RESUMO
RESUMO. A epidemiologia brasileira do comportamento suicida, no que tange ao gênero, é análoga à maioria dos países no cenário internacional, de acordo com a pesquisa da Organização Mundial de Saúde, envolvendo 172 nações. No Brasil, o número de óbitos por suicídio é de três a quatro vezes maior entre os homens e, além disso, pesquisas revelam que a prevalência de tentativas de autoextermínio pode ser maior na população sexo-diversa masculina. A partir dos dados estatísticos que inferem questões de gênero e de sexualidade relacionadas ao sofrimento psíquico de homens, a presente pesquisa teve como escopo analisar qualitativamente, por meio das teorias das masculinidades, relatos biográficos de homens gays, bissexuais e heterossexuais que já manifestaram o comportamento suicida. O intuito foi dar enfoque nos contextos de sofrimento que levaram os sujeitos às ideações e tentativas de autoextermínio. Ao final, as categorias identificadas apontam para similaridades e distinções nas narrativas de cada grupo de orientação sexual e evidenciam a forma como a não correspondência à masculinidade hegemônica se expressa nas sexualidades estudadas.
RESUMEN La epidemiología brasileña del comportamiento suicida, con respecto al género, es análoga a la mayoría de los países en el escenario internacional, de acuerdo con la investigación de la Organización Mundial de la Salud, con 172 naciones. En Brasil, el número de muertes por suicidio es de tres a cuatro veces mayor entre los hombres y, además, investigaciones revelan que la prevalencia de intentos de suicídio puede ser mayor en la población sexodiversa masculina. Con base en los datos estadísticos que infieren las cuestiones de género y sexualidad relacionadas con el sufrimiento psicológico de los hombres, la presente investigación tuvo como objetivo analizar cualitativamente, a través de las teorías de la masculinidad, los relatos biográficos de hombres homosexuales, bisexuales y heterosexuales que ya manifestaron conductas suicidas. La intención fue centrarse en los contextos de sufrimiento que llevaron a los participantes a ideas e intentos de autodestrucción. Al final, las categorías identificadas señalan similitudes y distinciones en las narrativas de cada grupo de orientación sexual y muestran cómo la falta de correspondencia con la masculinidad hegemónica se expresa en las sexualidades estudiadas.
ABSTRACT. The Brazilian suicidal behavior epidemiology, in what concerns to gender, is analogous to most countries in the international scenario, according to the World Health Organization survey, with 172 nations. In Brazil, the number of suicide deaths is three to four times higher among men and, in addition, research shows that the prevalence of self-extermination attempts may be higher in the male sex-diverse population. Based on the statistical data that infer gender and sexuality issues related to the psychological suffering of men, the present research aimed to qualitatively analyze, through the theories of masculinities, the biographical reports of gay, bisexual and heterosexual men who have already manifested suicidal behavior. The intention was to focus on the contexts of suffering that led the participants to ideations and attempts at self-extermination. In the end, the categories identified point to similarities and distinctions in the narratives of each sexual orientation group and show how the non-correspondence to hegemonic masculinity is expressed in the studied sexualities.
Assuntos
Humanos , Masculino , Adulto , Suicídio/psicologia , Masculinidade , Comportamento Sexual/psicologia , Estresse Psicológico/psicologia , Virilismo/psicologia , Bissexualidade/psicologia , Homossexualidade/psicologia , Fatores Epidemiológicos , Sexualidade/psicologia , Heterossexualidade/psicologia , Morte , Homofobia/psicologia , Minorias Sexuais e de Gênero/psicologia , Violência de Gênero/psicologia , Identidade de GêneroRESUMO
CONTEXT: In 46,XY disorders of sexual development (DSD) patients, several factors may affect psychosexual development, leading to gender identity discrepancy and gender change later in life. Prenatal sexual steroid exposure and external genital virilization are considered to influence human psychosexual development, but their roles not completely understood yet. DESIGN: A total of 144 individuals (18 to 60 years of age) with a clinical/molecular diagnosis of 46,XY DSD from a single tertiary center were enrolled. Psychosexual outcomes (gender role, gender identity, and sexual orientation) were assessed using questionnaires and psychological test. The Sinnecker score was used for genital virilization measurement. Prenatal androgen exposure was estimated according to 46,XY DSD etiology. RESULTS: We found a positive association between prenatal androgen exposure and male psychosexual outcomes. Alternatively, prenatal estrogen exposure, age of gonadectomy, and the degree of external genital virilization did not influence any psychosexual outcome. There were 19% (n = 27) with gender change, which was associated with prenatal androgen exposure (P < 0.001) but not with the external genital virilization. The median age of gender change was 15 years, but most of the patients reported the desire for gender change earlier. CONCLUSIONS: Prenatal androgen exposure influenced psychosexual development in 46,XY DSD favoring male psychosexuality in all psychosexual outcomes, whereas the degree of external genital virilization did not influence these outcomes. The organizational effect of sexual steroids on psychosexuality at puberty appears to be weak in comparison with the prenatal effects. Prenatal androgen exposure also influenced female-to-male gender change frequency. All 46,XY DSD conditions with prenatal androgen exposure must be followed for gender issues in their management.
Assuntos
Androgênios/administração & dosagem , Transtorno 46,XY do Desenvolvimento Sexual/psicologia , Identidade de Gênero , Efeitos Tardios da Exposição Pré-Natal/psicologia , Procedimentos de Readequação Sexual/estatística & dados numéricos , Adolescente , Adulto , Transtorno 46,XY do Desenvolvimento Sexual/etiologia , Transtorno 46,XY do Desenvolvimento Sexual/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Comportamento Sexual/efeitos dos fármacos , Comportamento Sexual/psicologia , Desenvolvimento Sexual/efeitos dos fármacos , Virilismo/psicologia , Adulto JovemRESUMO
In individuals with congenital adrenal hyperplasia (CAH) and 46,XX karyotype, androgens produced by the adrenal glands during the intrauterine development promote virilization of the genitals, which may even result in the development of a well-formed penis. Some of these children with late diagnosis are registered as males after birth. After obtaining approval from the internal review board, we evaluated gender identity and sexual function in four 46,XX severely virilized patients with CAH, who were originally registered and raised as males, assisted in our Disorders of Sexual Development Clinic. The evaluation consisted of questionnaires to assess gender identity and sexual activity and interview with the multidisciplinary team that provides care for these patients. The patients underwent surgery to remove uterus, ovaries, and remaining vaginal structures, in addition to implantation of testicular prosthesis and correction of hypospadias, when necessary. All four patients have developed a clear male gender identity, and when evaluated for sexual activity, they have reported having erections, libido, orgasms, and sexual attraction to women only. Two of these 4 patients had satisfactory sexual intercourses when assessed using the International Index of Erectile Function questionnaire. The other two patients who never had sexual intercourse reported not having a partner for sexual activity; one is 18 years old, and the other is 14 years old. This study showed that this group of 46,XX severely virilized patients with CAH, registered and raised as males, adapted well to the assigned male gender, with satisfactory sexual function in patients who had sexual intercourse.
Assuntos
Hiperplasia Suprarrenal Congênita/complicações , Identidade de Gênero , Comportamento Sexual/fisiologia , Virilismo/psicologia , Adolescente , Adulto , Androgênios , Feminino , Genitália , Humanos , Masculino , Ereção Peniana , Desenvolvimento Sexual , Inquéritos e Questionários , Virilismo/etiologiaAssuntos
Humanos , Masculino , Adolescente , Hiperplasia Suprarrenal Congênita/complicações , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/terapia , Virilismo/complicações , Virilismo/psicologia , Disgenesia Gonadal 46 XX , Equipe de Assistência ao Paciente , Papel do Médico , Identidade de GêneroAssuntos
Humanos , Masculino , Adolescente , Hiperplasia Suprarrenal Congênita/complicações , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/terapia , Virilismo/complicações , Virilismo/psicologia , Equipe de Assistência ao Paciente , Identidade de Gênero , Papel do MédicoRESUMO
OBJECTIVE: To determine psychological health in individuals with one form of intersexuality, congenital adrenal hyperplasia (CAH), and its relation to characteristics of the disease and treatment. STUDY DESIGN: Participants (ages 3-31 years) included 72 females and 42 males with CAH, and unaffected relatives (44 females and 69 males). Psychological adjustment was assessed with parent-reports on the Child Behavior Checklist (CBCL) and subject self-reports on the Self-Image Questionnaire for Young Adolescents (SIQYA) or the Multidimensional Personality Questionnaire (MPQ). Information about disease characteristics and genital surgery was obtained from medical records. RESULTS: There were no significant differences between females with CAH and unaffected females on any measure. Psychological adjustment was not significantly associated with genital virilization or age at genital surgery. Males with CAH were not significantly different from unaffected males in childhood, but they showed more negative affect at older ages. CONCLUSIONS: Psychological adjustment is not compromised in females with virilized genitalia who are treated early in life and reared as females. Adjustment does not appear to depend on the characteristics of the disease or its treatment, but sample size and restricted range limit generalizability about adjustment-disease associations.