Dr Ayodhya S. MalalagamaConsultant PsychiatristBase Hospital Warakapola

Sri Lanka College of Sexual Health and HIV Medicine

22nd Annual Scientific Sessions – 2017

7th October

Boys Don't Cry

1999 American biographical film

Brandon Teena

Violence Against the Transgender Community in 2017Human Rights Campaign Foundation Overview

National Center for Transgender Equity and the National Gay and Lesbian Task Force 2011

Sexual identity

Gender identity

Biological Cultural

Intercultural Communication: The Indian ContextRao RN, Thombre A 2015

Sexual development

Gender development

Sexual diamorphism

Gender bias

IntrinsicBiologicalepigenetic

ExtrinsicEnviornmentalcultural

Gender Identity

Gender Plasticity

Nascent Gender Identity

Sexuality

Personality

DisordersAnxieties

Peer interactions

Sexuality

PubertyPhysical

dev

Cisgender

Gender identity consistent with the

sex they were assigned at birth

Transgender

Gender identity that does not match the

sex they were assigned at birth.

Gender Spectrum

Gender Spectrum Theory Angela N. Tharp

TerminologyGender binary Gender Non binary (GNB)

Fluctuation of gender identity

some days / rather times awareness of a certain gender has suddenly grown strong in a

person in that very moment, without question

Gender fluid

Agender/genderless/Gender neutral/Neutrois

Androgyne Gender which is simultaneously feminine and masculine

although not necessarily in equal amounts

Western society currently recognizes no set gender roles for androgynes

Pangender

Non binary gender terms

gender ambiguous

gender bender

gender blender

gender smoothie

gender expansive

masculine of center

feminine of center

Ehrensaft D. 2011 Gender Born, Gender Made: Raising Healthy Gender-Nonconforming Children. New York, NY: The Experiment. 290 p. 2

Transsexual

Dual role transvestism

Fetishistictransvestism

Buhrich N 1977

Transgender / Transsexual

Prevalence: 1 in 30 000 natal males / 1 in 100 000 natal females

(Hoenig 1974)

Prevalence of self-reported transgender identity in children, adolescents and adults : 0.5 to 1.3%.

(Zucker 2017)

Refers to the broad spectrum of individuals who transiently or persistently identify with a gender different from their gender at birth.

Gender Identity Disorder

A. Marked incongruence between one’s experienced/ expressed gender and assigned gender, of at least 6 months duration, as manifested by 2 or more of the following indicators:

2. Strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender

3. Strong desire for the primary and/or secondary sex characteristics of the other gender

4. Strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)

5. Strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)

6. Strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)

B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning, or with a significantly increased risk of suffering, such as distress or disability

Is gender dysphoria a mental illness?

Sexual health and HIV

(Reisner 2010)

(Keuroghlian AS. Sexual Health among Transgender People. National LGBT health education centre)

• Most research on risk for transgender women also assumes heterosexuality

• Being the receptive partner involving penetration (Bauer 2015).

• Due to lack of funding, research is focused mainly on HIV risk and prevention

• Not on other STIs

• or sexual health concerns, such as fertility or pregnancy(Reisner 2016).

All transgender persons should be screened at

least once for HIV. Repeat screening is based on HIV risk

assessment.National guidelines from the U.S. Centres for Disease Control (CDC) U.S. Preventive Services Task Force (USPSTF)

Effective risk assessment

References

1. Tharp AN. Gender Spectrum Theory.2. Madeline B. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People,

Centre of Excellence for Transgender Health. June 17 (2), 2016.3. https://www.genderspectrum.org/quick-links/understanding-gender4. Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender

nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232.5. Eden K, Wylie K, Watson E. Gender dysphoria: recognition and assessment. Advances in Psychiatric Treatment. 18:2

-11.2012.6. Gates GJ. How many people are lesbian, gay, bisexual and transgender. The Williams Institute :4; 2011.7. http://pulitzercenter.org/reporting/Thailand-empower-don’t-pity-trans-sex-worker8. Reisner SL, Perkovich B, Mimiaga M J. A mixed methods study of the sexual health needs of New England transmen

who have sex with nontransgender men. AIDS patient care and STDs, 24(8), 501-513. 2010.9. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N. HIV/AIDS Prevention Research Synthesis

Team. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS and Behavior, 12(1), 1-17.2008.

10.Buhrich N, McConaghy N. Can Fetishism Occur in Transsexuals?. Archives of Sexual Behavior. 6;3.1977.