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Gardner M, Brinkman WB, Carley M, Liang N, Lightfoot S, Pinkelman K, Speiser PW, Schafer-Kalkhoff T, Suorsa-Johnson KI, VanderBrink B, Weidler EM, Wisniewski J, Stacey D, Sandberg DE. Decisional Support Needed when Facing Tough Decisions: Survey of Parents with Children having Differences of Sex Development. FRONTIERS IN UROLOGY 2023; 3:1089077. [PMID: 37920725 PMCID: PMC10621652 DOI: 10.3389/fruro.2023.1089077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Introduction Parents of infants and young children newly diagnosed with differences of sex development (DSD) commonly face medical and psychosocial management decisions at a time when they are first learning about the condition and cannot consult their child for input. The aim of this study was to identify areas of greatest need for parental decisional support. Methods 34 parents of children receiving care for DSD at one of three US children's hospitals participated in a survey to learn what clinical and psychosocial decisions needed to be made on behalf of their child. Parents were then asked to identify and focus on a "tough" decision and respond to questions assessing factors affecting decision-making, decision-making preferences, decisional conflict, and decision regret. Descriptive analyses were conducted. Results Decisions about surgery and aspects of sharing information about their child's condition with others were the two most frequently reported decisions overall, experienced by 97% and 88% of parents, as well as most frequently nominated as tough decisions. Many parents reported mild to moderate levels of decisional conflict (59%) and decision regret (74%). Almost all parents (94%) reported experiencing at least one factor as interfering with decision-making (e.g., "worried too much about choosing the 'wrong' option"). Parents universally reported a desire to be involved in decision-making - preferably making the final decision primarily on their own (79%), or together with their child's healthcare providers (21%). The majority of parents judged healthcare providers (82%) and patient/family organizations (58%) as trustworthy sources of information. Discussion Parents of children with DSD encounter medical, surgical, and psychosocial management decisions. Despite difficulties including emotional distress and informational concerns (including gaps and overload), parents express strong desires to play key roles in decision-making on behalf of their children. Healthcare providers can help identify family-specific needs through observation and inquiry in the clinical context. Together with families, providers should focus on specific clinical management decisions and support parental involvement in making decisions on behalf of young children with DSD.
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Affiliation(s)
- Melissa Gardner
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - William B. Brinkman
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Noi Liang
- Patient / parent / caregiver stakeholder partners, Denver, CO, USA
| | | | - Kendra Pinkelman
- Patient / parent / caregiver stakeholder partners, Ann Arbor, MI, USA
| | - Phyllis W. Speiser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Feinstein Institute for Medical Research, Manhasset, New York, USA
| | | | | | - Brian VanderBrink
- Division of Urology, Cincinnati Children’s Hospital Medical Center, Cincinnati, USA
| | - Erica M. Weidler
- Division of Pediatric Surgery, Phoenix Children’s Hospital, Phoenix, AZ
- Accord Alliance, USA
| | | | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - David E. Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Accord Alliance, USA
- Division of Pediatric Psychology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
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2
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Hegarty P, Smith A. Public understanding of intersex: an update on recent findings. Int J Impot Res 2023; 35:72-77. [PMID: 35031713 PMCID: PMC9935380 DOI: 10.1038/s41443-021-00485-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/17/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022]
Abstract
Surgical interventions on infants with intersex characteristics are considered justified by some on the grounds that they carry a high risk of intolerable stigma. However, public understanding of intersex and its medicalization are under-researched. We review recent qualitative and quantitative studies of the understandings of intersex and its medicalization among people who have no particular professional or public experience of intersex. First, such laypeople reason about clinical dilemmas by drawing on values in similar ways as expert healthcare professionals do. Second, laypeople can over-estimate the utility of current 'umbrella terms,' including intersex, for people with direct familial experience of intersex. Third, beliefs about good and bad effects of medical intervention are affected by framing intersex as either a medical condition or the natural basis for a social identity. Fourth, sexual identity is the best evidenced predictor of opinions about early surgical intervention and its legal limitation on human rights grounds. We argue that possible stigmatizing reactions from the public may not be a solid basis on which to justify early surgical intervention on intersex characteristics.
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3
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Miano P, Di Salvo G, Lavaggi M. An undermined therapeutic alliance: A case study. PSYCHODYNAMIC PRACTICE 2021. [DOI: 10.1080/14753634.2021.1972035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Paola Miano
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Italy
| | | | - Massimo Lavaggi
- Associazione Consultorio Transgenere, Torre Del Lago Puccini, Italy
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4
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Hart B, Shakespeare-Finch J. Intersex lived experience: trauma and posttraumatic growth in narratives. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1938189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Bonnie Hart
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jane Shakespeare-Finch
- School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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5
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Bennecke E, Köhler B, Röhle R, Thyen U, Gehrmann K, Lee P, Nordenström A, Cohen-Kettenis P, Bouvattier C, Wiesemann C. Disorders or Differences of Sex Development? Views of Affected Individuals on DSD Terminology. JOURNAL OF SEX RESEARCH 2021; 58:522-531. [PMID: 31985272 DOI: 10.1080/00224499.2019.1703130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Over a decade ago, the participants at the International Consensus Conference on Intersex proposed Disorders of Sex Development (DSD) as an umbrella term for "congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is atypical". The Group recommended the terminology be sensitive to concerns of individuals having these conditions. Yet, controversy rages over the term DSD. This multicentre clinical evaluation study was initiated as part of the European research group dsd-LIFE to evaluate patient-reported outcome. In total, 1,040 individuals with conditions labeled as Disorders of Sex Development were recruited in Poland, Sweden, Germany, France, United Kingdom and the Netherlands. All participants were asked to rate the terms describing their conditions. Overall, a large majority of participants (69%) reported that the term Disorders of Sex Development applied to their condition or that they felt neutral about it. Most participants preferred terms that were specific to their somatic condition. Overall, our data do not support the view that, in general, the term Disorders of Sex Development is insensitive to concerns of affected persons and that it should therefore be abandoned. However, in the clinical encounter, we recommend that clinicians evaluate each patient's preferences.
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Affiliation(s)
- Elena Bennecke
- Sozialpädiatrisches Zentrum (SPZ), Center for Chronically Sick Children, Charité University Medicine
| | - Birgit Köhler
- Department of Paediatrics, Division of Endocrinology and Diabetology, Charité University Medicine
| | - Robert Röhle
- Koordinierungszentrum Klinische Studien (KKS), University Medicine
| | - Ute Thyen
- Hospital for Children and Adolescents, University of Lübeck
| | - Katharina Gehrmann
- Department of Paediatrics, Division of Endocrinology and Diabetology, Charité University Medicine
| | - Peter Lee
- Department of Paediatrics, Penn State College of Medicine
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital
| | | | | | - Claudia Wiesemann
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen
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6
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Steers DM, Andrews GL, Wiltshire EJ, Ballantyne AJ, Collings SC, Stubbe MH. Young people with a variation in sex characteristics in Aotearoa/New Zealand: identity, activism and healthcare decision-making. CULTURE, HEALTH & SEXUALITY 2021; 23:457-471. [PMID: 33356928 DOI: 10.1080/13691058.2020.1863472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
Young people born with variations in sex characteristics (VSC) or disorders of sex development (DSD) face numerous challenges in navigating issues relating to identity and to their lived and embodied experience. There is limited published research amplifying the voices of young people with a VSC, especially from Aotearoa/New Zealand. This qualitative study provides an up-to-date picture of the lived experience of 10 young people with a VSC in Aotearoa/New Zealand. The research was conducted in collaboration with the advocacy group, Intersex Youth Aotearoa, and explored the level of support provided by health services, peers and advocacy groups in relation to the ways the participants viewed themselves and their bodies, and their health related decision-making. Findings reveal the pressure on young people with a VSC to conform to cultural and societal norms, specifically, heteronormative and traditional constructs of how male and female bodies should look in Aotearoa/NZ society. Such views, often held and perpetuated by health professionals and parents, contributed to complexities surrounding identity, agency and acceptance of difference experienced by these young people. The implications of these findings are discussed, including the need for better psychological and peer support for young people.
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Affiliation(s)
- Denise M Steers
- Suicide and Mental Health Research Group, University of Otago, Wellington, New Zealand
| | | | - Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Angela J Ballantyne
- Department of Primary Health Care and General Practice (Wellington), Bioethics Centre (Dunedin), University of Otago, New Zealand
| | - Sunny C Collings
- Suicide and Mental Health Research Group, University of Otago, Wellington, New Zealand
| | - Maria H Stubbe
- Department of Primary Healthcare & General Practice, University of Otago, Wellington, New Zealand
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7
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Prandelli M, Testoni I. Inside the doctor's office. Talking about intersex with Italian health professionals. CULTURE, HEALTH & SEXUALITY 2021; 23:484-499. [PMID: 32935650 DOI: 10.1080/13691058.2020.1805641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
This article explores how health professionals in Italy understand variations of sex characteristics (VSC), also referred to as intersex and/or disorders of sex development (DSD). With estimates of VSC frequency ranging from 0.018% to 1.7%, only a handful of highly specialised medical doctors are considered DSD experts. When addressing the daily health management of children and families who do not live near specialist DSD centres, these experts may refer individuals to the nearest health professional that Italian health services provides, opening up questions regarding how these professionals might act and react when faced with VSC. In this analysis of interview data from 65 Italian general practitioners, paediatricians and psychologists, we address two themes. The first theme discusses participants' previous experiences and case management, with a focus on social, medical and gender biases. The second theme examines health professionals' opinions and perspectives on ongoing conflicts concerning current best care practices. Our results highlight health professionals' cultural and gendered biases, confirming the need to develop specific professional training, guidelines and policies to improve the healthcare of people with VSC.
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Affiliation(s)
- Marta Prandelli
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padova, Italy
| | - Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padova, Italy
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8
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Lasisi T. The constraints of racialization: How classification and valuation hinder scientific research on human variation. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175:376-386. [PMID: 33675042 DOI: 10.1002/ajpa.24264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/18/2022]
Abstract
Human biological variation has historically been studied through the lens of racialization. Despite a general shift away from the use of overt racial terminologies, the underlying racialized frameworks used to describe and understand human variation still remain. Even in relatively recent anthropological and biomedical work, we can observe clear manifestations of such racial thinking. This paper shows how classification and valuation are two specific processes which facilitate racialization and hinder attempts to move beyond such frameworks. The bias induced by classification distorts descriptions of phenotypic variation in a way that erroneously portrays European populations as more variable than others. Implicit valuation occurs in tandem with classification and produces narratives of superiority/inferiority for certain phenotypic variants without an objective biological basis. The bias of racialization is a persistent impediment stemming from the inheritance of scientific knowledge developed under explicitly racial paradigms. It is also an internalized cognitive distortion cultivated through socialization in a world where racialization is inescapable. Though undeniably challenging, this does not present an insurmountable barrier, and this bias can be mitigated through the critical evaluation of past work, the active inclusion of marginalized perspectives, and the direct confrontation of institutional structures enforcing racialized paradigms.
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Affiliation(s)
- Tina Lasisi
- Department of Anthropology, Pennsylvania State University, State College, Pennsylvania, USA
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9
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Roen K, Carlquist E, Prøitz L. 'Does anyone else have this?' The role of emotion in forum discussions about medical conditions affecting sex characteristics. CULTURE, HEALTH & SEXUALITY 2021; 23:52-67. [PMID: 32031507 DOI: 10.1080/13691058.2019.1688867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
When people experience rare medical conditions or variations, searching online may be the only way to find others with similar experiences. This study examines what happens when people do just that. The dataset for the research has been generated from online posts by people living with variations of sex characteristics, which some call intersex variations. Our analysis focuses on how emotion appears in online posts, how affect becomes embodied in digital contexts, and how norms are negotiated as people relate to one another about the variations that some of them experience. We offer an analysis grounded in digital affect theory to contribute to health research literature. We suggest how health researchers and healthcare providers might develop more nuanced understandings of the emotional realities of people living with variations of sex characteristics.
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Affiliation(s)
- Katrina Roen
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik Carlquist
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Psychology, Bjørknes University College, Oslo, Norway
| | - Lin Prøitz
- Department of Psychology, University of Oslo, Oslo, Norway
- Faculty of Business, Languages, and Social Sciences, Østfold University College, Halden, Norway
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10
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Zeeman L, Aranda K. A Systematic Review of the Health and Healthcare Inequalities for People with Intersex Variance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186533. [PMID: 32911732 PMCID: PMC7559554 DOI: 10.3390/ijerph17186533] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 01/22/2023]
Abstract
Extensive research documents the health inequalities LGBTI people experience, however far less is known for people with intersex variation. This paper presents a review of intersex health and healthcare inequalities by evaluating research published from 2012 to 2019. In total 9181 citations were identified with 74 records screened of which 16 were included. A synthesis of results spans nine quantitative, five qualitative and two narrative reviews. Literature was searched in Medline, Web of Science, Cochrane, PsycInfo and CINAHL. People with intersex variance experience a higher incidence of anxiety, depression and psychological distress compared to the general population linked to stigma and discrimination. Progressive healthcare treatment, including support to question normative binaries of sex and gender, aids understand of somatic intersex variance and non-binary gender identity, especially when invasive treatment options are avoided or delayed until individuals are able to self-identify or provide consent to treatment. Findings support rethinking sex and gender to reflect greater diversity within a more nuanced sex-gender spectrum, although gaps in research remain around the general health profile and the healthcare experiences of people with intersex variance. More large-scale research is needed, co-produced with peers who have lived experience of intersex variation to ensure policy, education and healthcare advances with greater inclusivity and ethical accountability.
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Affiliation(s)
- Laetitia Zeeman
- School of Health Sciences, University of Brighton, Brighton BN1 9PH, UK;
- Centre for Transforming Sexuality and Gender, University of Brighton, Brighton BN2 0JG, UK
- Correspondence: ; Tel.: +44-0-1273-64-4194
| | - Kay Aranda
- School of Health Sciences, University of Brighton, Brighton BN1 9PH, UK;
- Centre for Transforming Sexuality and Gender, University of Brighton, Brighton BN2 0JG, UK
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11
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Roen K. Intersex or Diverse Sex Development: Critical Review of Psychosocial Health Care Research and Indications for Practice. JOURNAL OF SEX RESEARCH 2019; 56:511-528. [PMID: 30907687 DOI: 10.1080/00224499.2019.1578331] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Intersex or diverse sex development (dsd) can be conceptualized as an aspect of bodily diversity that has particular psychosocial implications. This is a review of psychosocial health care literature, published from 2007 to 2017, focusing on the well-being of people with a diagnosis relating to sex development. The analysis I offer here takes a critical psychological approach, questioning norms and taken-for-granted assumptions. This approach works from the understanding that how we know and how we talk about a phenomenon affects people in material and life-changing ways. This article offers recommendations concerning health care communication, the importance of taking time for emotion, and the process of building supportive relationships. The research reviewed provides clear evidence of psychosocial harm that is done through genital intervention and evidence that parents do not routinely give fully informed consent before their children undergo treatment. Finally, I highlight key points and recommendations for health professionals, indicating how psychosocial professionals can contribute to health care and well-being in the context of dsd when appropriately resourced and trained.
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Affiliation(s)
- Katrina Roen
- a Department of Sociology , University of Waikato
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12
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Hegarty P, Smith A, Bogan‐Carey T. Stigma as framed onYouTube: Effects of personal experiences videos on students’ beliefs about medicalizing intersex. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2019. [DOI: 10.1111/jasp.12570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Peter Hegarty
- School of Psychology University of Surrey Guildford UK
| | - Annette Smith
- School of Psychology University of Surrey Guildford UK
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13
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Ingraham N, Wingo E, Roberts SCM. Inclusion of LGBTQ persons in research related to pregnancy risk: a cognitive interview study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:bmjsrh-2018-200097. [PMID: 30217959 DOI: 10.1136/bmjsrh-2018-200097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/04/2018] [Accepted: 08/21/2018] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Recently, researchers have begun considering whether and how to include lesbian, gay, bisexual, transgender and queer (LGBTQ) people in research about abortion and contraception care. Including LGBTQ people in research about abortion and contraception care, as well as the risk for unintended pregnancy more broadly, requires accurate assessment of risk for unintended pregnancy, which involves different considerations for LGBTQ people. METHODS We created a survey with existing sexual orientation and gender identity measures, new reproductive anatomy questions to guide skip patterns, gender neutral terminology in sexual and behavioural risk questions, and existing contraception and pregnancy intentions questions that were modified to be gender neutral. We then assessed the appropriateness of these measures through cognitive interviews with 39 individuals aged 18-44 years who were assigned female at birth and identified as LGBTQ. Participants were recruited in the San Francisco Bay Area of California, Baltimore, Maryland and other cities. RESULTS Existing demographic questions on sexual orientation and gender identity were well received by participants and validating of participant reported identities. Participants responded positively to new reproductive anatomy questions and to gender neutral terminology in sexual behaviour and pregnancy risk questions. They felt skip patterns appropriately removed them out of inappropriate items (eg, use of contraception to avoid unintended pregnancy); there was some question about whether pregnancy intention measures were widely appropriate or should be further restricted. CONCLUSIONS This study provides guidance on ways to appropriately evaluate inclusion of LGBTQ people in abortion and contraception research.
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Affiliation(s)
| | - Erin Wingo
- UCSF Advancing New Standards in Reproductive Health (ANSIRH), Oakland, California, USA
| | - Sarah C M Roberts
- UCSF Advancing New Standards in Reproductive Health (ANSIRH), Oakland, California, USA
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14
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Lundberg T, Hegarty P, Roen K. Making sense of ‘Intersex’ and ‘DSD’: how laypeople understand and use terminology. PSYCHOLOGY & SEXUALITY 2018. [DOI: 10.1080/19419899.2018.1453862] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Tove Lundberg
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Peter Hegarty
- School of Psychology, University of Surrey, Guildford, England
| | - Katrina Roen
- Department of Psychology, University of Oslo, Oslo, Norway
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15
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Tishelman AC, Shumer DE, Nahata L. Disorders of Sex Development: Pediatric Psychology and the Genital Exam. J Pediatr Psychol 2017; 42:530-543. [PMID: 27098964 DOI: 10.1093/jpepsy/jsw015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/14/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To provide suggestions for clinical care of youth with disorders of sex development (DSD) and their families, by drawing on preexisting pediatric psychology literature with a particular focus on child sexual abuse (CSA) genital exams. Method Relevant peer-reviewed papers published since 1990 in the CSA literature were systematically reviewed, as well as an illustrative sample of general pediatric psychology papers. Results Empirical research from the CSA literature provided information on prevalence of distress and the impact of provider behavior, the importance of preparation, and proposed interventions. Expert recommendations from CSA literature and general findings gleaned from pediatric psychology also address these issues. Conclusions Psychological findings in the CSA pediatric population suggest that fears and anxieties are not universal and can be linked to a number of variables. Based on this review, we make a number of recommendations for potential interventions for youth with DSD and their families, emphasizing the need for further clinical research.
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Affiliation(s)
- Amy C Tishelman
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel E Shumer
- University of Michigan Health System, University of Michigan, Ann Arbor, MI, USA
| | - Leena Nahata
- Nationwide Children's Hospital, Columbus, Ohio, USA
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16
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Lee PA, Nordenström A, Houk CP, Ahmed SF, Auchus R, Baratz A, Baratz Dalke K, Liao LM, Lin-Su K, Looijenga LHJ, Mazur T, Meyer-Bahlburg HFL, Mouriquand P, Quigley CA, Sandberg DE, Vilain E, Witchel S. Global Disorders of Sex Development Update since 2006: Perceptions, Approach and Care. Horm Res Paediatr 2016; 85:158-80. [PMID: 26820577 DOI: 10.1159/000442975] [Citation(s) in RCA: 391] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/01/2015] [Indexed: 11/19/2022] Open
Abstract
The goal of this update regarding the diagnosis and care of persons with disorders of sex development (DSDs) is to address changes in the clinical approach since the 2005 Consensus Conference, since knowledge and viewpoints change. An effort was made to include representatives from a broad perspective including support and advocacy groups. The goal of patient care is focused upon the best possible quality of life (QoL). The field of DSD is continuously developing. An update on the clinical evaluation of infants and older individuals with ambiguous genitalia including perceptions regarding male or female assignment is discussed. Topics include biochemical and genetic assessment, the risk of germ cell tumor development, approaches to psychosocial and psychosexual well-being and an update on support groups. Open and on-going communication with patients and parents must involve full disclosure, with the recognition that, while DSD conditions are life-long, enhancement of the best possible outcome improves QoL. The evolution of diagnosis and care continues, while it is still impossible to predict gender development in an individual case with certainty. Such decisions and decisions regarding surgery during infancy that alters external genital anatomy or removes germ cells continue to carry risk.
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Affiliation(s)
- Peter A Lee
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pa., USA
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17
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Ahmed SF, Achermann JC, Arlt W, Balen A, Conway G, Edwards Z, Elford S, Hughes IA, Izatt L, Krone N, Miles H, O'Toole S, Perry L, Sanders C, Simmonds M, Watt A, Willis D. Society for Endocrinology UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development (Revised 2015). Clin Endocrinol (Oxf) 2016; 84:771-88. [PMID: 26270788 PMCID: PMC4855619 DOI: 10.1111/cen.12857] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/18/2015] [Accepted: 07/11/2015] [Indexed: 12/25/2022]
Abstract
It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional DSD team. In most cases, particularly in the case of the newborn, the paediatric endocrinologist within the regional team acts commonly as the first point of contact. This clinician should be part of a multidisciplinary team experienced in management of DSD and should ensure that the affected person and parents have access to specialist psychological support and that their information needs are comprehensively addressed. The underlying pathophysiology of DSD and the strengths and weaknesses of the tests that can be performed should be discussed with the parents and affected young person and tests undertaken in a timely fashion. Finally, in the field of rare conditions, it is imperative that the clinician shares the experience with others through national and international clinical and research collaboration.
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Affiliation(s)
| | - John C. Achermann
- Developmental Endocrinology Research GroupUniversity College London Institute of Child HealthLondonUK
| | - Wiebke Arlt
- Centre for Endocrinology, Diabetes and MetabolismUniversity of Birmingham Medical SchoolBirminghamUK
| | - Adam Balen
- Department of Obstetrics and GynaecologyLeeds Teaching HospitalsLeedsUK
| | - Gerry Conway
- Department of EndocrinologyThe Middlesex HospitalLondonUK
| | - Zoe Edwards
- Psychological Services (Paediatrics) Alder Hey Children's NHS Foundation TrustLiverpoolUK
| | | | | | - Louise Izatt
- Clinical Genetics DepartmentGuy's HospitalLondonUK
| | - Nils Krone
- Division of Medical SciencesUniversity of BirminghamBirminghamUK
| | | | - Stuart O'Toole
- Department of Paediatric SurgeryRoyal Hospital for Sick ChildrenGlasgowUK
| | - Les Perry
- Clinical BiochemistrySt Bartholomew's HospitalLondonUK
| | - Caroline Sanders
- Paediatric Urology & GynaecologyAlderhey Children's NHS Foundation TrustLiverpoolUK
| | | | - Andrew Watt
- Diagnostic ImagingRoyal Hospital for Sick ChildrenGlasgowUK
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