This is the 2007 version. Click here for the 2017 chapter 16 table of contents.

Sexual Disorders and Sex Therapy

Gender Dysphoria

Sex and gender are not the same thing. Sex is a biological activity. As behavior, sex is activity aimed at sexual satisfaction. It may or may not be directed at another person. Gender, as psychologists use the term, is a person's psychological identification as a male or female.

What is the difference between sex and gender?

What is gender dysphoria? How might it be explained?

Gender dysphoria is distinct from homosexuality. Dysphoria is the opposite of euphoria; it means distress and dissatisfaction. Gender dysphoria refers to alienation and dissatisfaction with one's outward gender. A gender dysphoric person feels like a female in a male body, or a male in a female body.

Such a mismatch may be due to hormone fluctuations during critical periods of development in the womb. As we saw in the first section of this chapter, hormones can alter the development of internal reproductive organs, external reproductive organs, and sex-typical behaviors...all at different times. A person's inner sexual identity may be formed at a different time than one's sexual organs. If testosterone is present during one phase but not the other, the result would be a mismatch between inner and outer sexual identity.

What is a transsexual or transgendered person?

During the 1960s and 1970s many sex-change operations were performed for people who genuinely felt "trapped in the wrong body." A person who switches from one gender to the other is called a transsexual transsexual or (more recently) a transgendered individual. Surgery can complete the outward transition, if it is desired. After a detailed examination of the individual's entire life history and hormonal makeup, plus a waiting period to make sure the decision was not impulsive, a doctor may use surgical procedures to alter the external genitalia. Hormones complete the process, adding breast development to males or body hair to females.

What could or could not be changed? How did transsexuals try to appear feminine?

The pitch of the voice cannot be changed, because this depends on the structure of the voicebox. Mannerisms characteristic of the opposite sex can be cultivated, however, and historically transsexuals after an operation sometimes adopted exaggerated, sexually stereotyped behaviors. One study showed male-to-female transsexuals were more likely to use feminine mannerisms, posture, and movement than a control group of women "selected for their feminine appearance" (Allgeier & Allgeier, 1984).

A person who receives a sex-change operation sometimes presents a convincing appearance as an individual of the opposite sex. On the other hand, some people cannot pass for the opposite sex, even after surgery, no matter how hard they try. A sex-change operation, hair removal, and female hormones still leave voice, height, and facial bone structure unchanged.

Why did Johns Hopkins stop doing sex-change operations?

Johns Hopkins University Medical Center, which pioneered sex change operations, did a long-term follow-up study comparing 29 transsexuals who had received sex-change surgery with 21 gender dysphoric individuals who did not have surgery. Years after the surgery, the two groups did not differ in educational attainments, job stability, or adjustment to marital relations (Restak, 1979). The research also showed that many sex-change patients were dissatisfied with the appearance of their surgically reconstructed sexual organs.

What alternative to surgery is common now?

Given the expensive and irreversible nature of the changes, this research discouraged sex-change operations. Consequently, while sex-change operations are still performed today, they are not performed as frequently or readily as in the early 1970s, and most transgendered people (as they became called in the 1990s) dress and act the role of the opposite sex without surgery.

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Copyright © 2007-2011 Russ Dewey