Care of the Patient Undergoing Sex Reassignment Surgery

SUMMARY

Sex reassignment surgery (SRS) has proven to be an effective intervention for the patient with gender dysphoria. As with any surgery, the quality of care provided before, during, and after SRS has a significant impact on patient outcomes. This article is intended to help primary care providers who are already familiar with routine transgender care to understand the specialized processes involved in SRS. Topics include guidelines for the recommendation of SRS, feminizing and masculinizing surgical procedures, suggested timelines for various interventions, expected course and recovery, risks and complications, and revisional surgery that may be required.     

Investigating digit ratio (2D:4D) in a highly male‐dominated occupation: The case of firefighters

Voracek, M., Pum, U. & Dressler, S. G. (2009). Investigating digit ratio (2D:4D) in a highly male‐dominated occupation: The case of firefighters. Scandinavian Journal of Psychology, 51, 146–156. Second‐to‐fourth digit ratio (2D:4D), a widely studied putative marker for masculinization through prenatal androgen exposure, is lower (more masculinized) in athletes than in general population controls, and athletes with lower 2D:4D have higher sporting success. Occupations differ markedly in perceived masculinity and actual maleness (sex ratios), but these givens have not yet been picked up and utilized in 2D:4D research. Accordingly, this study extended existing accounts on 2D:4D in athletes to a novel approach: 2D:4D and possible relationships to a variety of candidate variables (demographic, fertility‐related, psychological, and other) were investigated in firefighters, a highly male‐dominated occupation. Contrary to expectation, 2D:4D in firefighters (N = 134) was not lower than in local male population controls. Lower 2D:4D corresponded to lower service ranks. Replicating previous findings either unequivocally or partly, lower 2D:4D was associated with larger family size, later sibling position, left‐handedness, and higher scores in the disinhibition component of sensation seeking. Not replicating prior evidence, 2D:4D was unrelated to body‐mass index, offspring sex ratio, and sporting performance level. Novel findings included low 2D:4D in those with low relationship satisfaction and in cigarette smokers, especially among heavy smokers. Absolute finger length, a positive correlate of pubertal‐adolescent androgen levels, was also considered. This marker showed negative associations with relationship consensus and satisfaction and positive ones with perceived quality of relationship alternatives and the experience seeking component of sensation seeking. The merits of this additional marker, relative to 2D:4D, for supplementing studies of possible sex‐hormonal effects on personality and directions for future inquiry along these lines are discussed.     

Male-to-Female Sex Reassignment Surgery in Transsexuals

ABSTRACT

The technique of male-to-female sex reassignment surgery in a sample of 500 patients is described in detail and illustrated by 27 figures. Appropriate technique and care results in a naturally looking vulva and a functioning vagina. The complication rate is low, and most complications can be overcome by adequate correctional interventions.     

Atypical Gender Development: Why I Did Not Sign the GIRES-Review

ABSTRACT

This article discusses the review on Atypical Gender Development, published by the Gender Identity Research and Education Society (GIRES) in the International Journal of Transgenderism 9(1), 2006, pp. 29–44. Although appreciating the initiative of GIRES, the author, who was invited to join the signatories of the review chose to not do so for five major reasons: (1) The phenomenology of transgenderism displays such a great variety that it can not be explained by any individual factor, be it constitution, morphology, hormones or psychology. (2) The role of the Bed nucleus of the area striata of the hypothalamus is overemphasized in the review. (3) Regrets after SRS challenge biological explanations of transsexualism. (4) Dwelling on biological explanations may, as the history of sexology shows, be used in favor as well as against subject. (5) Striving for legal and social acknowledgement of transgendered persons and improvement of treatment conditions does not need biology as an argument.     

变性术后患者心理状况的影响因素分析及对策

变性术后的患者是个特殊的弱势群体,心理问题非常突出,它是生理、个人、家庭、社会等多种因素交互影响的结果;因此,通过社会、家庭及个体的共同努力,帮助其建立良好的个体心理模式,稳定其心理状态,可促进其心理的健康发展,这对于变性手术的成功和帮助变性后患者重新走向社会有重要意义。     

Optimism across cultures: In response to the severe acute respiratory syndrome outbreak

Based on our early research, we predicted that the Chinese may be more optimistic and less pessimistic than North Americans in response to negative life events. A survey was conducted to investigate optimism cross culturally in the context of the severe acute respiratory syndrome (SARS) outbreaks in Canada and China. Chinese students in Beijing and European Canadians in Toronto answered questions about their perceptions of SARS. No significant cultural difference was found on dispositional optimism, as measured by the Revised Life Orientation Test (LOT-R). Unrealistic optimism was measured in the context of SARS. Both groups demonstrated unrealistic optimism (i.e. reporting that the self was less likely than an average person to get infected with SARS). Such optimistic bias was stronger among Chinese than among Canadians. Compared to the actual infection rates in Beijing and Toronto, both Chinese and Canadian participants overestimated their own chances of getting infected, indicating that they were being pessimistic. Indeed, Chinese were less pessimistic than Canadians. In addition, even though the Chinese reported more inconvenience brought by SARS than did Canadians, they also reported more positive changes brought by SARS, reflecting the Chinese dialectical views of events. Implications for research on optimism in context are discussed.     

Editorial

Abstract

Intersex in Church documents has, thus far, been given very little coverage in its own right. However, it is sometimes presented as a foil to transgender; a "natural" if unfortunate state in contrast to the resolutely "non-biological" state of transgender. This serves to stigmatize transgender, and fails to understand the extent to which intersex disrupts binary, dualistic notions of sex and gender in their entirety. Utilizing opposites such as biological/non-biological is not, in fact, the most useful way to represent the relationship between intersex and transgender. Rather, it must be acknowledged that both conditions profoundly undermine the givenness of certainty and either/or tropes as "goods" when it comes to sex identity at all. This article gives a brief summary of some occurrences of the unproblematized contrasting of intersex and transgender in some Church documents, and suggests that they are being contrasted in the wrong ways.     

Early processing of emotional faces in children with autism: An event-related potential study

Social deficits are one of the most striking manifestations of autism spectrum disorders (ASDs). Among these social deficits, the recognition and understanding of emotional facial expressions has been widely reported to be affected in ASDs. We investigated emotional face processing in children with and without autism using event-related potentials (ERPs). High-functioning children with autism (n = 15, mean age = 10.5 ± 3.3 years) completed an implicit emotional task while visual ERPs were recorded. Two groups of typically developing children (chronological age-matched and verbal equivalent age-matched [both ns = 15, mean age = 7.7 ± 3.8 years]) also participated in this study. The early ERP responses to faces (P1 and N170) were delayed, and the P1 was smaller in children with autism than in typically developing children of the same chronological age, revealing that the first stages of emotional face processing are affected in autism. However, when matched by verbal equivalent age, only P1 amplitude remained affected in autism. Our results suggest that the emotional and facial processing difficulties in autism could start from atypicalities in visual perceptual processes involving rapid feedback to primary visual areas and subsequent holistic processing.     

The psychology behind the masks: Psychological responses to the severe acute respiratory syndrome outbreak in different regions

Severe acute respiratory syndrome (SARS) was first reported in China, and spread to 29 regions, affecting over 8000 people worldwide. For the general public, the psychological impact of SARS may have been greater than the physical health danger of the disease. The present paper proposes the influence of psychological factors on people's cognitive, affective, and behavioral responses during the SARS outbreak. The various papers in this special issue of the Journal reveal how people have reacted during the SARS outbreak: People's general coping styles may be related to their health behavior during the outbreak. Cultural differences were evident in the perception of SARS, and individuals' perceptual styles may have influenced their ability to cope with the outbreak. The way in which individuals coped with SARS-related stressful events was different from their usual practices of managing daily stress. Individual differences in the adoption of preventive measures were related to the distinct susceptibility to several social-cognitive biases.     

Constant vigilance: Heritage values and defensive pessimism in coping with severe acute respiratory syndrome in Singapore

The present study investigates the congruency of defensive pessimism in the Asian context and its role in coping with the severe acute respiratory syndrome (SARS) crisis in Singapore. Data collected from 174 Singaporeans supported the hypothesized relationships among Chinese values, defensive pessimism, SARS-related fears, compliance to preventive health-related behaviors and negative outcomes. Path analysis revealed that individuals' endorsement of Chinese value clusters − prudence, industry, and civic harmony − positively predicted their levels of defensive pessimism. The results also indicated that defensive pessimism had a direct positive effect on SARS-related fears and, SARS-related fears, in turn, were directly related to direct preventive health-related behaviors but not related to indirect preventive behaviors. In addition to the indirect effect of Chinese values on direct preventive health-related behaviors, Chinese values had a direct positive effect on both direct and indirect preventive health-related behaviors. Consistent with our contention that defensive pessimism has the potential for leading to particular negative outcomes, defensive pessimism was found to influence negative outcomes but this relationship was partially mediated by SARS-related fears.     

Coping with the threat of severe acute respiratory syndrome: Role of threat appraisals and coping responses in health behaviors

The present study examines the psychological impact of severe acute respiratory syndrome (SARS) by exploring the coping strategies and health behaviors enacted in response to the SARS epidemic. Hierarchical linear regression indicated that the use of wishful thinking in response to the threat of SARS was related to both avoiding public places and avoiding people perceived to be possible carriers of the SARS virus, but was not associated with the use of more adaptive health behaviors, such as using disinfectants and hand washing. Conversely, those who reported engaging in empathic responding in response to the threat of SARS were both less likely to report avoiding people perceived as being at a high risk for SARS and more likely to report engaging in effective health behaviors. Support seeking was not a significant predictor of the health behaviors examined in the present study. Results are discussed in terms of coping with health threats and health promotion.     

Quels enjeux pour les soins bucco-dentaires sous anesthésie générale chez les adultes ?

Common dental acts sometimes require to be performed under general anesthesia. This article describes the development of an adult consultation for dental care under general anesthesia at hospital Henri-Mondor in Créteil group. Forty-two people received dental care under general anesthesia during the year 2015 at Henri-Mondor hospital. Thirty-eight percent were aged 21 to 30 years. The main reason for using general anesthesia phobias 56%. The second reason, with 31%, is on disability. Among the type of intervention, 61% represent extractions of permanent teeth. However, our study shows that the indication of general anesthesia must be asked as a last resort. Other alternative techniques exist and must be offered an upstream. General anesthesia tends to grow and be part of a comprehensive treatment of certain categories of patients. General anesthesia comfort remains prohibited.     

Flexible coping responses to severe acute respiratory syndrome-related and daily life stressful events

Based on the theoretical framework of coping flexibility, the present study examined the coping flexibility of university students in response to severe acute respiratory syndrome (SARS)-related and daily life stressful events. The Coping Flexibility Questionnaire was used to investigate 93 university students' coping responses toward 10 SARS-related stressful events and 10 daily life stressful events that generally occur among university students. Results showed that the patterns of coping flexibility were different for the two types of stressful events. The flexible and the active-inflexible patterns were most commonly found in coping with daily life stressful events. By contrast, the passive-inconsistent pattern was dominant when coping with daily life stressful events. Moreover, participants showed lower discriminating ability to situation controllability, and displayed poorer strategy-situation fit to cope with SARS-related events than with daily life stressful events. The theoretical and practical implications of this study are discussed.     

高功能自闭症个体对威胁性情绪面孔的注意偏向

高功能自闭症(High-Functioning Autism, HFA)个体智力正常, 但也面临着严重的社会功能障碍。对威胁性情绪面孔的注意偏向与HFA个体社会功能的发展密切相关。梳理相关研究发现, HFA个体在自动加工阶段和情绪目标参与阶段, 不存在威胁性情绪面孔注意偏向; 而在任务与情绪无关的控制加工阶段, 存在威胁性情绪面孔注意偏向。针对HFA个体威胁性情绪面孔注意偏向的理论解释主要有杏仁核理论、强烈世界理论和执行功能理论等。神经生理机制方面, HFA个体对威胁性情绪面孔的注意偏向可能与其异常的皮下及皮层通路功能有关, 同时可能会受5-羟色胺系统基因及催产素水平等的影响。未来研究可在综合考虑研究方法及个体因素的基础上, 进一步探究其加工特征及神经生物机制, 着力开发科学有效的干预策略。     

中医药预防SARS之反思

SARS属中医"瘟疫"范畴.中药是以药性之偏来纠正人体之阴阳偏盛或偏衰,所以无论治疗还是预防用药,均应遵循中医学的因地、因时、因人制宜的辨证思想;并针对高危人群提出医护人员应当固护精气、老人注重补肾的预防用药思路.我们认为,清热解毒法为治疫常法,而非防疫常法,预防SARS应辨证用药.     

The holocaust of first nation people: Residual effects on parenting and treatment implications

The residential school experience was devastating for many First Nation (Indian) people. The lingering effects of this era have been far reaching and remain painfully evident throughout Native communities. One of the more obvious areas directly affected has been parenting. This paper discusses current parenting difficulties of Native clients who were formerly in residential schools. A connection is made between the abuse experienced by these individuals and their parental struggles. Along with addressing various sociopolitical issues, a number of clinical interventions designed to promote the healing process of these victims and their families are provided and discussed.