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Myth and Science of Sexuality: Disordered or Just Different? By Veronica Drantz, PhD Prepared for the Ethical Humanist Society of Chicago October 10, 2010
The Myth:  “The Gender Binary” ,[object Object],[object Object]
The Science: “Organization – Activation” Mechanism ,[object Object],[object Object],[object Object]
Sexual Differentiation of Internal Genitalia Figure 25-4  Embryonic differentiation of male and female internal genitalia (genital ducts) from wolffian (male) and müllerian (female) primordia.
Sexual Differentiation of  External Genitalia Figure 25-5  Differentiation of male and female external genitalia from indifferent primordial structures in the embryo.
Sexual Development in Mammals Figure 25-6  Diagrammatic summary of normal sex determination, differentiation, and development in humans. MIS, müllerian inhibiting substance; T, testosterone; DHT, Dihydrotestosterone
Male Testosterone Levels  Figure 25-8  Plasma testosterone levels at various ages in human males.
Mechanism of Steroid Hormone Action  Brain Figure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).
There Is Only One Sex! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sex Has Many Levels ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Primary sex characteristic
Core Sexuality – Nature or Nurture? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
John Money "Neutrality-at-Birth“ Theory ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Psychologist
Milton Diamond  “Sexuality-at-Birth" Theory ,[object Object],[object Object],[object Object],[object Object],Biologist
1959 – Breakthrough at University of Kansas ,[object Object],[object Object],[object Object],[object Object]
Diamond Versus Money ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The David Reimer Story “Identical Twins Case” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colapinto, John.  As Nature Made Him - The Boy Who Was Raised As A Girl   HarperCollins (2000)
Joan/Brenda Becomes John/David ,[object Object],Beh HG, Diamond M. An Emerging Ethical and Medical Dilemma: Should Physicians Perform Sex Assignment on Infants with Ambiguous Genitalia? MICHIGAN JOURNAL OF GENDER & LAW 7: 1-63, 2000
Colapinto, John.  As Nature Made Him - The Boy Who Was Raised As A Girl   HarperCollins (2000)
[object Object],[object Object],[object Object],[object Object],[object Object],David Reimer (1965-2004)
Intersex People Curtis Hinkle - Founder Organization Intersex International
Androgen Insensitivity Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],B rain
 
CAIS People Feel Like Women! Luria, Z., Friedman, S., and Rose, M.D.  HUMAN SEXUALITY.  New York:  John Wiley & Sons, 1987. Forbes, C.D. and Jackson, W.F.  A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE.  England:  Mosby-Wolfe (1993)
Partial AIS (2-5): Cannot Predict  Sexual Identity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Numbered I through 7 in order of increasing severity (more defective masculinization ) Adapted from  Quigley CA, DeBellis A, Marschke KB, El-Awady MK, Wilson EM, French FS.  Androgen Receptor Defects: Historical, Clinical, And Molecular Perspectives.  ENDOCRINE REV, 1 6:282; (1995)  with permission. In:  Diamond, Milton and Watson, Linda Ann.  Androgen Insensitivity Syndrome And Klinefelter’s Syndrome: Sex And Gender Considerations.  CHILD ADOLESC PSYCHIATRIC CLIN N AM 13: 623—640 (2004)
Congenital Adrenal Hyperplasia (CAH) ,[object Object],[object Object],Figure 22-7  Outline of hormone biosynthesis in the zona fasciculata and zona reticularis of the adrenal cortex. The major secretory products are underlined. The enzymes for the reactions are shown on the left and at the top of the chart. When a particular enzyme is deficient, hormone production is blocked at the points indicated by the shaded bars . Barrett KE, Barman SM, Boitano S, and Brooks HL.  GANONG’S REVIEW OF MEDICAL PHYSIOLOGY 23 rd  ed.  Lange Medical Books/McGraw-Hill (2010)
Five Degrees of Virilization Affecting the Urogenital Sinus and External Genitalia in Females Hines M, Brook C., Conway, G.S.  Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And Recalled Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasia (CAH).  J SEX RES, 41: 75-81 (2004)
Congenital Adrenal Hyperplasia (CAH)   Luria, Z., Friedman, S., and Rose, M.D.  HUMAN SEXUALITY.  New York:  John Wiley & Sons (1987) Forbes, C.D. and Jackson, W.F.  A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE.  England:  Mosby-Wolfe (1993)
Frequency of CAH ,[object Object],[object Object]
CAH (Adrenogenital Syndrome) Luria, Z., Friedman, S., and Rose, M.D.  HUMAN SEXUALITY.  New York:  John Wiley & Sons (1987)
Sexuality of CAH Women ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alex (46XX, CAH)
Cloacal Exstrophy ,[object Object],[object Object],[object Object],Bladder Extrophy and absence of the penis green arrows: everted bladder; blue arrows the scrotum; yellow arrows: umbilcal cord
Prenatal Androgen - Major Factor in Development of Sexual Identity ,[object Object],[object Object]
The Sexual Brain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Netter, Frank H.  The CIBA COLLECTION OF MEDICAL ILLUSTRATIONS.  Vol I.  Nervous System.  Part I.  Anatomy & Physiology.  New York:  CIBA (1983)
The Hypothalamus Drives You: -Hunger -Thirst -Sleep -Body Rhythms -Sex Barrett KE, Barman SM, Boitano S, and Brooks HL.  GANONG’S REVIEW OF MEDICAL PHYSIOLOGY 23 rd  ed.  Lange Medical Books/McGraw-Hill (2010)
Anterior Hypothalamus Governs Sexual Behavior in Mammals Figure 25-28  Loci where implantations of estrogen in the hypothalamus affect ovarian weight and sexual behavior in rats, projected on a sagittal section of the hypothalamus. The implants that stimulate sex behavior are located in the suprachiasmatic area above the optic chiasm (blue area), whereas ovarian atrophy is produced by implants in the arcuate nucleus and surrounding ventral hypothalamus (red). MB, mamillary body
[object Object],[object Object],Same Anatomy of Anterior Hypothalamus in All Mammals Paredes, Raul G., and Baum, Michael J.  Role Of The Medial Preoptic Area/Anterior Hypothalamus In The Control Of Masculine Sexual Behavior  ANNUAL REVIEW OF SEX RESEARCH  (1997)  Allen, L. S., Hines, M., Shryne, J. E., and Gorski, R. A.  Two Sexually Dimorphic Cell Groups In The Human Brain.  JOURNAL OF NEUROSCIENCE, 9: 497-506 (1989) Byne, William.  The Medial Preoptic And Anterior Hypothalamic Regions Of The Rhesus Monkey: Cytoarchitectonic Comparison With The Human And Evidence For Sexual Dimorphism.  BRAIN RESEARCH 793: 346-350 (1998)
Biology of Sexual Orientation ,[object Object],[object Object]
Same-sex Behavior In Nearly All Animals  ,[object Object],[object Object],[object Object],[object Object]
Sexual Orientation & INAH3 LeVay, S.  A Difference In Hypothalamic Structure Between Heterosexual And Homosexual Men.  SCIENCE, 253: 1034–1037 (1991)
Confirmation of LeVay’s Findings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anterior Hypothalamus Is Activated by Sex Pheromones ,[object Object],Berglund H, Lindstr ö m P, Savic I. Brain response to putative pheromones in lesbian women. PNAS  103:8269-8274 (2006)   AND =  progesterone derivative 4,16-androstadien-3-one EST =  estrogen-like steroid estra-1,3,5(10),16-tetraen-3-ol (EST)  Subject Activation of anterior hypothalamus Heterosexual males EST Homosexual males AND Heterosexual females AND Homosexual females EST
Genetics of Gayness in Males ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Genetics of Lesbianism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Biology of Sexual Identity Harry Benjamin's Syndrome (HBS)    Estimated incidence of HBS is 1 in 100.000 live births
Sexual Identity & Bed Nucleus of the Stria Terminalis Figure 2 : Representative sections of the BSTc innervated by vasoactive intestinal polypeptide (VIP). A: heterosexual man; B: heterosexual woman; C: homosexual man; D: male-to-female transsexual. Bar=0.5 mm. LV: lateral ventricle. Note there are two parts of the BST in A and B: small sized medial subdivision (BSTm), and large oval-sized central subdivision (BSTc) Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F..  A Sex Difference in the Human Brain and its Relation to Transsexuality.  NATURE, 378: 68-70 (1995) Looking at presynaptic neurons from amygdala (emotional input) synapsing with postsynaptic neurons of anterior hypothalamus (sexual behavior)
Bed Nucleus of the Stria Terminalis ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2 nd  Study:  Somatostatin Results Parallel VIP Results  Looking at postsynaptic neurons of anterior hypothalamus receiving input from amygdala
FtM Has Same Neuron Number in BSTc as Typical Male ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sexual Identity & INAH3 ,[object Object],[object Object],[object Object],[object Object]
MtF – Atypical Hypothalamic Response to Sex Pheromones ,[object Object],Berglund H, Lindström P. Dhejne-Helmy C, Savic I.   Male-to-Female Transsexuals Show Sex-Atypical Hypothalamus Activation When Smelling Odorous Steroids CEREB CORTEX 0:bhm216v1-bhm216 (2007)
Genetics of Transsexuality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Brain
Homosexuality – How to Explain in Darwinian Terms?   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fa'afafine A b roadly accepted social class in Samoa
Fa'afafine  Do “Kin Selection” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Gay Genes Spread Through Kin Selection ,[object Object],[object Object],[object Object],[object Object]
Is Gender-atypical Identity a Mentally Distressing Disorder? ,[object Object],[object Object],Vasey, P, Pocock, D . VanderLaan, D.  Kin Selection And Male Androphilia In Samoan Fa'afafine.  EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)
Transsexuality Not Distressing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object]
Organization-Activation Theory ,[object Object],Garcia-Falgueras A, Swaab DF.  Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC NEUROENDOCRINOLOGY 17: 22-35 (2010)
Critical Periods of Genitalia and Brain Are Different       ,[object Object],[object Object],[object Object]
Core Sexuality: Nature - Not Nurture! ,[object Object],[object Object]
Three Dimensions of Core Sexuality ,[object Object],[object Object],[object Object],Everyone occupies a point in this three-dimensional space! Gynemorphic Andromorphic Gynecentric Androcentric Gynephilic Androphilic
Sex    Gender ,[object Object],[object Object],[object Object],Castor Semenya Controversy over whether this South African eighteen-year old should be allowed to compete as a woman continues
The “Gender Binary” ,[object Object],[object Object],[object Object],[object Object]
NORTH AMERICA ,[object Object],Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Two-spirits Muxes
SOUTH AMERICA ,[object Object],Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Viados Travestís
EUROPE ,[object Object],Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Sworn Virgin Sworn Virgin Catamites
AFRICA ,[object Object],Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Mashoga
MIDDLE EAST ,[object Object],Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
ASIA ,[object Object],Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Hijras
ASIA continued ,[object Object],Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Kathoey Kathoey
ASIA-PACIFIC POLYNESIA ,[object Object],Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Fa’afafine
INDONESIA ,[object Object],Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Waria bakla
Disordered or Just Different? ,[object Object],[object Object],[object Object],[object Object]
Medical Profession’s Treatment of LGBT People Homosexuality was removed from the list of mental disorders by the World Health Organisation in 1990 1952 (DSM-I) Sociopathic Personality Disorders 1968 (DSM-II) Sexual Deviation 1970 Gay rights activists storm APA annual convention 1972 APA annual meeting –first-ever panel of non-patient homosexuals” and Dr. Anonymous 1973 (DSM-II Revision) Deletion of Homosexuality Substitution of Sexual Orientation Disturbance (Homosexuality is not illness but supposedly discomfort with being persecuted as a homosexual is an illness) 1980 (DSM-III) Gender Identity Disorder (GID) Ego-dystonic Homosexuality (formerly SOD) 1987 (DSM-III Revision) Homosexuality omitted entirely (Ego-dystonic homosexuality/SOD removed.  It’s normal to not want to be persecuted & empirical data to support diagnosis is lacking) )-> 2000 (APA Position Statement) Ethical psychiatrists should stop conversion or “reparative therapies”
The Science on Sexual Orientation ,[object Object],[object Object],[object Object],[object Object]
Anti-gay Quackery - “Reparative Therapy”
The Science on Sexual Identity ,[object Object],[object Object],[object Object]
The Quackery Against Transsexuals - GID ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Science on Intersexuality ,[object Object],[object Object],[object Object]
Intersex Problems Are Socio-cultural ,[object Object],[object Object],Curtis Hinkle - Founder Organization Intersex International http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html
The Quackery - Intersex People Are Necessarily Disordered ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
OUTCOMES:  Ambiguous Genitalia “Normalization” Surgery  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Pigeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bah burg, HFL, Rock, JA, Brown, TR, Canella, SJ, Market A, Ngai KM, Money J, Berkovitz GD.  Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p  (2002)
Genital “Normalization” Surgery - Dismal Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Migeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bahlburg, HFL, Rock, JA, Brown, TR, Casella, SJ, Maret A, Ngai KM, Money J, Berkovitz GD.  Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p  (2002)
Diamond, M.  Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004) NEW STANDARDS OF CARE FOR INTERSEX PATIENTS American Academy Pediatricians year 2000 British Association Pediatric Surgeons year 2001 #1. General moratorium on sex assignment cosmetic surgery No surgical moratorium (In1999, AAP decided that surgical moratorium was “unrealistic” because it was hypothesized that parents would not accept it) No surgical moratorium #2. Moratorium should not be lifted unless and until studies show outcomes are positive Recognized need for more research and greater candor and honesty Recognized need for more research and greater candor and honesty #3. Efforts should be made to undo effects of past physician deception and secrecy No call back to families or individuals that had previous treatment No call back to families or individuals that had previous treatment Response to intersex birth “ Social emergency” Informed consent includes “possibility of non-operative management” Gender assignment All virilized females (CAH or maternal androgen) should be girls (because of retained fertility) Gender assignment on individual basis; may include cultural considerations Clitoral surgery Infants raised as girls “will usually require clitoral reduction” “ There is a strong case for no clitoral surgery in lesser degrees of clitoromegaly” Penile surgery PAIS infants “in whom a very small phallus mandates a female sex of rearing” should have testes removed The risk of malignant testicular changes in AIS is small
Pediatric Policy Is Reprehensible  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Collaboration with participants in International Consensus Conference on Intersex organized by Lawson Pediatric Endocrine Society and European Society for Paediatric Endocrinology Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)
Pediatric Policy Must Change ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intersex People Now Can Also Have “Gender Incongruence”! ,[object Object],[object Object],[object Object]
Discrimination Against LGBTI People Is a Socio-cultural Disorder ,[object Object],[object Object],[object Object],[object Object]
Birthright:  To Be Who We Are ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Myth and science of sexuality short

  • 1. Myth and Science of Sexuality: Disordered or Just Different? By Veronica Drantz, PhD Prepared for the Ethical Humanist Society of Chicago October 10, 2010
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  • 4. Sexual Differentiation of Internal Genitalia Figure 25-4 Embryonic differentiation of male and female internal genitalia (genital ducts) from wolffian (male) and müllerian (female) primordia.
  • 5. Sexual Differentiation of External Genitalia Figure 25-5 Differentiation of male and female external genitalia from indifferent primordial structures in the embryo.
  • 6. Sexual Development in Mammals Figure 25-6 Diagrammatic summary of normal sex determination, differentiation, and development in humans. MIS, müllerian inhibiting substance; T, testosterone; DHT, Dihydrotestosterone
  • 7. Male Testosterone Levels Figure 25-8 Plasma testosterone levels at various ages in human males.
  • 8. Mechanism of Steroid Hormone Action Brain Figure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).
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  • 17. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 18.
  • 19. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 20.
  • 21. Intersex People Curtis Hinkle - Founder Organization Intersex International
  • 22.
  • 23.  
  • 24. CAIS People Feel Like Women! Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons, 1987. Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE. England: Mosby-Wolfe (1993)
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  • 27. Five Degrees of Virilization Affecting the Urogenital Sinus and External Genitalia in Females Hines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And Recalled Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasia (CAH). J SEX RES, 41: 75-81 (2004)
  • 28. Congenital Adrenal Hyperplasia (CAH)   Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons (1987) Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE. England: Mosby-Wolfe (1993)
  • 29.
  • 30. CAH (Adrenogenital Syndrome) Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons (1987)
  • 31.
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  • 35.
  • 36. The Hypothalamus Drives You: -Hunger -Thirst -Sleep -Body Rhythms -Sex Barrett KE, Barman SM, Boitano S, and Brooks HL. GANONG’S REVIEW OF MEDICAL PHYSIOLOGY 23 rd ed. Lange Medical Books/McGraw-Hill (2010)
  • 37. Anterior Hypothalamus Governs Sexual Behavior in Mammals Figure 25-28 Loci where implantations of estrogen in the hypothalamus affect ovarian weight and sexual behavior in rats, projected on a sagittal section of the hypothalamus. The implants that stimulate sex behavior are located in the suprachiasmatic area above the optic chiasm (blue area), whereas ovarian atrophy is produced by implants in the arcuate nucleus and surrounding ventral hypothalamus (red). MB, mamillary body
  • 38.
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  • 41. Sexual Orientation & INAH3 LeVay, S. A Difference In Hypothalamic Structure Between Heterosexual And Homosexual Men. SCIENCE, 253: 1034–1037 (1991)
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  • 46. Biology of Sexual Identity Harry Benjamin's Syndrome (HBS)   Estimated incidence of HBS is 1 in 100.000 live births
  • 47. Sexual Identity & Bed Nucleus of the Stria Terminalis Figure 2 : Representative sections of the BSTc innervated by vasoactive intestinal polypeptide (VIP). A: heterosexual man; B: heterosexual woman; C: homosexual man; D: male-to-female transsexual. Bar=0.5 mm. LV: lateral ventricle. Note there are two parts of the BST in A and B: small sized medial subdivision (BSTm), and large oval-sized central subdivision (BSTc) Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995) Looking at presynaptic neurons from amygdala (emotional input) synapsing with postsynaptic neurons of anterior hypothalamus (sexual behavior)
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  • 55. Fa'afafine A b roadly accepted social class in Samoa
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  • 77. Medical Profession’s Treatment of LGBT People Homosexuality was removed from the list of mental disorders by the World Health Organisation in 1990 1952 (DSM-I) Sociopathic Personality Disorders 1968 (DSM-II) Sexual Deviation 1970 Gay rights activists storm APA annual convention 1972 APA annual meeting –first-ever panel of non-patient homosexuals” and Dr. Anonymous 1973 (DSM-II Revision) Deletion of Homosexuality Substitution of Sexual Orientation Disturbance (Homosexuality is not illness but supposedly discomfort with being persecuted as a homosexual is an illness) 1980 (DSM-III) Gender Identity Disorder (GID) Ego-dystonic Homosexuality (formerly SOD) 1987 (DSM-III Revision) Homosexuality omitted entirely (Ego-dystonic homosexuality/SOD removed. It’s normal to not want to be persecuted & empirical data to support diagnosis is lacking) )-> 2000 (APA Position Statement) Ethical psychiatrists should stop conversion or “reparative therapies”
  • 78.
  • 79. Anti-gay Quackery - “Reparative Therapy”
  • 80.
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  • 87. Diamond, M. Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004) NEW STANDARDS OF CARE FOR INTERSEX PATIENTS American Academy Pediatricians year 2000 British Association Pediatric Surgeons year 2001 #1. General moratorium on sex assignment cosmetic surgery No surgical moratorium (In1999, AAP decided that surgical moratorium was “unrealistic” because it was hypothesized that parents would not accept it) No surgical moratorium #2. Moratorium should not be lifted unless and until studies show outcomes are positive Recognized need for more research and greater candor and honesty Recognized need for more research and greater candor and honesty #3. Efforts should be made to undo effects of past physician deception and secrecy No call back to families or individuals that had previous treatment No call back to families or individuals that had previous treatment Response to intersex birth “ Social emergency” Informed consent includes “possibility of non-operative management” Gender assignment All virilized females (CAH or maternal androgen) should be girls (because of retained fertility) Gender assignment on individual basis; may include cultural considerations Clitoral surgery Infants raised as girls “will usually require clitoral reduction” “ There is a strong case for no clitoral surgery in lesser degrees of clitoromegaly” Penile surgery PAIS infants “in whom a very small phallus mandates a female sex of rearing” should have testes removed The risk of malignant testicular changes in AIS is small
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