DOCSLIB.ORG

Genital Treatment Practices Under Scrutiny in Disorders of Sex Development

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Genital Treatment Practices Under Scrutiny in Disorders of Sex Development THE PAST THE PRESENT, THE FUTURE GENITAL TREATMENT PRACTICES IN DISORDERS OF SEX DEVELOPMENT UNDER SCRUTINY 3 “ The truth is rarely pure and never simple “ Oscar Wilde Promotor Prof. dr. Martine Cools Vakgroep Pediatrie en Genetica Copromotor Prof. dr. Piet Hoebeke Vakgroep: Urogynaecologie Overige leden promotiecommissie: dr. Griet De Cuypere dr. Arianne Dessens Decaan Prof. dr. Guy Vanderstraeten Rector Prof. dr. Anne De Paepe This doctoral thesis was made possible by a research fellowship grant from the Flanders Research Foundation (FWO). The research described was done at the Departments of Pediatric Endocrinology and Urology, University Hospital Ghent, Belgium, Ghent University 4 (Research groups Pediatrics and Genetics, and Urogynecology) and the Department of Pediatric Endocrinology, Sophia Children’s Hospital - Erasmus Medical Center Rotterdam, The Netherlands. Financial support for the distribution costs of this thesis was provided by Pelvitec. Document Design: Sterck.co Illustrations: Eva De Block & Sterck.co Printed by: University Press © Nina Callens ISBN: 978-90-9028-080-6 No part of this thesis may be reproduced, stored in a retrieval system or transmitted in any form or by any means without permission of the author, or, when appropriate, of the publishers of the publications. 5 Faculteit Geneeskunde & Gezondheidswetenschappen NINA CALLENS THE PAST, THE PRESENT, THE FUTURE: GENITAL TREATMENT PRACTICES IN DISORDERS OF SEX DEVELOPMENT UNDER SCRUTINY Proefschrift voorgelegd ter verkrijging van de graad van Doctor in de Medische Wetenschappen 2014 6 7 Acknowledgments It has taken a small army of people to get me through finishing this doctoral thesis and I have them all to thank. Warm thanks are due to all the remarkable women and men who participated in this project. They have been extraordinarily generous with their time, experience and honesty and this project was entirely dependent upon their willingness to share their stories. It was my good fortune to have been affiliated with a unique group of researchers, at Ghent University Hospital and Erasmus Medical Center Rotterdam, whose interest and knowledge regarding hormones, genitals, brain and behavior span the territory from molecules to (wo) man. I owe the greatest debt of gratitude to my advisor, Prof. dr. Martine Cools. Martine, you welcomed my first naive thoughts about this complicated issue and strengthened my critical capacities and development of my own voice in the writing, with unimaginable patience. Thank you for providing me with direction and redirection, and for letting me explore other psychological projects beyond this one. I admire your ability to combine highest standards of academic work with a true interest in the people you work with. You helped me to see –with your never ending and highly appreciated enthusiasm- that this work is relevant not only to the clinical setting, but also to further the reach of academic work in the broader world. I hope that this dissertation is only the first step towards a long and pleasant collaboration beyond ‘academic puberty’. I also want to thank my co-advisers, Prof. dr. Piet Hoebeke and dr. Griet De Cuypere, who were more than generous with their time, support and expertise than I could have hoped for. Piet, your feedback and many of your comments found their way into the articles. Griet, thank you for restoring my faith in my own convictions along the way. This project would also not have been possible without the support of numerous collaborators. 8 Prof. dr. Guy T’Sjoen, Prof. dr. Stan Monstrey, Prof. dr. Steven Weyers, Bie Stockman, Birgit van Hoorde, dr. Eline Van Hoecke, dr. Kristien Roelens, dr. Mireille Merckx, An Desloovere, dr. Erik Van Laecke and all the other members of the DSD team at Ghent University Hospital, your input and support were greatly appreciated. It was a pleasure for having worked with people who not only enjoy a common passion for the topic, but also their time with each other. I want to say a special thanks to Eline Van Hoecke and the child psychology team, for giving me the opportunity to find connection with the Child Psychology Department and to Bie Stockman for her unwavering support in the vaginal dilation program ('What you do yourself, you do usually better'). I am also grateful to Guy Bronselaer and Prof. dr. Petra De Sutter, for the fruitful collaboration in the genital sensitivity project. Petra, conducting research with you was not only an intellectually stimulating, but also truly pleasant work experience. An, Marleen, Mieke and Dimitri, thank you for making me look forward to coming to work during the times that we ‘shared’ an office. I am also particularly grateful to my co-advisor dr. Arianne Dessens, and Prof. em. dr. Stenvert Drop from the Erasmus Medical Center in Rotterdam for my participation in the Dutch DSD project. Arianne & Sten, your knowledgeable, detailed and thoughtful readings of the manuscripts and your critical insights, as well as encouragement during the course of this project were highly appreciated. I owe special thanks to Yvonne van der Zwan. Yvonne, I have benefitted enormously from our friendship and research time together. Numerous colleagues from the Dutch Study Group on DSD from Erasmus Medical Center Rotterdam, Vrije Universiteit Medical Center Amsterdam, Radboud University Medical Center Nijmegen and University Medical Center Utrecht have helped with the challenging data collection and analysis, and provided wonderful provocative ideas and insight along the way, with special thanks to dr. Katja Wolffenbuttel, Prof. dr. Leendert Looijenga, dr. Marjan van den Berg, and Prof. em. dr. Peggy Cohen-Kettenis. Annastasia Ediati, thank you for the inspiring multicultural discussions. In addition, I would like to thank dr. Melissa Hines at Cambridge University, whose keen insight and intellectual rigor inspired me during my unforgettable training experience prior to this doctoral quest. 9 Moreover, I want to thank the members of the exam commission, far and near, for reading this thesis. Prof. em. dr. Peggy Cohen-Kettenis, at Vrije Universiteit Medical Center Amsterdam, dr. Vickie Pasterski at Cambridge University, dr. Erica van den Akker at Erasmus Medical Center Rotterdam, Prof. dr. Jean De Schepper at Free University of Brussels & Ghent University, and Prof. dr. Johan Vande Walle, Prof. dr. Hans Verstraelen & dr. Kristien Roelens at Ghent University. Warm thanks also go to dr. Ira Haraldsen and Swavek Wojniusz from the Rikshospitalet in Oslo, Norway. Although our work on heart rate variability and neurocognitive functioning of girls with precocious puberty is not included in this dissertation here, your enthusiasm and encouragement were always highly appreciated and I truly enjoyed working with you. Thank you for providing me with a warm and caring home whenever I was in Oslo. In the end, it is to my family and friends that I owe the greatest thanks and acknowledgment. My parents, Johan Callens & Marie-Claire De Block, and sister, Kee Callens, for encouraging me to explore the world and for always offering a safe haven to return to. Aunts, uncles, cousins and grandparents for their hospitality and excellent food (for thought). Stijn Van Herck and Eva De Block for the brilliant, creative coming - together of this booklet. Michael Boiger, Joana Lima & Charlotte Le Divelec, for enduring my physical and mental absences, but more specifically for wholeheartedly teaching me the art of living. Kiran Vanbinst & Anja Waegeman for being constant unconditional supporters. Ines Ghijselings, Stijn Van Herck, Bernard Derveaux, Annelore Willaert & Daan Nevens for always encouraging me to go that extra mile. Vincent Van der Velde, Vincent Ginis, Naomi Vanlessen, Bram Dewolfs, Sven Retore, Tom Lootens, Marieke Dewitte, Pauline Steverlynck, Sarah Slembrouck, Ellen Marcelis, Lynn Vercammen & Inge Peeters: friendship is no small matter to a person staring down deadlines. Thank you for reminding me that life needs to include love & play. Nina Callens Bruxelles, October 2013 10 List of Abbreviations AIS: androgen insensitivity syndrome AMH: anti-Müllerian hormone CAIS: complete androgen insensitivity syndrome CAH: congenital adrenal hyperplasia DHT: dihydrotestosterone DSD: disorders of sex development GA: gestational age GD: gonadal dysgenesis LH: luteneizing hormone MIS: Müllerian inhibiting substance MRKH: Mayer-Rokitansky-Küster- Hauser syndrome PAIS: partial androgen insensitivity syndrome QOL: quality of life SPL: stretched penile length 11 List of Definitions 17ß hydroxysteroid dehydrogenase deficiency (17ß HSD): genetic disorder of steroid formation, caused by a deficiency of the testicular enzyme 17ß hydroxysteroid dehydrogenase that produces testosterone from androstenedione. Plasma testosterone and dihydrotestosterone (DHT) are decreased and androstenedione is increased. It is characterized in XY individuals by ambiguous or feminine-appearing external genitalia at birth, with masculinization at puberty. 5α reductase deficiency (5α RD): genetic disorder of steroid formation, caused by a deficiency of the testicular enzyme 5α reductase that produces dihydrotestosterone (DHT) from testosterone. Plasma DHT is decreased, testosterone is increased. It is characterized in XY individuals by ambiguous or feminine-appearing external genitalia at birth, with masculinization at puberty. Androgen insensitivity syndrome (AIS): X-linked genetic disorder that results in the inability of receptors to respond to androgens. The receptor deficiency can be partial
Load more

Recommended publications
  • Le Rapport Du Réseau Convention D'istanbul
    Mise en œuvre de la Convention d‘Istanbul en Suisse Rapport alternatif de la société civile Ed. Réseau Convention Istanbul Juin 2021 Netzwerk Istanbul Konvention Réseau Convention Istanbul Rete Convenzione di Istanbul 1 Impressum Editrice : Réseau Convention Istanbul www.conventionistanbul.ch / juin 2021 Coordination & rédaction : Simone Eggler (Brava, anciennement TERRE DES FEMMES Suisse) & Anna-Béatrice Schmaltz (cfd – l’ONG féministe pour la paix) Auteurs des rapports thématiques approfondis : Voir les rapports approfondis Traduction : weiss traductions genossenschaft (www.weiss-traductions.ch), Mirjam Werlen (Inter- Action Suisse), Izabel Barros (cfd – l’ONG féministe pour la paix) Layout: Nora Ryser www.noraryser.ch Table des matières 6 Annex 7 Remerciements 7 Introduction 7 Le Réseau Convention d’Istanbul 7 Rapport du réseau 8 Structure du rapport 8 Les limites dues aux ressources lors de l’élaboration du rapport 8 Processus de monitorage CI : une autre façon de procéder pour les militant.e.x.s et le groupe de base 9 Lien avec les autres obligations internationales 9 Langage inclusif 9 Définitions 10 Femmes 10e Genr 11 Intersexuation / intersexe / variations des caractéristiques sexuelles (VCS) 11 Personnes trans 11 LGBTIQA+ 11 Handicaps 12 Intersectionnalité 12 Inclusion 12 Violence à l’égard des femmes 12 Violence basée sur le genre 12 Violence « au domicile » 14 Violence numérique 14 Violence structurelle 14 Violence institutionnelle 15 Violence sexuée 15 Victime, personne concernée, survivant.e.x 15 Situation en Suisse 16 Situation des différents groupes de personnes concernées 17 Chapitre I – Buts, définitions, égalité et non-discrimination, obligations générales 18 Art. 1 Buts de la Convention & Art. 2 Champ d’application de la Convention 20 Art.
    [Show full text]
  • Association of the Rectovestibular Fistula with MRKH Syndrome And
    Association of the rectovestibular fistula with MRKH Syndrome and the paradigm Review Article shift in the management in view of the future uterine transplant © 2020, Sarin YK Yogesh Kumar Sarin Submitted: 15-06-2020 Accepted: 30-09-2020 Director Professor & Head Department of Pediatric Surgery, Lady Hardinge Medical College, New Delhi, INDIA License: This work is licensed under Correspondence*: Dr. Yogesh Kumar Sarin, Director Professor & Head Department of Pediatric Surgery, Lady a Creative Commons Attribution 4.0 Hardinge Medical College, New Delhi, India, E-mail: [email protected] International License. DOI: https://doi.org/10.47338/jns.v9.551 KEYWORDS ABSTRACT Rectovestibular fistula, Uterine transplantation in Mayer-Rokitansky-Kuster̈ -Hauser (MRKH) patients with absolute Vaginal atresia, uterine function infertility have added a new dimension and paradigm shift in the Cervicovaginal atresia, management of females born with rectovestibular fistula coexisting with vaginal agenesis. MRKH Syndrome, The author reviewed the relevant literature of this rare association, the popular and practical Vaginoplasty, Bowel vaginoplasty, classifications of genital malformations that the gynecologists use, the different vaginal Ecchietti vaginoplasty, reconstruction techniques, and try to know what shall serve best in this small cohort of Uterine transplantation, these patients lest they wish to go for uterine transplantation in future. VCUA classification, ESHRE/ESGE classification, AFC classification, Krickenbeck classification INTRODUCTION
    [Show full text]
  • Management of Vaginal Hypoplasia in Disorders of Sexual Development: Surgical and Non-Surgical Options
    Sex Dev 2010;4:292–299 Published online: July 24, 2010 DOI: 10.1159/000316231 Management of Vaginal Hypoplasia in Disorders of Sexual Development: Surgical and Non-Surgical Options R. Deans M. Berra S.M. Creighton University College Hospital, Institute of Women’s Health, London , UK Key Words gardless of the vaginal reconstruction technique, patients Disorders of sexual development ؒ Surgery ؒ should be managed in a multidisciplinary team where there Vaginal hypoplasia is adequate emotional and psychological support available. Copyright © 2010 S. Karger AG, Basel Abstract Patients with disorders of sexual development (DSD) requir- Introduction ing vaginal reconstruction are complex and varied in their presentation. Enlargement procedures for vaginal hypo- Patients with disorders of sexual development (DSD) plasia include self-dilation therapy or surgical vaginoplasty. requiring vaginal reconstruction are complex and varied There are many vaginoplasty techniques described, and in their presentation. Enlargement procedures for vagi- each method has different risks and benefits. Reviewing the nal hypoplasia include self-dilation therapy or surgical literature on management options for vaginal hypoplasia, vaginoplasty. These interventions are offered to improve the results show a number of techniques available for the psychological and sexual outcomes. The concept of sur- creation of a neovagina. Studies are difficult to compare due gery for DSD conditions has become increasingly contro- to their heterogeneity, and the indications for surgery are versial in the last decade. Clinicians and patients have not always clear. Psychological support improves outcomes. become involved in the debate, with strong views on both There is a paucity of evidence to inform management re- sides of the fence, with minimal evidence to inform man- garding the optimum surgical technique to use, and long- agement.
    [Show full text]
  • NVA Research Update E- Newsletter September – October – November 2016
    NVA Research Update E- Newsletter September – October – November 2016 www.nva.org __________________________ Vulvodynia The Vulvar Pain Assessment Questionnaire inventory. Dargie E, Holden RR, Pukall CF. Pain. 2016 Aug 1. https://www.ncbi.nlm.nih.gov/pubmed/27780177 Millions suffer from chronic vulvar pain (ie, vulvodynia). Vulvodynia represents the intersection of 2 difficult subjects for health care professionals to tackle: sexuality and chronic pain. Those with chronic vulvar pain are often uncomfortable seeking help, and many who do so fail to receive proper diagnoses. The current research developed a multidimensional assessment questionnaire, the Vulvar Pain Assessment Questionnaire (VPAQ) inventory, to assist in the assessment and diagnosis of those with vulvar pain. A large pool of items was created to capture pain characteristics, emotional/cognitive functioning, physical functioning, coping skills, and partner factors. The item pool was subsequently administered online to 288 participants with chronic vulvar pain. Of those, 248 participants also completed previously established questionnaires that were used to evaluate the convergent and discriminant validity of the VPAQ. Exploratory factor analyses of the item pool established 6 primary scales: Pain Severity, Emotional Response, Cognitive Response, and Interference with Life, Sexual Function, and Self-Stimulation/Penetration. A brief screening version accompanies a more detailed version. In addition, 3 supplementary scales address pain quality characteristics, coping skills, and the impact on one's romantic relationship. When relationships among VPAQ scales and previously researched scales were examined, evidence of convergent and discriminant validity was observed. These patterns of findings are consistent with the literature on the multidimensional nature of vulvodynia. The VPAQ can be used for assessment, diagnosis, treatment formulation, and treatment monitoring.
    [Show full text]
  • DSD Population (Differences of Sex Development) in Barcelona BC N Area of Citizen Rights, Participation and Transparency
    An analysis of the different realities, positions and requirements of the intersex / DSD population (differences of sex development) in Barcelona BC N Area of Citizen Rights, Participation and Transparency An analysis of the different realities, positions and requirements of the intersex / DSD population (differences of sex development) in Barcelona Barcelona, November 2016 This publication forms part of the deployment of the Municipal Plan for Sexual and Gender Diversity and LGTBI Equality Measures 2016 - 2020 Author of the study: Núria Gregori Flor, PhD in Social and Cultural Anthropology Proofreading and Translation: Tau Traduccions SL Graphic design: Kike Vergés We would like to thank all of the respond- ents who were interviewed and shared their knowledge and experiences with us, offering a deeper and more intricate look at the discourses and experiences of the intersex / Differences of Sex Develop- ment community. CONTENTS CHAPTER I 66 An introduction to this preliminary study .............................................................................................................. 7 The occurrence of intersex and different ways to approach it. Imposed and enforced categories .....................................................................................14 Existing definitions and classifications ....................................................................................................................... 14 Who does this study address? ..................................................................................................................................................
    [Show full text]
  • Polycystic Ovary Syndrome
    Review: Polycystic ovary syndrome Polycystic ovary syndrome Maharaj S, MBChB, FCP(SA) Amod A, MBChB, FCP(SA) Department of Endocrinology and Metabolism, Division of Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa Correspondence to: Dr Sureka Maharaj, e-mail: [email protected] Keywords: polycystic ovary syndrome, PCOS, polycystic ovarian disease, PCOD, polycystic ovarian morphology, PCOM Introduction The description of polycystic ovaries dates back as far as 17211 but it was Stein and Leventhal who first reported the disorder, that we now know as the polycystic ovary (or ovarian) syndrome (PCOS), in seven women with amenorrhoea, enlarged ovaries with multiple cysts and hirsutism.2 These patients were treated with ovarian wedge resection and of the seven all had return of their menstrual cycles, and two conceived. With the advent of hormonal assays in the late 1960’s and early 1970’s, the diagnostic focus expanded to include endocrine abnormalities in the hypothalamic-pituitary-gonadal (HPG) axis.3 Elevated luteinising hormone (LH) levels and hyperandrogenaemia were therefore added to the diagnostic criteria for PCOS.4 The advent of pelvic ultrasonography in the late 1970’s allowed for the non-invasive detection of polycystic ovarian morphology. However, this tool confounded matters when it was discovered that polycystic ovaries was a “common finding in normal women”,5 and that it also occurred in diverse endocrine disorders such as hypothyroidism, hyperprolactinaemia, congenital adrenal hyperplasia and hypothalamic amenorrhoea.6 The finding of polycystic ovaries in normal women has been variably referred to as polycystic ovarian disease (PCOD), polycystic ovaries (PCO) and polycystic ovarian morphology (PCOM).
    [Show full text]
  • Anne Tamar-Mattis, JD* Advocates for Informed Choice
    Report to the Inter-American Commission on Human Rights: Medical Treatment of People with Intersex Conditions as a Human Rights Violation Anne Tamar-Mattis, JD* Advocates for Informed Choice March 13, 2013 I. Introduction Americans born with intersex conditions, or variations of sex anatomy, face a wide range of violations to their sexual and reproductive rights, as well as the rights to bodily integrity and individual autonomy. Beginning in infancy and continuing throughout childhood, children with intersex conditions are subject to irreversible sex assignment and involuntary genital normalizing surgery, sterilization, medical display and photography of the genitals, and medical experimentation. In adulthood, and sometimes in childhood, people with intersex conditions may also be denied necessary medical treatment. Moreover, intersex individuals suffer life-long physical and emotional injury as a result of such treatment. These human rights violations often involve tremendous physical and psychological pain and arguably rise to the level of torture or cruel, inhuman, or degrading treatment (CIDT).† The treatment experienced by American intersex people is a violation of the American Convention on Human Rights. The Convention recognizes torture and cruel, inhuman, or degrading treatment (CIDT) as human rights abuses. Under Article V, “(1) Every person has the right to have his physical, mental, and moral integrity respected. (2) No one shall be subjected to torture or to cruel, inhuman, or degrading punishment or treatment.” §1-2. In order to demonstrate why specific medical practices are human rights abuses against intersex people, we have applied Article 16 of the Convention Against Torture (CAT), and interpretations by the European Court of Human Rights and the mandate of the Special Rapporteur on Torture (SRT).
    [Show full text]
  • Disorders of Sexual Differentiation and Surgical Corrections
    Marmara Medical Journal Volume 2 No: 5 April 1989 DISORDERS OF SEXUAL DIFFERENTIATION AND SURGICAL CORRECTIONS C. Ôzsoy, M.D.* / A. KadioÇlu, M.D.*** / H. Ander, M.D.** * Professor, Department of Urology, Istanbul Medical Faculty, Istanbul, Turkey. ** Associate Professor, Department of Urology, Istanbul Medical Faculty, Istanbul, Turkey. * * * Research Assistant, Department of Urology, Istanbul Medical Faculty, Istanbul, Turkey. SUMMARY Patients with ambiguous genitalia who applied to our ?). Developments in Cytogenetics and Radio-immu- clinic are investigated and they are classified as true no assay after 1950's provided the easy diagnosis of hermaphroditism, male and female pseudohermaph­ sexual differentiation disorders. roditism. Normal sexual differentiation: The normal human After chromosomal, psychological, hormonal, phe­ diploid cell contains 22 autosomal pairs of chromoso­ notypic and surgical evaluation, the final sex is de­ mes and 2 sex chromosomes. Except spermatozoon termined and appropriate reconstructive surgery is and oocyt normal human cell is diploid. The chromo­ performed. somal sex is determined at the time of fertilization. An XX female or male determined chromosomal sex, In six of our 18 patients we reassigned the female sex influences sexual differentiation by causing the bipo- to male. 2 of our 18 patients are true hermaphrodites tenlial gonad to develop either as a testis or as an (one being male and the other is female). 2 of them are ovary. female pseudohermaphrodites and 14 of them are male pseudohermaphrodites. 6 patients who under­ Until the 7th week of gestation the gonads are indis­ went sexual reassignment were male pseudoher- tinguishable. In the presence of Y chromosome or H- maphrodiles. Y antigen, which is located on the short arm of X chromosome, the medulla of gonads will begin testi­ In our opinion the most important aspect of sex reas­ cular differentiation.
    [Show full text]
  • Table of Contents
    Society for Sex Therapy and Research SSTAR 2008: 33rd Annual Meeting Continuing Medical Education Credit is provided through joint sponsorship with The American College of Obstetricians and Gynecologists (ACOG). Intercontinental Hotel Chicago, Illinois USA March 13-15, 2008 TABLE OF CONTENTS President‘s Welcome ..........................................................................................................1 SSTAR 2009: 34th Annual Meeting – Arlington, Virginia, USA ........................................2 SSTAR 2008 Fall Clinical Meeting – New York, New York USA ....................................2 SSTAR Executive Council and Administrative Staff ..........................................................3 Continuing Education Accreditations & Approvals ............................................................5 Acknowledgements ..............................................................................................................6 Program Schedule ................................................................................................................7 2008 Award Recipients ....................................................................................................14 SSTAR Health Professional Book Award .............................................................14 Sex, Therapy, and Kids Recipient: Sharon Lamb, EdD SSTAR Service Award ..........................................................................................14 Recipient: Bill Maurice, MD SSTAR Student Research Award Abstract ............................................................15
    [Show full text]
  • Co™™I™™Ee Opinion
    The American College of Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS COMMITTEE OPINION Number 673 • September 2016 (Replaces Committee Opinion No. 345, October 2006) Committee on Gynecologic Practice This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice and the American Society for Colposcopy and Cervical Pathology (ASCCP) in collaboration with committee member Ngozi Wexler, MD, MPH, and ASCCP members and experts Hope K. Haefner, MD, Herschel W. Lawson, MD, and Colleen K. Stockdale, MD, MS. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Persistent Vulvar Pain ABSTRACT: Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. It can be difficult to treat and rapid resolution is unusual, even with appropriate therapy. Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. Although optimal treatment remains unclear, consider an individualized, multidisciplinary approach to address all physical and emotional aspects possibly attributable to vulvodynia. Specialists who may need to be involved include sexual counselors, clinical psychologists, physical therapists, and pain specialists. Patients may perceive this approach to mean the practitioner does not believe their pain is “real”; thus, it is important to begin any treatment approach with a detailed discussion, including an explanation of the diagnosis and determination of realistic treatment goals. Future research should aim at evaluating a multimodal approach in the treatment of vulvodynia, along with more research on the etiologies of vulvodynia.
    [Show full text]
  • Medical Histories, Queer Futures: Imaging and Imagining 'Abnormal'
    eSharp Issue 16: Politics and Aesthetics Medical histories, queer futures: Imaging and imagining ‘abnormal’ corporealities Hilary Malatino Once upon a time, queer bodies weren’t pathologized. Once upon a time, queer genitals weren’t surgically corrected. Once upon a time, in lands both near and far off, queers weren’t sent to physicians and therapists for being queer – that is, neither for purposes of erotic reform, gender assignment, nor in order to gain access to hormonal supplements and surgical technologies. Importantly, when measures to pathologize queerness arose in the 19th century, they did not respect the now-sedimented lines that distinguish queernesses pertaining to sexual practice from those of gender identification, corporeal modification, or bodily abnormality. These distinguishing lines – which today constitute the intelligibility of mainstream LGBT political projects – simply did not pertain. The current typological separation of lesbian and gay concerns from those of trans, intersex, and genderqueer folks aids in maintaining the hegemony of homonormative political endeavors. For those of us interested in forging coalitions that are attentive to the concerns of minoritized queer subjects, rethinking the pre-history of these queer typologies is a necessity. This paper is an effort at this rethinking, one particularly focused on the conceptual centrality of intersexuality to the development of contemporary intelligibilities of queerness. It is necessary to give some sort of shape to this foregone moment. It exists prior to the sedimentation of modern Western medical discourse and practice. It is therefore also historically anterior 1 eSharp Issue 16: Politics and Aesthetics to the rise of a scientific doctrine of sexual dimorphism.
    [Show full text]
  • 46 XY Gonadal Dysgenesis in Adulthood 'Pitfalls of Late Diagnosis'
    BMJ Case Reports: first published as 10.1136/bcr.12.2010.3626 on 10 February 2012. Downloaded from Reminder of important clinical lesson 46 XY gonadal dysgenesis in adulthood ‘pitfalls of late diagnosis’ Jarna Naing Hamin, 1 Francis Raymond P Arkoncel,2 Frances Lina Lantion-Ang, 1 1 Mark Anthony S Sandoval 1 Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines ; 2 Division of Urology, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines Correspondence to Dr Mark Anthony S Sandoval, [email protected] Summary Disorders of sex development (DSD) include congenital conditions where developments of chromosomal, gonadal or anatomical sex are atypical. Ostrer in 2000, reported a prevalence of 1:20 000 for 46 XY DSD and complete gonadal dysgenesis. A 21-year-old patient consulted for sexual ambiguity at the out-patient department of the Philippine general hospital. At birth, the perceived female external genitalia and clitoromegaly, led the parents to register and eventually rear the patient as a female. At puberty, he developed masculine features and growth of phallus. Patient was more interested in male activities and began to identify himself as male in the community. The discrepancy between his birth certifi cate and his male gender jeopardised his ambition to become a policeman; this led him to seek medical consult. On physical examination, he was phenotypically male. The external genitalia showed the phallus length of 3.5 cm and perineoscrotal hypospadias. Chromosomal sex was normal 46 XY with neither numerical nor structural aberrations in all cell lines, serum testosterone was low and gonadotrophins were elevated.
    [Show full text]