social, and psychological considerations must be noted when treating transgender patients.     

跨性别者性别身份的心理评估和社会学观点

本文介绍了跨性别者在精神病诊断手册上的阶段性变化,从最初的精神病理性诊断到DSM-V和ICD-11最新版的去精神病化诊断,讨论了单纯精神病学诊断对理解跨性别现象的局限性。总结了国内外学者对跨性别者的性别身份这一概念的现有研究成果,介绍了对跨性别者的性别身份认同的心理评估量表。介绍了跨性别现象的社会学观点,即跨性别者如何自我建构跨性别身份的理论模型,旨在促进并加深读者对跨性别现象的理解。     

简析当今形势下的性犯罪问题与普及健康性认知的思考

当今社会存在较典型的性犯罪形式包括网络性犯罪、变性人的性犯罪、同性性犯罪等.本文论述了当今社会中存在的这几种性犯罪形式,同时指出相应的解决建议,引出普及健康性认知的必要性.健康科学的认识"性",有助于在一定程度上减少或避免性犯罪的发生.     

Dermatology-related epidemiologic and clinical concerns of men who have sex with men, women who have sex with women, and transgender individuals

OBJECTIVE: To review the recent literature relevant to dermatologists regarding sexual-minority patients: men who have sex with men, women who have sex with women, and transgender and intersex individuals. DATA SOURCES: We searched MEDLINE for articles relating to sexual-minority patients and dermatology. DATA EXTRACTION: Information regarding clinical, epidemiologic, and terminology issues relating to sexual-minority patients, with particular attention to concerns relevant to dermatologists. CONCLUSIONS: Sexual-minority patients have specific clinical and epidemiologic issues that are relevant to dermatologists. Knowledge of these issues, as well as sensitivity to issues of terminology, can enable dermatologists to better care for sexual-minority patients.