Since the 17th century there has been a proliferation of discourse on sex and a host of sexual identities have been surfaced. One such sexuality that is particularly marginalised is transsexuality; central to which is the management of the transsexual self. The critical study of such practices has often been neglected in favour of ‘mainstream’ research on transsexuality’s deviance, aetiology and treatment. Furthermore, internet-based resources have been identified as a key site for the management of the transsexual self. Hence, this study aimed to investigate the constructions of transitioning in popular websites aimed at transsexuals and significant others, family, friends and allies of transgendered persons (SOFFAs). A search strategy was adapted to select the most popular websites for analysis. A discourse analysis – guided by Parker’s (1992) 20 ‘steps’ – was conducted on 12 webpages. The construction of transitioning was dominated by biomedicine and the ‘psy’ professions. Due to these hegemonic powers the transsexual identity was associated with distress and thus a number of technologies of self – particularly medical intervention – were ‘needed’ for the management of the transsexual self. This construction spoke to the rights and health of transsexuals but also appeared to limit their freedom and serve capitalist gain rather than the interests of trans persons. Uncovering these power dynamics may have important implications for the Standards of Care, the controversial status of gender identity disorder in the DSM and allowing for the creation of alternative power strategies which may permit more freedom in the care of the gendered self.

A construção de gênero é um reflexo dos percursos sociais e culturais. Pessoas transgêneras são aquelas cuja identidade de gênero diferencia-se do sexo biológico. A infância e adolescência são demarcados pela construção de identidades e questões relativas ao gênero. Estudos sobre Qualidade de Vida de crianças e adolescentes são de grande relevância pela especificidade dessa população. O presente estudo qualitativo tem como objetivo descrever os atributos associados à Qualidade de Vida de crianças e adolescentes transgêneros brasileiros segundo sua própria percepção. Os participantes, entre oito e 18 anos, participaram de grupos focais ou entrevistas. Os depoimentos foram transcritos, agrupados com auxílio do software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires, versão 0.7 alpha 2 e descritos segundo a definição da Organização Mundial da Saúde no que concerne às dimensões mental, física e social. Os resultados apontam a participação de crianças com média de idade igual a 9,9 anos, desvio-padrão de 0,9 ano. No grupo dos adolescentes, a média de idade foi de 15,9 anos, desvio-padrão de 1,5 anos. Em relação ao gênero, 58,3% das crianças se identificam com o feminino e, os adolescentes, 80,0% com o masculino. Os depoimentos foram categorizados em cinco classes para as crianças e quatro para adolescentes, trazendo subsídios para a compreensão dos atributos que impactam positiva ou negativamente na Qualidade de Vida das crianças e adolescentes transgêneros brasileiros. A partir disso, foi possível identificar o núcleo familiar como o principal meio de suporte social, que impacta positivamente na Qualidade de Vida das crianças e adolescentes transgêneros. Por outro lado, a vivência de preconceito e discriminação foram atributos negativos associados a Qualidade de vida. A transexualidade na infância e adolescência é um tema pouco estudado no Brasil. Os depoimentos indicam que a vida das crianças e adolescentes transgêneros é impactada por fatores sociais, físicos e mentais em virtude do estigma e discriminação vivenciados. Espera-se com esse estudo contribuir com a formulação de políticas públicas antitransfóbicas e ampliar a discussão sobre deveres e direitos dos cidadãos frente à transexualidade/transgeneridade / Building a gender is a reflection of the social and cultural. Transgender people are the ones whose gender identity is different from the biological sex. Childhood and adolescence are marked out by the construction of identities and questions related to the gender. Studies about quality of life of children and teenagers are of great relevance due to the specificity of such population. This qualitative study aims to describe the attributes related to Brazilian children and teenagers quality of life according to their own perceptions. The participants, between eight and 18 years old, were interviewed or took part on focal groups. Their answers were written, grouped by means of the software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires, version 0.7 alpha 2, and described according to the definition regarding mental, physical and social dimensions proposed by the World Health Organization. Children with a mean age of 9.9 years and standard deviation of 0.9 years old and adolescents with a mean age of 15,9 years and standard deviation of 1.5 years old took part of the study. Considering the gender, 58.3% of the children identified themselves as females, while 80.0% of the adolescents considered themselves as males. The statements were categorized into five classes, while considering the children and into four classes, relating to the adolescents, such statements provide support for understanding the attributes that positively or negatively impact on the quality of life of Brazilian transgender children and adolescents. Based on the results, it is possible to identify the family as the principal way of social support which positively impacts on the quality of life of transgender children and adolescents. On the other hand, prejudice and discrimination experience are mostly negative attributes associated with quality of life. Transsexuality in childhood and adolescence is not widely studied in Brazil. The testimonies indicate that the lives of transgender children and adolescents are impacted by social, physical and mental factors due to stigma and discrimination experienced. It is hoped that this study will contribute to the formulation of anti-transphobic public policies and broaden the discussion about citizens\' rights and duties towards transsexuality/transgender

Introdução: Os homens biológicos profissionais do sexo (male sex workers MSW) constituem uma população heterogênea, de forma que uma classificação tipológica poderá promover o desenvolvimento de políticas públicas mais específicas. Embora existam diversas classificações para o homem que se prostitui nas ruas das cidades (street hustlers), há poucos estudos que avaliam aspectos psicopatológicos específicos desses indivíduos. Este estudo examina aspectos dimensionais da personalidade, impulsividade, uso de álcool e drogas e envolvimento com atividades criminais entre street hustlers da cidade de Santo André/SP. Método: Trata-se de um estudo seccional e retrospectivo, realizado pelo Ambulatório de Transtornos da Sexualidade da Faculdade de Medicina do ABC (ABSex), em associação com o Grupo Interdisciplinar de Estudos de Álcool e Drogas do Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São Paulo (GREA Ipq FMUSP). Oitenta e seis sujeitos foram avaliados por meio de questionários autoresponsivos, sendo as entrevistas realizadas nas ruas de Santo André/SP, no próprio local de trabalho dos entrevistados, entre 2008 e 2010. Resultados: MSW portadores de transtornos de identidade de gênero (TIG) apresentaram maiores níveis de Esquiva ao Dano, mais frequente história de agressão física por parte dos clientes e menor oportunidade de outros empregos quando comparados com MSW sem TIG. MSW com uso inconsistente de preservativos apresentaram mais problemas com uso de álcool e drogas, maiores níveis de Dependência de Gratificação, mais frequente história de tentativas prévias de suicídio e antecedente criminal quando comparados a MSW com uso consistente de preservativos. Conclusões: A prostituição masculina é um fenômeno composto de múltiplos aspectos. Há múltiplas variações em termos de motivações e padrões de vida entre os MSW, de forma ser necessário dividi-los em categorias. A identidade e papel de gênero, uso de substâncias psicoativas e aspectos de personalidade são variáveis importantes a serem consideradas quando do desenvolvimento de políticas de saúde pública mais específicas. A habilidade em avaliar tais características pode ser ferramenta importante no desenvolvimento de propostas mais efetivas para o manejo dessa complexa população / Introduction: Male sex workers (MSW) are a heterogeneous population, and researchers aim to categorize them into typology groups to develop more specific public health policies. Although there are several classifications for MSW who work on streets (street hustlers), there are few studies that evaluate specific psychopathology aspects of these individuals. This study examines the dimensional aspects of personality, impulsiveness, alcohol and drug use, and criminal history among street hustlers in the city of Santo André/SP. Method: This is a cross-sectional and retrospective study, carried out by Ambulatory for the Treatment of Sexual Disorders of ABC Medical School (ABSex), in association with the Interdisciplinary Group of Studies on Alcohol and Drugs, Psychiatry Institute Faculty of Medicine - São Paulo University (GREA - IPQ - FMUSP). Eighty-six subjects were assessed through self-report questionnaires. The interviews were performed on the streets of Santo André/SP, in the workplace of the MSW, from 2008 to 2010. Results: MSW with gender identity disorder (GID) showed higher Harm Avoidance levels, more frequent history of physical aggression by clients and less opportunity of other jobs when compared with street MSW without GID. MSW with inconsistent condom use showed more alcohol and drug use problems, higher levels of Reward Dependence, higher frequency of personal history of suicide attempts and criminal history. Conclusions: Male prostitution is a phenomenon composed of multiple aspects. Variations of personal motivations and life patterns among MSW are huge. So it is necessary to divide them into clusters. Identity and gender roles, substance abuse, personality aspects, like Harm Avoidance and Reward Dependence, are important variables to be considered for the development of more specific public health policies. The ability to assess such characteristics may be an important tool in developing proposals for more effective management of this complex population

O transexualismo é um transtorno da identidade sexual, associado a uma forte e persistente identificação com o sexo oposto. Há poucos estudos referentes à utilização de testes psicológicos para auxiliar no diagnóstico do transexualismo. O objetivo deste estudo foi avaliar os aspectos da psicossexualidade de pacientes autodenominados transexuais através do teste de Szondi: Estudo retrospectivo e prospectivo no quais os pacientes com transtornos da identidade de gênero foram avaliados através de entrevistas livres; com aplicação dos critérios diagnósticos de transexualismo da DMS-IV da Associação Psiquiátrica Americana, seguido da aplicação dos testes projetivos de Szondi e H-T-P. O teste de Szondi foi aplicado por 8 vezes em cada indivíduo para avaliação quantitativa das proporções psicossexuais Dur e Moll. OS pacientes com diagnóstico de transtorno específico da identidade de gênero (transexualismo) foram acompanhados em psicoterapia de grupo por pelo menos 2 anos. Casuística: 105 indivíduos autodenominados transexuais (78 masculinos); grupo controle: 109 indivíduos (55 homens) autodenominados heterossexuais. Após aplicação dos critérios diagnósticos para transtorno da identidade de gênero do DMS-IV da Associação Psiquiátrica Americana e acompanhamento psicoterápico foram definidos como transexuais 41 indivíduos do sexo masculino e 17 indivíduos do sexo feminino. Na análise estatística as variáveis obtidas nos testes Szondi e H-T-P foram avaliadas por testes não paramétricos. Resultados: No grupo masculino, houve predomínio da proporção Moll total assim como na proporção Moll no vetor sexual e no do ego nos transexuais em comparação aos heterossexuais e aos portadores de transtorno da identidade de gênero não especificado (p<0,05). A sensibilidade do teste Szondi para identificação feminina nos transexuais masculinos foi de 80%, a especificidade de 86% e a acurácia de 83% enquanto que a sensibilidade do teste H-T-P foi de 88%, a especificidade de 54% e a acurácia de 72%. No grupo feminino houve predomínio da proporção Dur total assim como na proporção Dur do ego nas transexuais em comparação as heterossexuais e as portadoras de transtorno da identidade de gênero não especificado (p<0,05). A sensibilidade do teste Szondi para identificação masculina nos transexuais femininos foi de 94%, a especificidade de 67% e a acurácia de 85% enquanto que no teste H-T-P a sensibilidade foi de 94%, a especificidade foi de 33% e a acurácia de 73%. No período pós-cirúrgico todos os pacientes portadores de transtorno específico da identidade de gênero se mostraram satisfeitos, com alguma frustração pela limitação do processo transexualizador, por terem realizado a cirurgia, porém com melhora significativa dos vínculos sócio-familiares. Discussão: A validação de testes psicológicos para o diagnóstico dos transtornos de identidade de gênero é de grande importância visto o número crescente de pacientes com queixas de transtorno sexual que procuram tratamento. No estudo atual analisamos as propriedades do teste Szondi e do teste H-T-P num grupo de pacientes com transtornos da identidade de gênero classificados através dos critérios vigentes. Verificamos que a acurácia do teste Szondi foi maior que a do teste H-T-P no diagnóstico dos transtornos específicos da identidade de gênero a custa de uma maior especificidade frente a uma sensibilidade semelhante. Além disto, a detecção de transtornos psíquicos pelo teste Szondi, que podem ser causa ou efeito do transtorno da identidade de gênero, permite alertar o psicoterapeuta na indicação da cirurgia de transgenitalização. Conclusão: O teste Szondi mostrou ser um excelente teste auxiliar para o diagnóstico do transexualismo em ambos os sexos / Transsexualism is a disorder of sexual identity associated with strong and persistent identification with the opposite sex. There are few studies concerning the use of psychological tests as diagnostic tools for transsexualism. The objective of this study was to assess the psychosexual aspects of self-denominated transsexuals through the Szondi test. Retrospective and prospective study in which patients were firstly assessed through free interviews. monitoring psychotherapy, with assessment of DMS-IV diagnostic criteria for transsexualism from the American Psychiatric Association followed by the HTP projective personality test. The Szondi test was applied 5-10 times to each subject to quantitatively assess the Dur-Moll psychosexual reactions. Subjects: 105 self-determined transsexuals (78 men); control group: 109 selfdetermined heterosexuals (55 men). Twenty-two male subjects and 10 female subjects were defined as transsexuals DMS-IV diagnostic criteria for transsexualism from the American Psychiatric Association followed by monitoring psychotherapy. Statistical analysis of the variables obtained in SZONDI and HTP projective tests were evaluated by non-parametric tests. Results: In the male group, there was a predominance in total Moll proportion and in Moll proportion at the sexual and ego vectors in transsexuals compared to heterosexual and not specified gender identity disorder groups (p <0.05). The sensitivity of the SZONDI test to identify female gender identity in men was 80%, specificity 86% and accuracy 83% while the sensitivity of the H-T-P test was 88%, specificity 54% and accuracy 72%. In the female group total Dur proportion and Dur proportion at ego vector was predominant in transsexuals compared to heterosexual and not specified disorder of gender identity groups (p <0.05). The sensitivity of the SZONDI test to identify male gender identity in women was 94%, specificity 67% and accuracy 85% while for H-T-P test the sensitivity was 94%, specificity 33% and accuracy 73%. After surgery all transsexuals patients were happy but with some frustration with the transgender process limitation but with significant improvement of social and family contacts. Discussion: The validation of psychological tests for diagnosis of gender identity disorders is of great importance considering the increasing number of patients with sexual identity disorder seeking treatment. In the present study we analyzed the properties of SZONDI and H-T-P tests in a group of patients with of gender identity disorders classified by current criteria. We found that the accuracy of the SZONDI test was higher than the H-T-P test in the diagnosis of transsexualism due to greater specificity with similar sensitivity. Furthermore, the detection of mental disorders by SZONDI test, which may be the cause or effect of the gender identity disorder, can alert the psychotherapist in the indication of transgender surgery. Conclusion: The SZONDI test showed to be an excellent tool for transsexualism diagnosis in both sexes

I bakgrunden tas betydelsen av en bra vårdrelation upp, liksom transpersoners plats inom dagens vård. Även tidigare forskning presenteras. Syftet är att belysa transpersoners (könskorrigerade och icke könskorrigerade) upplevelser av brister inom vården. För att besvara syftet har en litteraturöversikt utförts enligt Fribergs (2006) modell. Resultatet redovisar att vården idag för denna minoritetsgrupp är bristfällig, med diskriminering och okunskap som ständigt möter transpersoner inom vården, liksom att vården styrs av heteronormativitet. I diskussionen diskuteras den heteronormativitet som uppmärksammats i resultatet, liksom vad som tas upp om ämnet HBTQ i utbildningar. Även diskriminering diskuteras. Slutsatsen är att vårdpersonal har bristande kunskap om transpersoner, vilket leder till att vården blir heteronormativ och då diskriminerande. Resultatet kan användas för vårdpersonal att reflektera över deras arbetsplats bemötande av transpersoner för att kunna förbättra vårdmiljön till mer inkluderande. / Program: Sjuksköterskeutbildning

<p>Även om ordet transperson är relativt nytt har det funnits könsöverskidare i alla tider. Sverige blev först i världen med lagliga könskorrigeringar 1972 och i dag går det att få ett könsbyte bekostat av staten. Men okunskapen är fortfarande stor om transpersoner, speciellt inom vården. Det medför att många känner sig dåligt behandlade och undviker att söka vård, visar rapporter. Nu arbetar bland annat RFSL för att förbättra bemötandet av transpersoner.</p>

<p>Syftet med denna undersökning är att testa tre hypoteser om transsexualism i Sverige, genom att studera lagen och debatten om lagen om könsbyte från 1972 som uttryck för den dominerande diskursen om transsexualism. Studien är gjord historiskt, där olika tidsmässiga nedslag i debatten om lagen studeras för att nå insikt om huruvida transsexualism skapas av den empiri jag studerar. Teorierna som hjälpt analysen av utvecklingen av lagen och rösterna i debatten är främst inspirerade av Michel Foucaults diskursteori, samt Judith Butlers teori om den heterosexuella matrisen. Metodologiskt söks svar på de frågor som utformats för att testa hypoteserna och genomgående står erkända kunskaper om transsexualism samt normerande av kön, genus och sexualitet i fokus för analysen. Vidare diskuteras vad den lagligt fastställda dominerande diskursen om transsexualism och diagnosen kräver för ett erkännande av det transsexuella subjektet. Studien av empirin kring lagen om könsbyte resulterar i tesen att transsexualism inte enbart kan förstås som ett naturligt förekommande fenomen utan att det styrs av olika diskursivt skapade sanningar om kön, genus och sexualitet, vilka även villkorar det transsexuella subjektet. Analysens resultat är att transsexualism, precis som normerna kring kön, genus och sexualitet, är diskursivt skapat och villkorat och således är föränderligt.</p> / <p>This study is aimed at the Swedish 1972 law on transsexualism and the debate on this subject before and since then. The purpose is to test three hypotheses through three questions focused on trying to find out whether it is possible to state that transsexualism is discursively created. The theories which underlay the analysis are mainly derived from Michel Foucault’s theory on reality and truth as constructed through discourse and Judith Butler’s theory on the force of the heterosexual matrix. By analyzing historical texts in this debate I examine how acknowledged truths together discursively construct certain truths about transsexualism in relation to truths on the subject of sex, gender and desire created through the heterosexual matrix. In relation to these theories I also examine in what ways the recognized transsexual subject is constructed through the conditions in the law and diagnosis. My thesis is that the studied materials, seen as representing the Swedish dominating discourse on transsexualism, together sets the terms for and constructs both transsexualism and the transsexual subject through a set of norms on sex, gender and desire. As these norms are subject to change, so is transsexualism, and therefore transsexualism can not be understood as merely a natural condition.</p>

Även om ordet transperson är relativt nytt har det funnits könsöverskidare i alla tider. Sverige blev först i världen med lagliga könskorrigeringar 1972 och i dag går det att få ett könsbyte bekostat av staten. Men okunskapen är fortfarande stor om transpersoner, speciellt inom vården. Det medför att många känner sig dåligt behandlade och undviker att söka vård, visar rapporter. Nu arbetar bland annat RFSL för att förbättra bemötandet av transpersoner.

Syftet med denna undersökning är att testa tre hypoteser om transsexualism i Sverige, genom att studera lagen och debatten om lagen om könsbyte från 1972 som uttryck för den dominerande diskursen om transsexualism. Studien är gjord historiskt, där olika tidsmässiga nedslag i debatten om lagen studeras för att nå insikt om huruvida transsexualism skapas av den empiri jag studerar. Teorierna som hjälpt analysen av utvecklingen av lagen och rösterna i debatten är främst inspirerade av Michel Foucaults diskursteori, samt Judith Butlers teori om den heterosexuella matrisen. Metodologiskt söks svar på de frågor som utformats för att testa hypoteserna och genomgående står erkända kunskaper om transsexualism samt normerande av kön, genus och sexualitet i fokus för analysen. Vidare diskuteras vad den lagligt fastställda dominerande diskursen om transsexualism och diagnosen kräver för ett erkännande av det transsexuella subjektet. Studien av empirin kring lagen om könsbyte resulterar i tesen att transsexualism inte enbart kan förstås som ett naturligt förekommande fenomen utan att det styrs av olika diskursivt skapade sanningar om kön, genus och sexualitet, vilka även villkorar det transsexuella subjektet. Analysens resultat är att transsexualism, precis som normerna kring kön, genus och sexualitet, är diskursivt skapat och villkorat och således är föränderligt. / This study is aimed at the Swedish 1972 law on transsexualism and the debate on this subject before and since then. The purpose is to test three hypotheses through three questions focused on trying to find out whether it is possible to state that transsexualism is discursively created. The theories which underlay the analysis are mainly derived from Michel Foucault’s theory on reality and truth as constructed through discourse and Judith Butler’s theory on the force of the heterosexual matrix. By analyzing historical texts in this debate I examine how acknowledged truths together discursively construct certain truths about transsexualism in relation to truths on the subject of sex, gender and desire created through the heterosexual matrix. In relation to these theories I also examine in what ways the recognized transsexual subject is constructed through the conditions in the law and diagnosis. My thesis is that the studied materials, seen as representing the Swedish dominating discourse on transsexualism, together sets the terms for and constructs both transsexualism and the transsexual subject through a set of norms on sex, gender and desire. As these norms are subject to change, so is transsexualism, and therefore transsexualism can not be understood as merely a natural condition.

Patients suffering from transsexualism (TS) who apply for sex reassignment surgery (SRS) go through a complex evaluation process before being accepted for treatment. In general, the results from SRS are satisfying. However, further knowledge is needed to clearly delineate transsexualism from other related gender identity disorders (GID) and to improve the selection of candidates for SRS. Personality has for a long time been considered as the key concept for that purpose but systematic studies using reliable instruments are lacking. The present study aims at improving the assessment procedure, validating the concept of transsexualism and studying the outcome of SRS and important prognostic factors. Two methodological studies deal with the development and validation of two self-report instruments based on DSM-III-R: SCID screen covering Axis II personality disorders/traits and Global Assessment of Functioning (GAF-scale, Axis V). SCID screen diagnoses of personality disorders (PD) were compared with diagnoses from independent structured interviews by means of the SCID-II. The overall kappa in identifying a PD was 0.78 varying from 0.34 to 0.81 for the specific PDs when cut-off was adjusted. When applied to a group of GID-patients SCID screen diagnoses agreed well with clinical diagnoses (kappa 0.77). Self-report of the GAF also proved to be a reliable (overall Pearson r=0.62) and useful method and the study lends further support to the validity of Axis V. In three papers a group of 19 transsexuals was studied by means of a) SCID screen to examine their personality in a dimensional and traditional categorical way, b) the GAF-scale to study psychosocial functioning, c) Structural Analysis of Social Behavior (SASB) to examine self-image and d) Defense Mechanism Test (DMT) to analyze psychological defense structures from a psychodynamic perspective. Patients with atypical gender identity disorders (GIDAANT) and patients with borderline personality disorders as well as healthy subjects were used as contrast groups. Among the transsexuals 10 out of 19 had an additional axis I disorder and 37% had at least one PD, predominantly within cluster B. When analyzed dimensionally according to SCID screen, frequent subthreshold personality pathology was found and biological women fulfilled more axis II criteria than men. TS had less axis I and II pathology compared with GIDAANT and psychiatric patients. According to SASB, TS had a positive self-image with both self-control and spontaneous self and predominating self-love. They appeared significantly more healthy on self-image measures than GIDAANT patients. The DMT revealed a different pattern; TS patients were more disturbed in several areas than patients with borderline personality disorder. TS showed no ”emotional investment” and poorer reality orientation in contrast to both healthy controls and the borderline group but shared a similar pregenital pathology with the borderline patients. Finally, five-year outcome was studied among the transsexuals from a multidimensional approach (e.g. work, interpersonal relations, partnership, subjective opinion) and related to index- measurements on DSM-III-R, SCID screen, GAF, SASB and DMT. Based on combined outcome variables, 68% of the subjects were judged to have improved and 16% had an unsatisfactory outcome. One single case regretted the sex change. SCID screen pathology and SASB disturbances emerged as significant predictors for negative outcome, as well as male biological sex and lack of partnership. It was concluded, that although outcome is in general very favorable, the instruments under investigation, in particular SCID screen and SASB, revealed valuable prognostic information and they are suggested to become part of the future routine assessment of candidates for SRS. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1995, härtill 6 uppsatser.</p> / digitalisering@umu