Sexual identity trajectories among sexual-minority youths: gender comparisons

The present investigation explored gender differences in sexual identity development--first same-sex attractions, self-labeling, same-sex sexual contact, and disclosure--among 164 sexual-minority young adults. Based on interviews, results indicated the value of assessing gender differences in the context, timing, spacing, and sequencing of sexual identity milestones. Adolescent males had an earlier onset of all milestones except disclosure. The context for sexual identity milestones were likely to be emotionally oriented for young women and sexually oriented for young men. The gap from first same-sex attractions (8-9 years of age) to first disclosure (around 18 years) averaged 10 years for both sexes. Young women followed label-first developmental trajectories; men were more likely to pursue sex before identifying themselves as gay. In terms of achieving sexual identity milestones, gender mattered, but it was not everything.

Sexuality of children and adolescents with developmental disabilities

Children and adolescents with developmental disabilities, like all children, are sexual persons. However, attention to their complex medical and functional issues often consumes time that might otherwise be invested in addressing the anatomic, physiologic, emotional, and social aspects of their developing sexuality. This report discusses issues of puberty, contraception, psychosexual development, sexual abuse, and sexuality education specific to children and adolescents with disabilities and their families. Pediatricians, in the context of the medical home, are encouraged to discuss issues of sexuality on a regular basis, ensure the privacy of each child and adolescent, promote self-care and social independence among persons with disabilities, advocate for appropriate sexuality education, and provide ongoing education for children and adolescents with developmental disabilities and their families.

Caring for individuals with a difference of sex development (DSD): a Consensus Statement

The term differences of sex development (DSDs; also known as disorders of sex development) refers to a heterogeneous group of congenital conditions affecting human sex determination and differentiation. Several reports highlighting suboptimal physical and psychosexual outcomes in individuals who have a DSD led to a radical revision of nomenclature and management a decade ago. Whereas the resulting recommendations for holistic, multidisciplinary care seem to have been implemented rapidly in specialized paediatric services around the world, adolescents often experience difficulties in finding access to expert adult care and gradually or abruptly cease medical follow-up. Many adults with a DSD have health-related questions that remain unanswered owing to a lack of evidence pertaining to the natural evolution of the various conditions in later life stages. This Consensus Statement, developed by a European multidisciplinary group of experts, including patient representatives, summarizes evidence-based and experience-based recommendations for lifelong care and data collection in individuals with a DSD across ages and highlights clinical research priorities. By doing so, we hope to contribute to improving understanding and management of these conditions by involved medical professionals. In addition, we hope to give impetus to multicentre studies that will shed light on outcomes and comorbidities of DSD conditions across the lifespan.

Psychosexual development of women with congenital adrenal hyperplasia

Women with congenital adrenal hyperplasia (CAH) (N = 31) and their unaffected sisters or female cousins (N = 15) participated in a study of psychosexual development. All participants were > or = 18 years of age (mean age, 25 years; range, 18-40). Comparisons were also made between the CAH women with the salt-wasting (SW) form of the disorder and those with simple virilization (SV). A psychosexual assessment protocol examined six variables: (1) sex assignment at birth (probands only); (2) recalled sex-typed behavior during childhood; (3) gender identity and gender role identification in adulthood; (4) relationship status; (5) sexual orientation in fantasy; and (6) sexual orientation in behavior. Salt-wasting status and sex assignment at birth were also ascertained for the CAH women who either refused to participate in the study (N = 10) or could not be traced (N = 13). Compared to the controls, the women with CAH recalled more cross-gender role behavior and less comfort with their sense of "femininity" during childhood. The two groups did not differ in degree of gender dysphoria in adulthood, although the probands showed more cross-gender role identification. Three of the nonparticipant probands were living, as adults, in the male social role (2 reared from birth as boys and 1 who changed from the female to the male social role during adolescence). The CAH women and the controls did not differ in relationship status (married/cohabiting vs. single). The CAH women had lower rates of exclusive heterosexual fantasy and fewer sexual experiences with men than the controls; however, the CAH women did not have more sexual experiences with women than the controls. Comparisons between the SW and SV revealed several differences: the SW were less likely to be assigned to the female sex at birth, recalled more cross-gender role behavior during childhood, were less likely to be married or cohabiting, and had lower rates of sexual experiences with men. The results were discussed in relation to the effects of prenatal androgens on psychosexual differentiation.

Sexual orientation in women with classical or non-classical congenital adrenal hyperplasia as a function of degree of prenatal androgen excess

46,XX individuals with classical congenital adrenal hyperplasia (CAH) due to deficiency of the enzyme, 21-hydroxylase, show variable degrees of masculinization of body and behavior due to excess adrenal androgen production. Increased bisexuality and homosexuality have also been reported. This article provides a review of existing reports of the latter and presents a new study aimed at replicating the previous findings with detailed assessments of sexual orientation on relatively large samples, and at extending the investigation to the mildest form, non-classical (NC) CAH. Also, this is the first study to relate sexual orientation to the specific molecular genotypes of CAH. In the present study, 40 salt-wasters (SW), 21 SV (simple-virilizing), 82 NC, and 24 non-CAH control women (sisters and female cousins of CAH women) were blindly administered the Sexual Behavior Assessment Schedule (SEBAS-A, 1983 ed.; H. F. L. Meyer-Bahlburg & A. A. Ehrhardt, Privately printed). Most women were heterosexual, but the rates of bisexual and homosexual orientation were increased above controls not only in women with classical CAH, but also in NC women, and correlated with the degree of prenatal androgenization. Classifying women by molecular genotypes did not further increase the correlation. Diverse aspects of sexual orientation were highly intercorrelated, and principal components analysis yielded one general factor. Bisexual/homosexual orientation was (modestly) correlated with global measures of masculinization of non-sexual behavior and predicted independently by the degree of both prenatal androgenization and masculinization of childhood behavior. We conclude that the findings support a sexual-differentiation perspective involving prenatal androgens on the development of sexual orientation.

Sexual behavior in adolescent and adult females with congenital adrenal hyperplasia

As part of a comprehensive interview study, 34 female patients with congenital adrenal hyperplasia (CAH) plus 14 control sisters (ages 11-41 yr.) reported on their psychosexual development and sexual orientation (90 items). Fewer patients than sisters had ever experienced love relationships and sexual activities with male partners (p < 0.05 to 0.001). Twenty percent of the patients and none of the sisters wished for and/or had had homosexual relationships; in the patients > 21 yr 44% expressed this interest (p < 0.07). For most items, patients with the salt-wasting variant of CAH (SW) differed more clearly from the sisters than the simple-virilizing patients (SV). For two scales "indicating" homosexual (HOM) and heterosexual orientation (HET) and for two indices of HOM/HET differences), the patients also revealed relatively stronger homosexual and/or weaker heterosexual interests than the sisters (p < 0.05 to 0.001). Here, too, the SW/sister differences were more clear-cut. These results corroborate earlier reports on both delays in reaching psychosexual milestones and increased rates of bisexual/homosexual fantasies and experiences in CAH women.

Brain pathology in pedophilic offenders: evidence of volume reduction in the right amygdala and related diencephalic structures

CONTEXT

Pedophilic crime causes considerable public concern, but no causative factor of pedophilia has yet been pinpointed. In the past, etiological theories postulated a major impact of the environment, but recent studies increasingly emphasize the role of neurobiological factors, as well. However, the role of alterations in brain structures that are crucial in the development of sexual behavior has not yet been systematically studied in pedophilic subjects.

OBJECTIVE

To examine whether pedophilic perpetrators show structural neuronal deficits in brain regions that are critical for sexual behavior and how these deficits relate to criminological characteristics.

DESIGN

Amygdalar volume and gray matter of related structures that are critical for sexual development were compared in 15 nonviolent male pedophilic perpetrators (forensic inpatients) and 15 controls using complementary morphometric analyses (voxel-based morphometry and volumetry). Psychosocial adjustment and sexual offenses were also assessed.

RESULTS

Pedophilic perpetrators showed a significant decrease of right amygdalar volume, compared with healthy controls (P = .001). We observed reduced gray matter in the right amygdala, hypothalamus (bilaterally), septal regions, substantia innominata, and bed nucleus of the striae terminalis. In 8 of the 15 perpetrators, enlargement of the anterior temporal horn of the right lateral ventricle that adjoins the amygdala could be recognized by routine qualitative clinical assessment. Smaller right amygdalar volumes were correlated with the propensity to commit uniform pedophilic sexual offenses exclusively (P = .006) but not with age (P = .89).

CONCLUSIONS

Pedophilic perpetrators show structural impairments of brain regions critical for sexual development. These impairments are not related to age, and their extent predicts how focused the scope of sexual offenses is on uniform pedophilic activity. Subtle defects of the right amygdala and closely related structures might be implicated in the pathogenesis of pedophilia and might possibly reflect developmental disturbances or environmental insults at critical periods.

Sexual differentiation of the brain and behavior

During the intrauterine period the human brain develops in the male direction via direct action of a boy's testosterone, and in the female direction through the absence of this hormone in a girl. During this time, gender identity (the feeling of being a man or a woman), sexual orientation, and other behaviors are programmed. As sexual differentiation of the genitals takes places in the first 2 months of pregnancy, and sexual differentiation of the brain starts during the second half of pregnancy, these two processes may be influenced independently of each other, resulting in transsexuality. This also means that in the case of an ambiguous gender at birth, the degree of masculinization of the genitals may not reflect the same degree of masculinization of the brain. Differences in brain structures and brain functions have been found that are related to sexual orientation and gender.

Gender change from female to male in classical congenital adrenal hyperplasia

The psychoendocrinology of the development of normal gender identity and its variations is poorly understood. Studies of gender development in individuals born with endocrinologically well-characterized intersex conditions are heuristically valuable for the disaggregation of factors that are acting in concert during normal development. Four 46,XX individuals with classical congenital adrenal hyperplasia (CAH) and atypical gender identity entered a comprehensive research protocol including systematic interviews and self-report inventories on gender role behavior and identity, sexual history, and psychiatric history. Some of the data on gender variables were compared to data from 12 CAH women with the salt-wasting variant (CAH-SW) with female gender identity. The four patients (ages 28, 35, 38, and 30 years) represented three different subtypes of classical early-onset CAH: 21-OH deficiency, simple virilizing (CAH-SV); 21-OH deficiency, salt-wasting (CAH-SW); and 11-beta-OH deficiency. Their medical histories were characterized by delay beyond infancy or lack of surgical feminization of the external genitalia and progressive virilization with inconsistent or absent glucocorticoid replacement therapy. Although three patients had undergone one or more genital surgeries, all had retained at least some orgasmic capacity. In regard to childhood gender-role behavior, the four gender-change patients tended to be more masculine or less feminine than (behaviorally masculinized) CAH-SW controls. All patients were sexually attracted to females only. The process of gender change was gradual and extended well into adulthood. The most plausible factors contributing to cross-gender identity development in these patients appeared to be neither a particular genotype or endocrinotype nor a sex-typing bias on the part of the parents but a combination of a gender-atypical behavioral self-image, a gender-atypical body image, and the development of erotic attraction to women. Implications for psychosocial management are also discussed.

Sexual identity development among ethnic sexual-minority male youths

The current research explores how ethnicity influences sexual identity development. Among 139 sexual-minority male youths, measures of sexual identity development assessed the timing and sequencing of developmental milestones, disclosure of sexual identity to others, internalized homophobia, and same- and opposite-sex relationship histories. Findings demonstrated that participants, regardless of ethnicity, experienced most identity milestones at developmentally appropriate ages, had moderately low levels of internalized homophobia, and became romantically and sexually involved with other males during adolescence. Differences across ethnic groups were found in the timing and sequencing of certain milestones, disclosure of sexual identity to family members, and romantic and sexual involvement with females.

Pubertal neuromaturation, stress sensitivity, and psychopathology

Normal adolescent development is often accompanied by transient emotional and behavioral problems. For most individuals with postpubertal-onset adjustment problems, there is a resolution by early adulthood and relative stability through the adult life span. But for a minority, adjustment problems escalate during adolescence and portend the development of serious mental illness in adulthood. In this article, we explore adolescent behavioral changes and neurodevelopmental processes that might contribute to stress sensitivity and vulnerability for the emergence of the mental disorders. Of particular interest is the role that hormonal changes might play in the expression of genetic vulnerabilities for psychopathology. Drawing on recent findings from clinical research and behavioral neuroscience, we describe the ways in which postpubertal hormones might alter brain function and, thereby, behavior. It is concluded that there are both activational and organization effects of hormones on the adolescent brain, and these contribute to developmental discontinuities in behavioral adjustment. Implications for adult psychopathology and preventive intervention are discussed.

Approach to assigning gender in 46,XX congenital adrenal hyperplasia with male external genitalia: replacing dogmatism with pragmatism

The goal of sex assignment is to facilitate the best possible quality of life for the patient. Factors such as reproductive system development, sexual identity, sexual function, and fertility are important considerations in this regard. Although some DSD gender assignments are relatively straightforward, those with midstage genital ambiguity and unclear gonadal function represent a major challenge. A recent major change in DSD care has been to encourage a male assignment for 46,XY infants with ambiguous genitalia who have evidence of testicular function and in utero central nervous system androgen exposure. In contrast, assignment of virilized 46,XX DSD patients remains female when ovaries and internal organs are present, regardless of the extent of virilization of the external genitalia. In this paper, we propose consideration of male assignment for these 46,XX patients who have fully developed male genitalia based on available outcome data.

The neurodevelopment of human sexual orientation

One of the most enduring and controversial questions in the neuroscience of sexual behaviour surrounds the mechanisms which produce sexual attraction to either males or females. Here, evidence is reviewed which supports the proposal that sexual orientation in humans may be laid down in neural circuitry during early foetal development. Behaviour genetic investigations provide strong evidence for a heritable component to male and female sexual orientation. Linkage studies are partly suggestive of X-linked loci although candidate gene studies have produced null findings. Further evidence demonstrates a role for prenatal sex hormones which may influence the development of a putative network of sexual-orientation-related neural substrates. However, hormonal effects are often inconsistent and investigations rely heavily on 'proxy markers'. A consistent fraternal birth order effect in male sexual orientation also provides support for a model of maternal immunization processes affecting prenatal sexual differentiation. The notion that non-heterosexual preferences may reflect generalized neurodevelopmental perturbations is not supported by available data. These current theories have left little room for learning models of sexual orientation. Future investigations, across the neurosciences, should focus to elucidate the fundamental neural architecture underlying the target-specific direction of human sexual orientation, and their antecedents in developmental neurobiology.

The magical age of 10

Developmental processes of "puberty" and their cultural contexts in understanding the emergence of sexual subjectivity, especially sexual attraction, prior to gonadarche are critically examined. In particular, we consider the hypothesis that "sexual attraction" follows the onset of adrenal puberty, termed adrenarche, precipitating the development of stable and memorable attraction toward others approximately by the age of 10. In a prior study, the authors suggested that adrenarche is a significant source of this developmental change in sexuality (McClintock, M., and Herdt, G., 1996). The inferential evidence from New Guinea is compared with recent studies from the United States, including clinical findings on "precocious puberty." We conclude with the question of whether the age of 10 is a human universal in the development of attraction and sexuality.

Prenatal androgens and gender-typed behavior: a study of girls with mild and severe forms of congenital adrenal hyperplasia

Gender-typed behaviors and interests were investigated in 26 girls, aged 2-10 years, affected with congenital adrenal hyperplasia (CAH) and in 26 unaffected girls matched for age. Girls with CAH were more interested in masculine toys and less interested in feminine toys and were more likely to report having male playmates and to wish for masculine careers. Parents of girls with CAH rated their daughters' behaviors as more boylike than did parents of unaffected girls. A relation was found between disease severity and behavior indicating that more severely affected CAH girls were more interested in masculine toys and careers. No parental influence could be demonstrated on play behavior, nor did the comparison of parents' ratings of wished for behavior versus perceived behavior in their daughters indicate an effect of parental expectations. The results are interpreted as supporting a biological contribution to differences in play behavior between girls with and without CAH.

Psychosocial predictors of delay of first sexual intercourse by adolescents

This investigation predicted adolescents' delay of intercourse onset from attitudes, social norms, and self-efficacy about refraining from sexual intercourse. Age, gender, ethnicity, and parental education were also examined as predictors and moderators of the relationships among the 3 psychosocial determinants and onset. The participants (N = 827), part of a cohort initially surveyed in the 9th grade, reported at baseline that they had never engaged in intercourse. The multivariable proportional hazards regression model suggested that adolescents with more positive attitudinal and normative beliefs, as well as those with a parent who graduated from college, were less likely to engage in intercourse in the follow-up period (up to approximately 2 years). Interventions that include an objective to delay onset may benefit from addressing psychosocial determinants, especially attitudes and norms about sexual intercourse.

Rearing piglets in a poor environment: developmental aspects of social stress in pigs

Effects of rearing conditions on the development of social relationships were investigated in female pigs. For that purpose, one group of piglets was reared in a poor environment (i.e., a commercially used indoor 4.2-m2 standard farrowing crate) and the other in an enriched environment (i.e., 0.5-ha outdoor pasture with half-open farrowing crates). After weaning, all piglets were housed in pairs under standard conditions. Dominant and subordinate individuals were distinguished within pairs and social relationships between members of a pair were studied in adulthood. The results show that pairs reared in a poor environment behave more aggressively. The subordinates of these pairs also develop symptoms indicative of chronic social stress exposure: i.e., they show a delayed onset of puberty, a smaller daily weight gain, and elevated basal cortisol levels that are also higher 5 h after an acute restraint stressor (tethering stress). No such deviations were found in subordinates reared in an enriched environment. It is concluded that rearing piglets in a poor environment may facilitate the development of social stress in adult (subordinate) pigs. Two underlying mechanisms may be proposed: a) deteriorated social skills lead to increased social stress, or b) a failure to cope with stressors in general, and the stress of being subordinate in particular, occurs in animals reared under poor conditions.

Effects of prenatal stress on development in mice: maturation and learning

Female CD-1 mice were stressed during the final week of gestation. Beginning 3 days after birth, until weaning, their pups were examined for eye opening, startle response, tooth eruption, surface righting, ability to cling to and climb an incline, tail pull reflex, rotation, linear movement and exploration. At 3 months of age, they were tested in a Morris Water Maze. Stressed animals were significantly lighter and shorter than non-stressed animals the first week after birth. By 3 days after birth, significantly fewer stressed animals could rotate or right themselves. By 6 days after birth, significantly fewer stressed animals could cling to or climb an inclined screen, or show the tail pull reflex. By 9 days of age, significantly fewer stressed animals had teeth. In contrast, by day 12 of age, significantly more stressed animals demonstrated exploratory behavior than did non-stressed animals. There were no sex differences in the ability of animals to perform these tasks at the same age. Stressed animals were significantly slower than non-stressed animals to reach the hidden platform in the water maze on all trials, and this difference was due to stressed females being slower to find the platform than non-stressed females, with no main effect of stress on males. This study supports and expands previous findings in rodents that prenatal stress can cause deficiencies in some early indices of physical maturation and also that these deficiencies can be continued into adulthood.

Gender identity development and issues

This article focuses on the psychosexual development of children and adolescents who have sex-typed behavioral patterns that correspond to the diagnosis of Gender Identity Disorder, as defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. The author provides an update on phenomenology and diagnosis, associated behavior problems, developmental course, biologic and psychosocial influences, and treatment and ethical issues.

Psychosexual development in genetic males assigned female: the cloacal exstrophy experience

Genetic males who have cloacal exstrophy, a rare, severe pelvic field defect that leads to aphallia, traditionally have been socially, legally, and surgically sex-assigned female at birth and reared female, despite a male karyotype and a typical male prenatal hormonal milieu. Psychosexual development in such children previously has been unknown. Studies of 29 children revealed that despite the absence of the typical postnatal and pubertal androgen surges and the presence of female genitalia, all female-assigned subjects displayed a marked male-typical shift in psychosocial and psychosexual development. Nearly half of them have declared themselves male. Psychosexual development, including gender identity, in genetic and hormonal male neonates seems to be influenced heavily by prenatal androgen exposure. The clinical practice of surgical sex assignment at birth requires re-evaluation.

Age at puberty and mental illness. Towards a neurodevelopmental aetiology of Kraepelin's endogenous psychoses

The hypothesis of a neurodevelopmental aetiology of manic-depressive psychosis and schizophrenia is based on the relation between onset of puberty and the final regressive events in the central nervous system (elimination of 40% of neuronal synapses), and the discrepancy in body build in the two disorders which is similar to that between early- and late-maturing individuals. The marked rise in manic-depressive psychoses and decline in schizophrenia, particularly the non-paranoid categories, accompanying the decline in mean pubertal age by some four years during the past hundred years are taken as evidence that manic-depressive psychosis affects early maturers and schizophrenia particularly affects late maturers. Gender differences and social differentials accord with this theory. Redundancy of neuronal synapses characterises manic-depressive psychosis, and reduced density of synapses is a characteristic of schizophrenia, whereas 'normality', with optimal synaptic density, is in between.

Girls in detention: what are their characteristics? A project to explore and document the character of this target group and the significant ways in which it differs from one consisting of boys

In this article, the differences between male and female juvenile delinquency are discussed, from a behavioural and psychiatric perspective. At first the existence and nature of female juvenile delinquency is described. Further a, mostly literature-based, analysis of gender-related differences in juvenile delinquency and psychopathology is presented. Finally the results are given of a dossier research project into the behavioural aspects of female juvenile delinquency. Girls commit fewer and less serious offences. Girls in a detention centre are younger than boys in the same centre. Few Turkish and Moroccan girls are seen. The majority of girls are placed in a detention centre by a Civil Court Order. A relatively high percentage of retarded girls was found. Multiple sexual contacts from an early age, substance abuse, running away from home and truancy are risk behaviours in the development of female juvenile delinquency. In the majority of cases there was no record of previous contacts with the law. It seems as if there are gender-related factors according to the development of female juvenile delinquency. Answers on age-differences, early sexual development, the relation between behaviour and psychiatric diagnosis, the role of the risk behaviours in the development of the girls, intelligence and the reasons for placing girls in a detention centre should throw light on the development process of female juvenile delinquents.

Puberty, sexual development and eating disorders in adolescent outpatients

This study examined puberty and psychosexual state in a clinical sample of adolescents attending for assessment because of eating disorders (ED). A total of 57 adolescents (girls) aged 14-21 years (mean age 16.9 years) having either anorexia nervosa (AN) or bulimia nervosa (BN) were studied by semi-structured interviews and structured self-report questionnaires considering the timing of menarche, dating and attitudes to sexuality. The age at menarche did not differ statistically significantly between AN and BN. It was significantly lower in the BN group than in the normal population, but no statistically significant difference was found between the AN group and normal population. The general attitudes to sexuality were more negative in the AN group than in the BN group. In the AN group, there were also fewer dating experiences and interest in dating than in the BN group. After controlling for the effect of age, age at menarche and duration of ED, negative attitudes to sexuality and no dating experiences were still best predicted by AN. The results suggest different ways of coping with the developmental challenges in sexuality in AN and BN during adolescence.