Gender Identity & Sexual Orientation

Gender Identity
 At the most basic level it is how we identify ourselves
Male or Female

Typical Gender Identity Development

 6-8 months
Discriminate male vs. female voices Habituate with one category of faces

 9-11 months
Discriminate male vs. female faces Begin to correlate male and female faces with genderrelated objects

 12-14 months
Intermodal associations for male faces and voices

 18-20 months
Stereotyped knowledge Recognize labels associated with faces

 24-26 months
Gender labeling Generalized gender imitation Gender typed toy category awareness

 27-29 months
Gender labeling for majority

 30-32 months
Gender labeling Nonverbal gender identity

Developmental Theories
 Social-Cognitive Theory
Triadic Reciprocal Causation
Environmental events Personal factors Behavior patterns Children are active participants in selecting and creating environments

 Cognitive Developmental Theory

Gender constancy
Similar to idea of conservation

Gender identity
Knowledge of being a boy or a girl

Gender stability
Identity does not change over time

Gender consistency
Identity is not changed by changes in appearance, activities or traits

Higher levels of gender constancy are associated with increased responsiveness to gender related information and more rigid application of norms Active construction of meaning

 Gender Schema Theory

Cognitions about gender are central to development Schemas are prone to errors or distortion Work to attain consistency between schemas and behaviors

History-Transgender
 Present in all society from early times  Some cultures seen as positive and acceptable  Well-defined social roles: shaman, healers, entertainers, storytellers  Society determines treatment

Gender Identity Influences

 Parents gender schemas  Biological sex  Social/Cultural norms

Biology
 Estimates that 1 in 1,000 children born have ambiguous genitalia  Often referred to as intersexed  Variety of causes/conditions
Hermaphrodites- XX/XY Genetic errors
 Turners Syndrome-X0  Klinefelters Syndrom-XXY  Also-XXX, XYY  Congenital Adrenal Hyperplasia

Other Conditions
 Hypospadias  Microphallus

Terminology
 Transsexuals-persons who seek sex reassignment surgery  Transgendered: individual who lives (full or part time) as a member of a gender that is incongruent with his/her anatomic sex, frequently with hormonal support  These terms are sometimes used interchangeably  MTF: male to female transsexual  FTM: female to male transsexual

Caution
 Do not confuse transsexual or transgender with transvestite or homosexual
Transvestite: gets sexual arousal from cross dressing, gender is clear and sexual orientation varies

John Money
 Leader in issue of transgendered individuals  Felt gender identity was learned and in place by age 3  Gender identity is resistant to change, advocated early surgery  What initially looked like successes were later seen as having poor outcomes  Biology plays larger role than initially thought

Case of David Reimer

 Born mentally and physically healthy twin boy  Penis was destroyed during circumcision  Parents were told to raise him as a girl and advised by John Money to have David undergo reassignment surgery

Brenda
 Surgery performed at 22 months  Estrogen therapy

Brendas Adolescence
 Did not feel like a girl  Ostracized by peers  Age 13 suicidal depression  Parents told her the truth at age 15

David
 Assumed male identity at age 15  Testosterone injections  Double mastectomy  Two phalloplasty operations

Consequences
 Married and father to 3 stepchildren  Brother committed suicide in 2002
Trouble with accepting new relationship with brother rather than sister Mental disturbance, later developed schizophrenia

 David committed suicide in 2004

Sociocultural Issues
 Emphasis remains medical/biological model
Illness, poor mental health

 Focus is on binary expression

Male/Female

 Surgery on children  Pronoun usage  Legal issues

Medical Issues
 Second puberty
Hormonal therapies Will need both traditional male and female care Cant undo what has been done

 Health maintenance
Same needs as age matched peers
Prostate checks, mammograms

Multiple caregivers
Gynecologist and urologist

Sexual Orientation
Erotic affinity for and engaging in sex with  Those of the opposite sex (heterosexual)  Those of the same sex (homosexual)  Those of either sex (bisexual) Components  Desire, behavior, identity  Not necessarily congruent

A Range of Issues in Orientation

 Categories of sexual desire  Gender role attributes  Forms of sexual behavior  Personal and social identities  Degrees of normality/abnormality

Orientation and homosexuality

 Orientation is not an issue, at least in any conscious way, for most people who experience the default orientation of heterosexuality  Homosexuality is distinct from gender identity disorder and paraphilia

The concept of sexual identity

 Reflects belief that sexual desire and behavior are core characteristics and defining of selfhood  Reflects how personal narratives and constructs organize and explain experience  Despite variability in individual histories, experience of identity is widespread and meaningful to people

History
 Late 19th, early 20th centuries see scientific interest in sex, move away from primarily moral and religious views  Late 20th century different not necessarily seen as an illness
Removal of homosexuality as a mental disorder (1973)

 1969 Stonewall Rebellion-Gay Liberation Movement

Historical Conceptualizations
 Von Kraft-Ebing-degenerative sickness  Ellis-inborn, biological, not pathological  Kinsey-continuum, developed a scale of sexual preference going from heterosexuality to bisexuality to homosexuality  Garnets-orientation is flexible, complex and multifaceted

Prevalence
 Difficult to determine exact numbers  Differentiation between same sex sexual behavior and sexual identity  8.6-11.1% females and 7.9% males identify attraction after the age of 15  Estimates may be as much as 18% females and 21% males identify attraction after the age of 15

Etiology-Theories
 Biological Explanations
 -hormones, chromosomes, genes, brain development differences

 Associative Learning
 Sexual desire is conditioned, often during early chance experiences that are sexually arousing

 Timing of sexual maturity and peer group

 Early development leads to increased chance of homosexual interests

 Peer groups alone

 Exotic becomes erotic

 Peer groups and gender identity

 Rejection by peer group due to nonconformity with traditional roles

Model of Gay/Lesbian Identity Development-Cass (1979, 1996)

 Identity confusion  Identity comparison  Identity tolerance  Identity acceptance  Identity pride  Identity synthesis

Colemans Model
 Pre-coming out  Coming out  Exploration  First relationships  Integration

Reparative Therapy
 "There is no published scientific evidence supporting the efficacy of 'reparative therapy' as a treatment to change one's sexual orientation....  "The potential risks of 'reparative therapy' are great, including depression, anxiety and selfdestructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient."

The evidence
 Sampling activist populations  Success defined as reducing or eliminating homosexual behavior rather than creating or increasing heterosexual attractions.  Only self reports of patients or therapists' subjective impressions have been available  Careful study yielded 3% conversion

Coming out
 Most gay men first acknowledge they are probably gay between the ages of 12 and 17  Most young lesbian women first acknowledge they are probably lesbian between the ages of 16 and 20.  Commonly a process as much as an event

Issues of social environment

 Homophobia
Including internalized homophobia

 Absence of role models  Importance of all the other characteristics that influence social experience (e.g. race, socioeconomic status)  Gender as a social factor

Homophobia
 4 Assumptions
Homosexuality is sinful/immoral It is unnatural It is a chosen behavior that can be changed It can be taught to others

Caution
 Homosexuality does not equal pedophilia  Evidence is to the contrary
Of 175 adult males in Massachusetts of sexual assault against a child, none had an exclusively homosexual adult sexual orientation (Groth and Birnbaum 1978) Homosexual males responded no more to male children than heterosexual males responded to female children (Freund et al., 1989)

Health Care
 Challenges of communication
Patients hesitant to be forthcoming Providers uncomfortable and avoidant

 Apart from STDs in men, little comorbidity  Increase in adolescent suicide X3  Substance abuse more common but substance dependency is not

Some cautions and misperceptions

 Most people respond exclusively to one sex or the other, but isolated or situational experiences of response to the other sex are not all that unusual  People clearly do not in any realistic way experience sexual orientation as a choice  Homosexuality is not gender reversal

How little we know

 No specific biological or psychological basis is established  Arguably ingrained at an early age and essentially immutable  No meaningful psychological differences associated with orientation  No physiological differences in sexual response cycle

Challenges to adjustment
 Awareness of being different from others  Restricted access to social support  Social disapproval  Added complications in formation of personal identity  Religious and moral issues  Absence of models for romantic behavior

Rural populations
 May be even more isolated  Religious practices may be more homogeneous in these communities  How do you connect with others?

Expectations of Physicians
 First do no harm  Care and respect for the patient is essential  If you dont know something, let them teach you  Understand your own feelings and get help when your personal beliefs interfere with providing appropriate care