Abstract
Gender identity and gender role are expected to be consistent with gender assignment for optimal DSD management outcome. To our knowledge, our study is the first to attempt evaluation of gender related outcomes in Turkish DSD patients. After receiving institutional ethical board approval and subject (or parent) informed consent, subjects with DSD raised as girls (22 patients 46 XX DSD, 11 patients 46 XY DSD) answered 566 questions of the Minnesota Multiphasic Personality Inventory (MMPI) questionnaire including 60-item Masculinity-Femininity (MF) subscale which was the focus in this study. Controls (n: 50) were females similar to the probands in age, level of education, relationship status, and having a job or not also answered all questions. The answers were evaluated by a trained psychologist (Derya Inceoglu) on MMPI. For statistical purposes, seven findings were obtained from the data related to the MF subscale from the patients and controls. Of these seven findings (S1–S7), two were associated with masculinity (S3–S4) and another two were associated with femininity (S5–S6). In DSD patients, the percentages of masculinity findings were significantly higher when compared to controls (p < 0.001 and p < 0.001 for S3 and S4, respectively). In controls, the percentages of femininity findings were significantly higher when compared to DSD females (p < 0.001 and p < 0.001 for S5 and S6 respectively). There was no significant difference between 46 XX DSD patients and 46 XY DSD patients with respect to the percentage of any of the seven findings. Two patients requested gender change to male; only these two patients had the finding stating that sexual impulses could come to existence as actions (S7). In conclusion efforts to identify modifiable factors with negative impact and thus modifying them, and professional guidance may be important in minimizing the encountered gender related problems in DSD patients.
Highlights
In Turkish children with disorders of sex development (DSD) raised as females aged 6 months to 14 years at the time of evaluation, gender role was found to be appropriate for their gender of rearing but a male or neutral gender self-perception was reported in some of the girls [14]
In this study, we aimed to evaluate the two gender related long-term outcomes, namely gender identity and gender role, in our DSD patients raised as females
Of the seven findings which were obtained from our data, two findings (S1, S2) were related to undeveloped gender identity, or to gender identity not differentiated to one direction, neither to female nor to male
Summary
Previous studies indicated contentment with the sex of rearing in the majority of patients with disorders of sex development (DSD) raised as females [1,2,3], more recent reports suggest revision of views on female gender assignment in DSD patients to minimize unfavorable outcomes [4,5,6,7,8,9,10,11,12].At least three aspects of human psychosexual differentiation show sex-dimorphic differences which are gender identity, gender role, and sexual orientation [13]. In another study from Turkey, the results of surgical modalities for 55 children with ambiguous genitalia were evaluated after an average period of 4.1 years after the surgeries [15]. Some of these patients are some of the subjects of the present study. Among the 10 patients of postpubertal age at that time, none of them had sexual experience and issues related to gender role and gender identity had not been evaluated
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