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BMC Urology Mar 2024Aphallia is a rare congenital anomaly often associated with other urogenital anomalies. The management of aphallia cases for both the immediate and long-term treatment...
BACKGROUND
Aphallia is a rare congenital anomaly often associated with other urogenital anomalies. The management of aphallia cases for both the immediate and long-term treatment of patients with aphallia pose a major dilemma. Patients are at risk for psychosocial and psychosexual challenges throughout life.
METHODS
A systematic review was conducted on aphallia cases. We searched online databases until March 2023 for relevant articles and performed according to the PRISMA-P guidelines.
RESULTS
Of the 43 articles screened, there were 33 articles included. A total of 41 patients were analyzed qualitatively. Asia is the region with the most aphallia cases with 53% (n:22), while the United States is the country with the most most reported aphallia cases 31% (n:13). Most cases were identified as male sex (n: 40), and most cases were neonate with 68% (n:28) cases. Physical examination generally found 85% (N = 35) with normal scrotal development and palpable testes. The most affected system with anomalies is the genitourinary system with fistulas in 80% (n:29) cases. Initial management in 39% (n:16) of patients involved vesicostomy. Further management of 31% (n:13) included phalloplasty or penile reconstruction, and 12% (n:5) chose female sex. 17% (n:7) of patients refused medical treatment or were lost to follow-up, and 12% (n = 5) patients deceased.
CONCLUSION
Aphallia is a rare condition and is often associated with other inherited genitourinary disorders. In most cases, physical examinations are normal except for the absence of a phallus, and laboratory testing shows normal results. The initial management typically involves the vesicostomy procedure. Subsequent management focuses on gender determination. Currently, male sex is preferred over female. Due to the significant variability, the rarity of cases, and the lack of long-term effect reporting in many studies on aphallia, further research is needed to minimize bias.
Topics: Infant, Newborn; Humans; Male; Female; Systematic Reviews as Topic; Meta-Analysis as Topic; Penile Diseases; Penis; Urogenital Abnormalities
PubMed: 38549119
DOI: 10.1186/s12894-024-01445-4 -
The American Journal of Occupational... May 2024Disruption in school and the workplace are health concerns for transgender people.
IMPORTANCE
Disruption in school and the workplace are health concerns for transgender people.
OBJECTIVE
To evaluate transgender individuals' thoughts and comfort with how others perceive their gender identity (social affirmation) and its association with outness in the workplace and mistreatment at work or school.
DESIGN
Cross-sectional survey.
PARTICIPANTS
Survey respondents older than age 18 yr from the Study of Transition, Outcomes & Gender cohort (N = 696; n = 350 assigned male at birth, n = 346 assigned female at birth [AFAB]).
OUTCOMES AND MEASURES
Ever "out" to employer and treated unfairly at work or school or fired from job. Predictors were high social affirmation and comfort with how others perceive own gender identity. Descriptive statistics and logistic regression were used for analyses.
RESULTS
Individuals reporting high social affirmation were less likely to experience mistreatment at work or school than those with low social affirmation (odds ratio [OR] = 0.57, 95% confidence interval [CI] [0.38, 0.86]). Individuals AFAB who felt comfortable with how others perceived their gender identity were less likely to be out to their employers than individuals AFAB who did not (OR = 0.45; 95% CI [0.20, 0.97]).
CONCLUSIONS AND RELEVANCE
Individuals with high social affirmation were less likely to experience work or school mistreatment, and feeling comfortable with how others perceive their gender identity did not signify the need to be out. Plain-Language Summary: Occupational therapy practitioners can play a pivotal role when working with transgender individuals by assisting in creating new routines for self-presentation at work or school, navigating social environments, and providing guidance in self-advocacy skills. Individuals assigned male at birth may be in greater need because they report lower levels of social affirmation and acceptance at school and work than individuals assigned female at birth.
Topics: Infant, Newborn; Female; Male; Humans; Adolescent; Transgender Persons; Gender Identity; Cross-Sectional Studies; Surveys and Questionnaires; Schools
PubMed: 38536733
DOI: 10.5014/ajot.2024.050485 -
Acta Psychologica May 2024Traditional questionnaires do not capture the complexity of how people are viewed by others and grouped into categories on the basis of what is inferred (or not) about... (Review)
Review
Traditional questionnaires do not capture the complexity of how people are viewed by others and grouped into categories on the basis of what is inferred (or not) about them. This is critical in applying an intersectionality framework in research because people are negatively impacted because of "who they are" but also based on "how others see them." The purpose of this project was to develop and validate a questionnaire, grounded in intersectionality theory and a nuanced understanding of social position, that can be applied in large-scale, population-based surveys and studies. Drawing on 61 existing quantitative surveys collecting identity-based information and 197 qualitative studies on intersectionality describing the complex ways in which people's social positions are constructed and experienced, we created a draft questionnaire comprising five parts: 1) Sex and Gender, 2) Sexuality and Sexual Orientation, 3) Cultural Context, 4) Disability, Health, and Physical Characteristics, and 5) Socioeconomic Status. A draft of the questionnaire was then reviewed by experts via the Delphi process, which gauged the accessibility of the questionnaire (e.g., language used, length) and the relevance of its content using a 5-point scale and open-ended questions. These responses were ranked, analyzed, and synthesized to refine the questionnaire and, ultimately, to obtain ≥75 % consensus on each questionnaire item and response option. The SAFE questionnaire provides an opportunity to take a significant step forward in advancing our understanding of the complex, intersectional nature of social participation and marginalization.
Topics: Humans; Male; Female; Intersectional Framework; Gender Identity; Surveys and Questionnaires; Sexual Behavior
PubMed: 38531268
DOI: 10.1016/j.actpsy.2024.104235 -
Annals of Family Medicine 2024Genital tucking (tucking) is the practice of hiding or minimizing the appearance of one's genitals and gonads. We aimed to better understand the prevalence of tucking...
Genital tucking (tucking) is the practice of hiding or minimizing the appearance of one's genitals and gonads. We aimed to better understand the prevalence of tucking and its potential effect on behavior and health. An online questionnaire was distributed to adults with a diagnosis of gender dysphoria or gender incongruence (n = 98). The risk of side effects increased with the length of tucking sessions ( = 0.046) with many patients avoiding medical care despite experiencing side effects. Health care providers should empathetically discuss tucking and its potential risks and benefits with transgender and gender diverse patients. Further research is needed to better quantify the potential risks involved with tucking and to assist in developing educational resources.
Topics: Adult; Humans; Transgender Persons; Gender Identity; Gender Dysphoria; Genitalia
PubMed: 38527819
DOI: 10.1370/afm.3076 -
Frontiers in Public Health 2024Adolescents face an increased risk of contracting sexually transmitted infections (STIs) with alarming data especially concerning HIV. Limited data exists for teenagers... (Review)
Review
Adolescents face an increased risk of contracting sexually transmitted infections (STIs) with alarming data especially concerning HIV. Limited data exists for teenagers regarding the influence of their gender identity (GI) and sexual orientation on the risk of STIs. This narrative review aims to analyse the available data to provide a comprehensive overview of STIs incidence and risk factors among adolescents, taking into account the unique circumstances related to various sexual orientations and GIs. Transgender and gender minority (TGM) youth experience more challenges accessing health services compared to cisgender youth. This is often attributed to non-inclusive health environments, barriers to obtaining medical gender affirmation, and an underestimation of sexual risk perception. Literature analysis has revealed that the majority of adolescents, both cisgender and TGM, have limited awareness regarding the risks associated with their sexual behaviors, the most common sexually transmitted diseases, and strategies for prevention, such as PrEP and HPV vaccination. Moreover, a significant portion of pediatricians possess limited knowledge and comfort in addressing various aspects of sexual health, particularly when it involves discussing topics such as sexual orientation, gender identity, and sexual behaviors with sexually active adolescents. This underscores the pressing need for enhanced education for pediatricians, specifically focusing on STIs diagnosis, prevention, and screening.
Topics: Female; Humans; Adolescent; Male; Transgender Persons; Papillomavirus Infections; Gender Identity; Sexually Transmitted Diseases; Risk Factors; HIV Infections
PubMed: 38515602
DOI: 10.3389/fpubh.2024.1342532 -
Social Science & Medicine (1982) Apr 2024Understanding the unique ways in which queer, trans, and non-monogamous young women and non-binary youth navigate and negotiate equitable intimate relationships is a...
"Nobody has written the book about what non-binary people should put forward in relationships": Exploring gender equity in relationships of queer, trans, and non-monogamous young women and non-binary youth in British Columbia, Canada.
Understanding the unique ways in which queer, trans, and non-monogamous young women and non-binary youth navigate and negotiate equitable intimate relationships is a first step toward strong research, programs/resources, and policies to support healthy relationship dynamics across the life course. Using a youth-engaged collaborative Reflexive Thematic Analysis, we aimed to explore how youth of diverse genders and relationship experiences understand gender equity in their relationships. Thirty cis- and transgender inclusive young women (46.7%) and non-binary youth (53.3%) aged 17-29 who were in a current (76.6%) or recent (in past 12 months, 23.4%) non-heterosexual and/or non-monogamous intimate relationship and residing in British Columbia, Canada, completed qualitative interviews between August and November 2022. Of the 30 youth, 53.3% reported having experience living as a trans person, 33.3% identified only as bisexual and 10% identified as only lesbian or gay, whereas the remaining 56.7% identified with ≥1 of: queer, pansexual, and demisexual. Participants identified that relationship equity requires: 1) Moving away from cis-heteronormative conceptualizations of gender roles and norms; 2) Actively working to dismantle hierarchal power structures by sharing power, responsibility, labour, and decision-making; and 3) Accommodating and affirming each person's unique needs and identities in a relationship. For theme one, youth further described the ways in which they re-imagined relationship norms and discussed the various challenges to resisting ingrained hierarchical cis-heteronormativity. This research contributes a greater understanding of how to create equitable and healthy relationships and has important implications for healthcare providers, educators, and policymakers working with queer, transgender, and non-monogamous youth.
Topics: Humans; Female; Male; Adolescent; British Columbia; Gender Equity; Sexual and Gender Minorities; Gender Identity; Transgender Persons; Books
PubMed: 38513562
DOI: 10.1016/j.socscimed.2024.116759 -
GMS Journal For Medical Education 2024The possibility of balancing career and family is meanwhile a central concern for most physicians when choosing a job. The aim of this study was to identify current...
INTRODUCTION
The possibility of balancing career and family is meanwhile a central concern for most physicians when choosing a job. The aim of this study was to identify current barriers and opportunities for physician education and career planning.
METHODS
This cross-sectional study was conducted as an online survey between 11/2021 and 02/2022 and targeted physicians at all career levels in Germany who were members of a clinical professional association. Alternative and consent questions were used to assess experiences/attitudes toward various aspects of life and career planning, as well as alternative work and parental leave models, depending on gender, specialty, and hierarchical level.
RESULTS
The majority of the 2060 participants were female (69%) and had children (66%). Many childless residents reported that they felt they had to choose between children and a career. The majority of female residents, specialists and attending physicians (Ø 55.5%) stated that they had experienced career losses as a result of taking parental leave, while most men did not share this experience (Ø 53.7%). 92% of all participants agreed with the statement that men and women have different career opportunities. Job-sharing models were considered feasible at all levels of the hierarchy by an average of 55.6% of all medical executives.
CONCLUSION
Parenthood and the use of parental leave and part-time work appear to have a significant impact on the career paths of those surveyed. Although the majority of directors of medical training programs are open to job-sharing models, further measures are needed in order to equalize career opportunities for men and women.
Topics: Child; Humans; Male; Female; Cross-Sectional Studies; Career Choice; Physicians; Medicine; Gender Identity; Surveys and Questionnaires
PubMed: 38504867
DOI: 10.3205/zma001660 -
Australasian Psychiatry : Bulletin of... Jun 2024To examine the compatibility of gender-affirming care with the principles and practices of psychiatry.
OBJECTIVE
To examine the compatibility of gender-affirming care with the principles and practices of psychiatry.
CONCLUSIONS
The assumption that there is no pathology involved in the development of gender diversity is a necessary precondition for the unquestioning affirmation of self-reported gender identity. Cases where psychosis is the undeniable cause of gender diversity demonstrate this assumption is categorically false. To protect this false assumption, gender-affirming guidelines forbid the application of the core psychiatric competencies of phenomenology and psychopathology to the assessment of gender diversity. They substitute the political goal of expanding personal liberty for the evidence-based medicine processes of clinical reasoning, rendering them incompatible with competent, ethical medical practice.
Topics: Humans; Psychiatry; Transgender Persons; Female; Ethics, Medical; Gender Dysphoria; Male; Gender Identity; Clinical Competence
PubMed: 38504453
DOI: 10.1177/10398562241239478 -
Archives of Sexual Behavior May 2024Gender self-identification (transgender) is not permitted in most Asian countries. In Taiwan, individuals recognized as transgender must meet requirements mandated by...
Gender self-identification (transgender) is not permitted in most Asian countries. In Taiwan, individuals recognized as transgender must meet requirements mandated by the Gender Recognition Act. Currently, lifting the requirement for proof of sex-reassignment surgery is pending. The aim of this study was to survey a large sample of Taiwanese to gain a better understanding of the general population's attitudes toward gender self-identification. A self-report survey, entitled "Opinions of Gender Self-Identification," collected demographic information and responses (agree = 1, disagree = 0) to 14 statements about transgender women and women's safety, personal rights, and the law; one statement discussed rights of transgender men to give birth; total scores ranged from 0 to 14. The online survey was distributed to non-government organizations across Taiwan and the Taiwanese islands and was available between April 16 and 30, 2022. Most of the 10,158 respondents were female (77.4%); ages of respondents ranged from 15 to > 65 years. The mean total score was 0.95 ± 2.27, indicating respondents strongly disagreed with support for transgender females; 91.56% disagreed with all statements. Although there were significant differences in scores between parents and non-parents, and those ≤ 35 years versus ≥ 36 years (p < .01), all strongly disagreed with gender self-identification. Given the majority of respondents were females, survey findings should be regarded with caution. Public acceptance of gender self-identification requires support from its residents. Our findings suggest that gender self-identification has not begun to approach even a moderate level of public support among survey respondents.
Topics: Humans; Taiwan; Transgender Persons; Female; Adult; Male; Middle Aged; Adolescent; Surveys and Questionnaires; Aged; Young Adult; Gender Identity; Attitude
PubMed: 38498257
DOI: 10.1007/s10508-024-02819-3 -
Endokrynologia Polska 2024Many transsexual women seek to feminise their voice through pitch elevation surgeries so that it becomes congruent with their gender identity. This study aims to...
INTRODUCTION
Many transsexual women seek to feminise their voice through pitch elevation surgeries so that it becomes congruent with their gender identity. This study aims to determine the safety and effectiveness of Wendler glottoplasty (WG) in vocal feminisation through the assessment of acoustic and aerodynamic parameters of the voice, as well as voice-related quality of life (QoL) in male-to-female transsexuals.
MATERIAL AND METHODS
We retrospectively reviewed the medical records of transsexual women who underwent WG for voice feminisation at our institution between 2016 and 2023. All acoustic and aerodynamic analyses, a voice self-assessment, and a videolaryngostroboscopic evaluation were performed in the immediate preoperative period and at the follow-up visit 6 weeks after the procedure.
RESULTS
A total of 11 patients with a mean age of 32.73 years were included. After WG, there was a significant fundamental frequency and speaking fundamental frequency increase of 109.64 Hz and 83.48 Hz, respectively (p < 0.001), representing an average rise by 9.71 semitones and 8.36 semitones (STs), respectively. No significant differences were found between the mean pre- and postoperative values of fundamental frequencies, frequency range, upper limit of the frequency range of spoken voice, and maximum phonation time. Contrarily, the mean lower limit of frequency range rose by 75.56 Hz (p < 0.001), representing an average increase of 10.56 STs. None of the assessed spirometric parameters changed significantly after WG (p > 0.05). The mean overall Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL) scores significantly improved after the surgery, decreasing by 24.54 points (p = 0.008) and 11.5 points (p = 0.001), respectively. A significant improvement was observed in the functional and emotional domains of VHI. Additionally, significantly fewer patients considered the overall quality of their voice to be "poor" after WG.
CONCLUSIONS
WG constitutes an effective method of surgical voice feminisation in male-to-female transsexuals with concurrent improvement in their voice-related QoL. Furthermore, it remains a safe procedure without persistent complications and negative influence on the acoustic-aerodynamic measures of the voice.
Topics: Humans; Quality of Life; Adult; Male; Retrospective Studies; Voice Quality; Female; Transgender Persons; Transsexualism; Glottis; Treatment Outcome; Middle Aged; Sex Reassignment Procedures
PubMed: 38497370
DOI: 10.5603/ep.98899