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Made available in DSpace on 2016-04-26T20:30:29Z (GMT). No. of bitstreams: 1 Livia Cristina Rocha.pdf: 815766 bytes, checksum: 82635d5039ae0bb942d92f31298e9467 (MD5) Previous issue date: 2010-06-16 / This study aims to analyze the many issues raised in relation to the reassignment of sex in their ways: neocolpovulvoplastia and neofaloplastia. Among them: surgical inefficiency and the possibility of repentance, the body naturally created; finding injury of serious nature, and especially the consequences brought by this surgery in the legal world. The reassignment of sex is only compatible with the figure of the transsexual, except for his help in other cases the behavioral states of sexuality (intersex, hermaphroditism, homosexuality, bisexuality and transvestism). The transsexual is defined as the person who experience an ongoing conflict between their physical sex and psychological, in other words, their mental gender identity does not match with the biological, which leads the transsexual vehemently deny their sexual organs, and in some cases the injured themselves or commit suicide. Thus, the reassignment of sex is shown as the only proper means to repair the suffering of transsexuals and is the only effective treatment. She is the extent of body-mind balance and essential to the preservation of life, health, health (physical and mental) and well-being of the patient. Once accomplished, brings with anatomical transformation for the transsexual, but how it reflects the legal world? Currently, the transsexual surgery is recognized the right to change the first name and sex in its civil register. Emphasized that it is not a unanimous position. At this point, the course includes the three main current jurisprudence, the first one in favor of changing the civil registry and its dual knowledge (first name and gender), the second most favorable only to registration under the justification of preserving rights of third parties and continuity of existing Public and, finally, one that begs the insertion of the term "transsexual" in the cartouche would register, so it would be acting under the aegis of the veracity of public record. Beyond these points, see that the only way to promote social inclusion of transsexuals will be with the completion of the process begun with the reassignment of sex, which is just a phase, complemented with the conclusion of the civil registry change that, because only thus can preserve and realize the much-trumpeted principle of human dignity / O presente trabalho tem como objetivo analisar as questões suscitadas em relação à cirurgia de redesignação de sexo em suas modalidades: neocolpovulvoplastia e neofaloplastia. Dentre elas: ineficácia cirúrgica; possibilidade de arrependimento; naturalidade do órgão criado; constatação de lesão corporal de natureza grave; e, especialmente, os reflexos trazidos pela realização dessa cirurgia no mundo jurídico. A cirurgia de redesignação de sexo apenas é compatível com a figura do transexual, excluindo de seu amparo os demais casos de estados comportamentais da sexualidade (intersexualismo; hermafroditismo; homossexualismo; bissexualismo e travestismo). O transexual é definido como aquela pessoa que vivencia um conflito permanente entre seus sexos físico e psíquico, em outras palavras, sua identidade sexual psíquica não corresponde com a biológica, o que leva o transexual recusar veemente seus órgãos sexuais, chegando em alguns casos a lesionar-se ou suicidar-se. Destarte, a cirurgia de redesignação de sexo se mostra como o único meio hábil para reparar o sofrimento do transexual, constituindo a única forma de tratamento efetivo. Ela é o alcance do equilíbrio corpo-mente e essencial à preservação da vida, da saúde, da integridade (física e psíquica) e do bem-estar do paciente. Uma vez realizada, traz relevante transformação anatômica para o transexual, mas como isso reflete no mundo jurídico? Atualmente, ao transexual operado é reconhecido o direito à alteração do prenome e do sexo em seu registro civil. Ressalta que não é uma posição unânime. Neste ponto, serão estudadas as três principais correntes jurisprudências, a primeira delas favorável à alteração do registro civil e seu duplo conhecimento (prenome e sexo); a segunda delas favorável apenas à averbação, sob a justificativa de preservar direito de terceiros e a continuidade do registro público; e, por último, aquela que suplica pela inserção da denominação transexual na cártula registrária, assim estaria agindo sob a égide da veracidade do registro público. Ultrapassados esses pontos, verá que o único modo de promover a inclusão social do transexual será com a completude do processo iniciado com a cirurgia de redesignação de sexo, que é apenas uma fase, sendo complementada com a efetivação da alteração do registro civil daquele, pois, somente assim poderá preservar e efetivar o tão proclamado princípio da dignidade humana

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-08-29T11:33:29Z No. of bitstreams: 1 Pietra Mello Munin.pdf: 994421 bytes, checksum: ac08e1eca56c7954af354abe1bc978f5 (MD5) / Made available in DSpace on 2018-08-29T11:33:29Z (GMT). No. of bitstreams: 1 Pietra Mello Munin.pdf: 994421 bytes, checksum: ac08e1eca56c7954af354abe1bc978f5 (MD5) Previous issue date: 2018-08-10 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The history of the different experiences of gender transformation in various historical moments and cultures is a challenge faced in this dissertation. The concept of transsexuality was built in the twentieth century, with transsexuals initially identified as “homosexuals discontented" with their own bodies. In the 1950s, the condition came to be seen as an identity category, being used by medical discourse. On the representations of the transsexuality, different discourses were constructed: the medical discourse, the common sense and the one of the trans militancy. It is the purpose of this research to question how these different discourses influenced the institutionalization of medical care to transsexuals in the country, specifically in Hospital das Clínicas de São Paulo. The work to achieve this goal was hard, the subject is academically understudied. We sought to trace the historical background in a dialogue with the bibliography, as well as to recover the legal aspects related to transsexuality in Brazil, through emblematic cases such as the transsexual Roberta Close and that of Dr. Roberto Farina, as well as reconstituting the legal struggle process (different bills) involving issues such as rectification of civil records and medical care for transsexuals. Seeking to give voice to the agents of these actions, we collected testimonies from transsexuals under care of the Program of the Hospital das Clínicas of São Paulo, as well as retrieved resolutions and ordinances from the Federal Medical Council and the Ministry of Health. The analysis of these experiences allowed to identify the influence of the different discourses, the difficulties faced, the construction of identities, and the struggles around the question / A história das diferentes experiências do trânsito entre gêneros em vários momentos históricos e culturas é um desafio enfrentado nesta dissertação. O conceito de transexualidade foi construído no século XX, sendo os transexuais identificados, inicialmente, como “homossexuais descontentes” com o próprio corpo. Já na década de 1950 a condição passou a ser vista como uma categoria identitária, sendo utilizada pelo discurso médico. Sobre as representações da transexualidade foram construídos diferentes discursos: o discurso médico, o do senso comum e o da militância trans. Consiste em objetivo desta pesquisa questionar como esses diferentes discursos influenciaram a institucionalização do atendimento médico a transexuais no país, especificamente no Hospital das Clínicas de São Paulo. O trabalho para alcançar tal objetivo foi árduo, o tema é pouco estudado academicamente. Procurou-se rastrear os antecedentes históricos num diálogo com a bibliografia, também recuperar os aspectos legais referentes à transexualidade no Brasil, através de casos emblemáticos como o da transexual Roberta Close e o do médico Dr. Roberto Farina, além de reconstituir o processo de luta legislativa (diferentes Projetos de Lei), envolvendo questões como a retificação dos registros civis e o atendimento médico a transexuais. Buscando dar voz aos agentes dessas ações, foram colhidos depoimentos de transexuais atendidos pelo Programa do Hospital das Clínicas de São Paulo, além de recuperadas resoluções e portarias do Conselho Federal de Medicina e do Ministério da Saúde. A análise dessas experiências permitiu identificar a influência dos diferentes discursos, as dificuldades enfrentadas, a construção de identidades e as lutas em torno da questão

Transsexuality remains grounded in pathologizing discourses. Mental health professionals largely classify transgender experiences as disorders, and transgender people seeking to alter their bodies typically must obtain authenticating letters from therapists verifying such diagnoses. Physicians usually require these letters to perform transition-related services, and sometimes require additional legitimization. In these ways, psychomedical professionals impose gatekeeping measures that withhold and confer services to transsexuals who desire medical transition. Using qualitative interview data and grounded theory methods with 20 female-to-male transsexuals, this study demonstrates that transmen typically represent informed consumers whom carefully research psychomedical protocol and anticipate providers’ adherence to professional standards. When they encounter gatekeeping, this preparedness informs their dialectical struggles within the psychomedical institutions wherein transmen must negotiate bodies within the confines of pathology. Ultimately, this dialectical process is managed and maintained by the larger regime of truth—the gender binary system.

Objectif et problématique : Le transsexualisme ainsi que son traitement par la transformation hormonale et chirurgicale (THC) sont des phénomènes au carrefour de toutes les limites : corps, subjectivité, société, psyché… Face au constat de cette complexité, partant des approches structurale et déconstructiviste, cette thèse a pour objectif de définir et proposer une nouvelle approche « transversale » du transsexualisme, et dans la continuité de celle-ci de l’identité sexuée, avec les éléments de la théorie psychanalytique que sont la pulsion sexuelle de mort, la troisième topique de l’Inconscient clivé, la réalisation pulsionnelle par la perception et la clinique de l’extrême et de l’ordinaire.Matériel et méthode : Sur un échantillon de six sujets transsexuels masculin vers féminin ayant actuellement recours ou ayant eu recours à la THC depuis plus de deux ans, nous avons analysé les résultats à un entretien clinique inspiré de l’approche structurale, aux tests projectifs du rorschach et du TAT selon l’école projectiviste de Paris Descartes, ainsi qu’au MMPI-2. Nos trois hypothèses sont que la problématique identitaire transsexuelle renverrait à la pulsion sexuelle de mort, à l’Inconscient amential et à la clinique de l’extrême, puis que la THC aurait le potentiel d’agir telle une réalisation pulsionnelle par la perception.Résultats : Les résultats valident les deux premières hypothèses sur la pulsion sexuelle, l’Inconscient amential et la clinique de l’extrême, mais pas celle sur la réalisation pulsionnelle par la perception.Conclusion et discussion : Ces résultats montrent l’intérêt d’une approche transversale pour appréhender un phénomène limite comme le sont le transsexualisme et l’identité sexuée qui se voient éclairés par les éléments théoriques transversaux proposés (pulsion sexuelle de mort, Inconscient amential et clinique de l’extrême). Concernant, les effets de la THC au niveau psychique, il semble nécessaire de poursuivre notre investigation, la réalisation pulsionnelle par la perception ayant été validée chez un de nos deux sujets ayant terminé la THC depuis plus de deux ans, mais exclue chez l’autre. / Objective and problematic: the transsexualism as well as its treatment by the hormonal and surgical sex reassignment are phenomena in the crossroads of all the limits: body, subjectivity, society, psyche … In front of this complexity, running with the approaches structural and deconstructivist, this thesis has for objective to define and to propose a new "transversal" approach of the transsexualism, and in the continuity of this one of the sexed identity, with the elements of the psychoanalytical theory that are the sexual death drive, the third topical of the splited Unconscious, the impulsive realization by the perception and the clinical of the extreme and the ordinary.Material(Equipment) and method: on sample of six subjects transsexuals male to female resorting at present or having resorted to the sex reassignment for more than two years, we analyzed the results in a clinical interview inspired by the structural approach, in the projective tests of the rorschach and the TAT according to the projectivist method of Paris Descartes, as well as in the MMPI-2. Our three hypotheses are that the transsexual identity problematic would send back to the sexual death drive, to the amential Unconscious and to the clinical of the extreme, then that the sex reassignment would have the potential to act such as an impulsive realization by the perception.Results: the results validate both first ones hypothesis on the sex drive, the amential Unconscious and the clinical of the extreme, but not that one on the impulsive realization by the perception.Conclusion and discussion: these results show the interest of a transversal approach to dread a phenomenon borderline as are it the transsexualism and the sexed identity which see each other lit by the transversal theoretical proposed elements (sexual death drive, amential Unconscious and private hospital of the extreme). Concerning, the effects of psychic sex reassignment at the level, it seems necessary to pursue our investigation, the impulsive realization by the perception has been validated to one of our subject but excluded to the other one.

A presente dissertação trata-se de um estudo de caso exploratório que discorre sobre fatores neuro-estruturais, hormonais, neuropsicológicos e suas possíveis associações, em um par de gêmeos monozigóticos adulto, do sexo masculino, discordantes para o transexualismo. Ambos os gêmeos foram submetidos a entrevistas semi-estruturadas por meio de equipe especializada pertencente ao Programa de Transtorno de Identidade de Gênero do Hospital de Clínicas de Porto Alegre (HCPA). Aplicou-se o intrumento Wechsler Adult Intelligence Scale (WAIS), com o objetivo de avaliar diversas funções cognitivas verbais e não-verbais que contribuem para a inteligência geral e realizou-se Ressonância Magnética do encéfalo, com a finalidade de medir o volume de uma série de estruturas cerebrais. Ainda, a mãe dos sujeitos (o pai alegou não ter disponibilidade em participar) forneceu informações sobre a gestação, parto, condições de nascimento, infância, meio ambiente, alterações clínicas presentes e passadas e eventos incomuns na história de vida dos gêmeos. Em cinco regiões cerebrais foram detectadas diferenças nos volumes de determinadas estruturas, e nas habilidades de linguagem e raciocínio viso-espacial houve divergência entre os gêmeos. Sugere-se que fatores epigenéticos possam estar envolvidos tanto na discordância fenotípica como nos achados deste estudo. / The present work is an exploratory study case that discusses about neuroanatomical, hormonal and neuropsychological factors and their possible associations in one monozygotic male twin pair discordant for transsexualism. Both twins answered semi-structural interviews applied by specialized team from Gender Identity Disorder Program of Hospital de Clínicas de Porto Alegre, Brazil; In addition, they were tested with the Wechsler Adult Intelligence Scale (WAIS) battery that evaluate verbal and non verbal cognitive functions that contribute to general intelligence; and underwent magnetic resonance imaging (MRI) to measure the volumes of specific cerebral structures. The mother of the twins gave information (father did not want to participate) about the pregnancy, delivery, conditions of birth, childhood, raising environment, unusual medical or life history events. Both neuroimaging and cognitive function testing detected different outcome between the twins. In six different cerebral regions differences have been found in the volume of specific structures, as well as in language, visuo-spatial abilities. It is suggested that epigenetic factors could be related to the phenotypic discordance and the findings of this study

Esta pesquisa problematiza a categoria da transexualidade, em sua dimensão psicopatológica, e questiona seu caráter normativo, que pretende alinhar sexo, gênero, prática sexual e desejo, concernente às identidades sexuais. Ao desenvolvê-la, são discutidas as implicações dos determinismos anatomosexual e de gênero, no processo de subjetivação das transexuais; também se reflete quanto à pertinência do diagnóstico psiquiátrico de Transtorno de Identidade de Gênero, para a transexualidade; analisam-se concepções psicanalíticas que sustentam o diagnóstico de psicose para a transexualidade; investiga-se a possibilidade da intervenção cirúrgica de transgenitalização subverter a ordem binária sexo/gênero e, finalmente, consideram-se as implicações da mudança de sexo, nas subjetividades das transexuais. Os dados da pesquisa foram coletados e analisados, segundo a práxis do método qualitativo, utilizando-se a entrevista semiestruturada como principal instrumento de trabalho de campo. Os participantes da pesquisa são transexuais de homem para mulher, que já haviam realizado a cirurgia de transgenitalização ou que ainda aguardavam a oportunidade de fazê-la. A coleta de dados foi realizada no Serviço de Ginecologia do Hospital das Clínicas da Universidade Federal de Pernambuco UFPE. Seus resultados foram discutidos à luz das contribuições teóricas de Michel Foucault e Judith Butler, no campo filosófico, e de Robert Stoller, Catherine Millot, Márcia Arán, Jurandir Costa e outros autores contemporâneos, no campo psicanalítico. Os resultados da pesquisa demonstram que, ao desconstruir as concepções normativas inerentes ao sistema binário sexo-gênero, as pessoas transexuais ultrapassam os limites das certezas psicopatológicas e, ao mesmo tempo, confirmam suas subjetividades / This research questions the category of transsexuality in its psychopathologic dimension and the normative character concerning the sexual identities, which intend to inextricably connect sex, gender, sexual practice and desire. The implications of the sexual-anatomic and gender determinism in the process of the development of the subjectivities of the transsexuals are discussed; the pertinence of the Gender Identity Disorder (GID) psychiatric diagnosis for transsexuality is questioned; the psychoanalytic conceptions that support the psychosis diagnosis for transsexuality are analyzed; the possibility of sex change surgery subverting the sex-gender binary order is investigated; and finally, the implications of sex change surgery are considered in the subjectivities of the transsexuals. The data was collected and analyzed according to the qualitative research method and the semi-structured interview was used as the main instrument for the field research. The participants were male-to-female (MTF)transsexuals who had already undergone the surgery or were still waiting for the opportunity to do so. The data collection took place in the Gynecological Clinic in the Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE) and the results were discussed in light of the theoretic contributions of Michel Foucault and Judith Butler, in the philosophical area, as well as those of Robert Stoller, Catherine Millot, Márcia Arán, Jurandir Costa and other contemporary authors, in the psychoanalytic area. The research results demonstrate that in deconstructing the normative conceptions inherent in the sex-gender binary system, the transsexuals transcend the limits of the psychopathologic certainties and, at the same time, confirm their subjectivities

A presente dissertação trata-se de um estudo de caso exploratório que discorre sobre fatores neuro-estruturais, hormonais, neuropsicológicos e suas possíveis associações, em um par de gêmeos monozigóticos adulto, do sexo masculino, discordantes para o transexualismo. Ambos os gêmeos foram submetidos a entrevistas semi-estruturadas por meio de equipe especializada pertencente ao Programa de Transtorno de Identidade de Gênero do Hospital de Clínicas de Porto Alegre (HCPA). Aplicou-se o intrumento Wechsler Adult Intelligence Scale (WAIS), com o objetivo de avaliar diversas funções cognitivas verbais e não-verbais que contribuem para a inteligência geral e realizou-se Ressonância Magnética do encéfalo, com a finalidade de medir o volume de uma série de estruturas cerebrais. Ainda, a mãe dos sujeitos (o pai alegou não ter disponibilidade em participar) forneceu informações sobre a gestação, parto, condições de nascimento, infância, meio ambiente, alterações clínicas presentes e passadas e eventos incomuns na história de vida dos gêmeos. Em cinco regiões cerebrais foram detectadas diferenças nos volumes de determinadas estruturas, e nas habilidades de linguagem e raciocínio viso-espacial houve divergência entre os gêmeos. Sugere-se que fatores epigenéticos possam estar envolvidos tanto na discordância fenotípica como nos achados deste estudo. / The present work is an exploratory study case that discusses about neuroanatomical, hormonal and neuropsychological factors and their possible associations in one monozygotic male twin pair discordant for transsexualism. Both twins answered semi-structural interviews applied by specialized team from Gender Identity Disorder Program of Hospital de Clínicas de Porto Alegre, Brazil; In addition, they were tested with the Wechsler Adult Intelligence Scale (WAIS) battery that evaluate verbal and non verbal cognitive functions that contribute to general intelligence; and underwent magnetic resonance imaging (MRI) to measure the volumes of specific cerebral structures. The mother of the twins gave information (father did not want to participate) about the pregnancy, delivery, conditions of birth, childhood, raising environment, unusual medical or life history events. Both neuroimaging and cognitive function testing detected different outcome between the twins. In six different cerebral regions differences have been found in the volume of specific structures, as well as in language, visuo-spatial abilities. It is suggested that epigenetic factors could be related to the phenotypic discordance and the findings of this study

A presente dissertação trata-se de um estudo de caso exploratório que discorre sobre fatores neuro-estruturais, hormonais, neuropsicológicos e suas possíveis associações, em um par de gêmeos monozigóticos adulto, do sexo masculino, discordantes para o transexualismo. Ambos os gêmeos foram submetidos a entrevistas semi-estruturadas por meio de equipe especializada pertencente ao Programa de Transtorno de Identidade de Gênero do Hospital de Clínicas de Porto Alegre (HCPA). Aplicou-se o intrumento Wechsler Adult Intelligence Scale (WAIS), com o objetivo de avaliar diversas funções cognitivas verbais e não-verbais que contribuem para a inteligência geral e realizou-se Ressonância Magnética do encéfalo, com a finalidade de medir o volume de uma série de estruturas cerebrais. Ainda, a mãe dos sujeitos (o pai alegou não ter disponibilidade em participar) forneceu informações sobre a gestação, parto, condições de nascimento, infância, meio ambiente, alterações clínicas presentes e passadas e eventos incomuns na história de vida dos gêmeos. Em cinco regiões cerebrais foram detectadas diferenças nos volumes de determinadas estruturas, e nas habilidades de linguagem e raciocínio viso-espacial houve divergência entre os gêmeos. Sugere-se que fatores epigenéticos possam estar envolvidos tanto na discordância fenotípica como nos achados deste estudo. / The present work is an exploratory study case that discusses about neuroanatomical, hormonal and neuropsychological factors and their possible associations in one monozygotic male twin pair discordant for transsexualism. Both twins answered semi-structural interviews applied by specialized team from Gender Identity Disorder Program of Hospital de Clínicas de Porto Alegre, Brazil; In addition, they were tested with the Wechsler Adult Intelligence Scale (WAIS) battery that evaluate verbal and non verbal cognitive functions that contribute to general intelligence; and underwent magnetic resonance imaging (MRI) to measure the volumes of specific cerebral structures. The mother of the twins gave information (father did not want to participate) about the pregnancy, delivery, conditions of birth, childhood, raising environment, unusual medical or life history events. Both neuroimaging and cognitive function testing detected different outcome between the twins. In six different cerebral regions differences have been found in the volume of specific structures, as well as in language, visuo-spatial abilities. It is suggested that epigenetic factors could be related to the phenotypic discordance and the findings of this study

Ce travail de recherche a comme objectif la révision de la logique de la sexuation dans la clinique psychanalytique contemporaine. La thèse freudienne du « primat de phallus », reprise par Lacan d’abord dans sa logique sexuée « être ou avoir », gardera toute son importance dans son tableau de la sexuation, présentée dans le séminaire Encore. Ce tableau de la sexuation, référé au phallus comme au seul et unique signifiant de la différence des sexes, nous laisse “déboussolé” dans la recherche des particularités des modes contemporains d’être sexué. Par contre, nous affirmons que la thèse de Lacan selon laquelle « l’être sexué ne s’autorise que de lui-même […] et quelques autres » trouve toute sa pertinence quant au devenir sexué du sujet contemporain et se met au premier plan dans le tout dernier enseignement de Lacan à travers son étude du parlêtre en terme de nouage et de suppléance. Nous avons ciblé la clinique du pousse-à-la-femme et des femmes-transsexuelles afin de montrer, que la psychanalyse, orientée par le dernier enseignement de Lacan, permet de reconsidérer ces deux cliniques de troubles d’identité sexuelle comme des modes de s’autoriser en tant que sexués. A travers nos cas cliniques, nous prétendons avoir démontré que pour ces sujets, faute de se servir du signifiant phallique « pour tous », il s’agit néanmoins de tentatives pour trouver leur manière sinthomatique de rejoindre dans leur quête identitaire le discours sexuel commun qui soutient pour l’instant la binarité des sexes. / This study aims at a revision of the sexuation logic within the modern psychoanalytical clinic. The Freudian thesis on the "primacy of phallus" was initially assumed by Lacan as a sexuated logic "to be or to have" a phallus, and it kept its importance in his later works, it was especially developed in his XX Seminar "Encore" in the table of sexuation. We have demonstrated that as far as the table of sexuation refers to the phallus, described in terms of the phallic function, that continues to be the only signifier of the difference between the sexes, we can hardly apply it to studying some of the particularities of the modern modes of sexuation. On the contrary we suggest that Lacan’s thesis that "the sexuated being is authorized only by himself [...] and by some others" remains valid as far as the becoming of the modern subject is concerned and it is brought to the forefront in the last teaching of Lacan through his study of the "talking being" in terms of knotting and suppliances. Therefore we have chosen the study of the the clinic of the push-to-be-the-woman and that of transsexual women in order to demonstrate that psychoanalysis oriented by the last teaching of Lacan gives us the possibility to reconsider these two clinics of sexual identity disorders in terms of modes of auto-authorization as sexuated. Via our clinical cases we suggest that these subjects left out of the possibility to appeal to the phallic signifiers "for everybody", try nevertheless to find their sintomatic way to join the common sexual discourse without the reference of the sexual binaries.