Human Sexuality and Gender/Gender

Sex vs. Gender
Sex and gender are two different terms that are sometimes used interchangeably, although they do have meanings that are not similar. Sex refers to the biological traits (internal and external reproductive anatomy, chromosomes, hormones, and other physiological characteristics). A person's sex is determined when these traits are examined. Sex cannot be changed unless surgical procedures are done. Gender on the other hand is how we perceive ourselves based on our own life experiences and/or the roles we play in our communities and society. Gender is seen as however one chooses to express themselves. Biology is the basis to social and cultural influences that impact gender roles and identity. Sex is whether you are male or female, although some people are intersex and are born without definite male or female characteristics or a combination of them. Gender is debatable. In a British survey taken by Women in Focus geared toward both the feminine and masculine side of men they found that men classify 32% of their values as feminine, 34% as masculine, and 34% as asexual. Your Gender has less and less to do with whether you are male or female particularly because more and more people possess the talent to switch from gender to gender depending on the situation: androgynous males and females. Some people prefer to completely switch their sex: transsexuals, whether it’d be females with the desire to become men or vice versa. According to Milton Diamond the term Gender has been misused for years now particularly as a synonym for the word sex. Male or female is the correct respond to what sex you are. Gender is the complicated part.

=Gender-Role Development= What is Gender Role Theory? Gender role theory implies that children learn the appropriate gender behavior and how to act based on the attitudes and actions that they observe from the people in their life. These people are considered role models: parents, caregiver, teacher and peers and the environment in which the child was raised help develop gender roles. “It specifies how gender conceptions are constructed from the complex mix of experiences and how they operate in concert with motivational and self-regulatory mechanisms to guide gender-linked conduct throughout the life course.” Society plays a main role in gender development and the social theory part discusses that social structure is the main force for gender differences. Gender differences become problematic because of the division of labor between the two sexes; male and female. This division is the gender roles which later lead to gender social behavior. Men’s unique physical advantages in term of body size and upper body strength provided them an edge over women in those social activities that demanded such physical attributes such as working construction jobs or going to war. Women’s biological makeup for reproduction and child-bearing is proposed to explain their limited involvement in other social activities. The divided activity for male and female and their purpose in life led to the division of labor between sexes. Social role theorists have explicitly stressed that the labor division is not narrowly defined as that between paid employment and domestic activities, rather, is conceptualized to include all activities performed within a society that are necessary for its existence and sustainability. The characteristics of how males and females act becomes perceptions and beliefs of the attributes of men and women. Division of labor led to gender roles, or gender stereotype. Ultimately, people expect men and women who occupy certain position to behave according to these attributes. The consequences of gender roles and stereotypes are sex-typed social behavior because roles and stereotypes are both socially shared descriptive norms and prescriptive norms. Gender roles provide guides to normative behaviors that are typical and traditional for each sex within certain social context. Gender roles also describe ideal, should-be, and thus desirable behaviors for men and women who are occupying a particular position or involving in certain social activities. Men and women strive to belong and seek for approval by complying and conforming to the social and cultural norms within their society. http://memory.syr.edu/jennifer/teaching/class_articles/BussBand99.pdf

Prenatal Development
At the moment of conception, gender-role development and sex of the newborn begins. Since the mother naturally gives the egg an X chromosome, unless the father gives a Y chromosome the newborn result to be the sex of a female. However, there are exceptions, such as females with only one X chromosome known as Turner’s syndrome or males with two X chromosomes known as Klinefelter’s syndrome. The embryo is going to form a female reproductive system, unless there the hormone testosterone present from the father’s genes. This process occurs around week six of the gestation period.

Throughout the rest of the prenatal period there are cases where the female fetuses may come in contact with androgens and cases where male fetuses are too insensitive to the androgens. These two cases can result in a baby born with ambiguous genitalia and reproductive systems.

Infancy
Once the baby is born, he or she will now experience the first main stages of gender-role socialization. Such exterior factors such as: names, clothing, toys and how the baby is acted towards will begin to reinforce or condemn actions affiliated with gender roles.

Early Childhood
Age’s two to six are the most important years in gender development roles, since during these years the child will begin to realize their gender and what type of play styles or actions are appropriate for them. During these years boys may not want to play with dolls because they say “those are girl’s toys” and girls may not wish to play with toy cars because they say that toy cars are “boys toys.” Such opinions are formed because of the types of toys the children are given to play with regard to their sex. Such complexes such as the Oedipal Crisis in boys and the Electra complex in girls come into play during this stage. During this stage same-sex behaviors are rewarded whereas imitating or acting like the opposite sex is not rewarded and in some cases may be punished. Gender schemas are developed during this stage, gender schemas are the children’s ideas of gender that help them categorize same-gender experiences or actions as correct.

Middle Childhood
Once children reach the age of six parents are no longer the major source of gender development. Starting around age six children begin to spend the majority of their days in school. In school, the majority of children separate into gender-segregated groups in which accepted actions and values are peer driven. At a young age boys and girls consider the other sex to be “toxic” of a sort; if you would come into contact with someone of the other sex you would get “cooties.” Within these segregated play groups, the types of activities and actions are dramatically different from each other. Boy’s groups are generally very competitive, consisting of a pecking order, organized in large groups, and are generally found participating in rigorous outdoor activities. Girl’s groups tend to be smaller and more focused on smaller subgroups that consist of intense conversations, girl groups tend to be less competitive. Groups of boys gradually gain the value that doing anything feminine is to be avoided.

Adolescence
During adolescence gender-role development is largely based upon self identity. Boys begin to practice “macho” roles and become homophobic. Girls tend to play down their intellectual advancement that they have over boys. Puberty also plays a large role on gender-role development because some experience puberty prior to others. Girls tend to encounter social hierarchy issues and experience depression, eating disorders and low self-esteem. Towards the end of adolescence both male and females begin to become more comfortable and confident in their gender. Values and perceptions of both genders are generally learned and practiced therefore accepted and unaccepted gender norms are practiced and condemned.

Disorders of Sexual Development
An  'intersexual'  is someone who posses a combination of male and female genitalia and reproductive structures, also known as ambiguous genitalia. A newer term,  'disorders of sex development' (DSD) is used to describe the congenital anatomy of an individual possessing a combination of both male and female reproductive structures. Genetics play a large role in disorders of sex development. Females are described as a homogametic sex because they can only pass the X chromosome to the child, males are a heterogametic sex because they can either pass on a X or Y chromosome. The usual chromosome combination for a female offspring is XX and XY for males. Fetus’ are naturally female possessing only the Y chromosome according to the Sex-Determining Region of the Y chromosome otherwise known as SRY. Examples of chromosomes with a DSD are as follows: XXY, and XXYY, XO, XYY and XX males and XXX females. Though in humans XO is known as Turner Syndrome, and generally present as females...

Kelly and Zucker (2000,2005) state that at least three major subgroups of individuals with DSD exist: true hermaphrodites, male pseudo-hermaphrodites and female pseudo-hermaphrodites. A true hermaphrodite may be born with both ovarian and testicular tissues, or possessing ovatestes a structure with a combination of an ovary and a testicle. A true hermaphrodite is extremely rare, with currently only about 400 known cases around the world. A female pseudo-hermaphrodite posses normal female internal reproductive organs with an XX chromosome, however they appear to have a more masculinized exterior appearance. This disorder is generally rare occurring in about one in every 14,000 births. Male pseudo-hermaphrodites have testes but having an XY chromosome they will have the appearance of a female.

Sex reassignment is a controversial procedure where “abnormal” genitalia are surgically corrected. The procedure is controversial because even if the genitalia appear to be of one or combination of sexes, the surgically corrected genitalia may not correlate with the sex hormones the individual possess.

Turner's Syndrome
Turner syndrome is a loss of an X chromosome in females. Females that have Turner syndrome are likely to have an odd hairline, be petite and sometimes their ovaries will not function. They are also at risk for having strange social behavior and high anxiety. For example, Keysor et al., 2002 did a study examining modulation arousal by comparing females aged 13-22 who had the Fragile X syndrome, Turner syndrome and females who had neither. Arousal can sometimes reflect a person’s ability to respond appropriately to life challenges. The task included mental arithmetic, divided attention, and risk-taking tasks (Roberts, Mazzocco, Murphy, & Hoehn-Saric, 2007). Females that had Turner syndrome had an extremely high correlation of anxiety measured from their skin conductance compared to those females that had the Fragile X syndrome and those that had neither. This suggests that females with Turner syndrome have a hard time adjusting to new social changes.

Adolescent girls with Turner Syndrome are at a greater risk for having problems related to lower social activity, poor social coping skills and increased immaturity, hyperactivity and impulsivity compared to their peers. Girls with Turner Syndrome may have more difficulties maintaining relationships, relating to others, have fewer friends and tend to be more socially isolated than controls. Social difficulties in girls with Turner Syndrome may partially stem from impairments in face and emotion processing as well as interpreting gaze in individuals with Turner Syndrome. Some researchers have suggested that a diagnosis of autism, a neurodevelopmental disorder characterized by social deficits, is more common among girls with Turner Syndrome but this remains controversial.

Klinefelter's Syndrome
Klinefelter’s syndrome is a disorder in sexual development characterized by the appearance of an additional X chromosome, causing an XXY chromosome pattern in males. According to a recent study by, Rijn et al. (2006) these individuals are at increased risk for psychiatric disorders. XXY men may have related difficulties with social-emotional issues such as schizophrenia and autism

The Klinefelter's syndrome is the most common sexual chromosome disorder for males (William, Timothy, Durk) This disorder happens to about 1 and every 1,000 males. A common effect that happens from the Klinefelter's syndrome is a reduce in size of a males testicles. Klinefelter's syndrome is the second most common disorder of extra chromosomes. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. p 549

Symptoms

This condition effects three types of development, the physical development, the language development, and the social development. Males with XXY, as babies have very weak muscles. They may be taller but are not able to have as much muscle control and coordination. Once they begin puberty they really do not make as much testosterone as other males. This results in less facial and body hair, broader hips, larger breasts, and weaker bones. When they become adults they are able to have normal sex lives but most of the time they make little or no sperm. About 25% to 85% of XXY males may have some sort of language problem. They may have problems reading, learning to talk late, and may have a problem processing what they hear. XXY males can have trouble fitting in with their peers and boys and may become less self confident, less active and more helpful and obedient. But as adults they have a similar to life to men without this condition. They are able to have friends, families and normal social relationships. (Klienfelter syndrome. par.2)

History

Klinefelter Syndrome was discovered in 1942, when Klinefelter described nine males with gynecomastia (the development of mammary glands or breasts in males), small testes, and azoospermia (the lack of sperm or live sperm in seminal fluid or ejaculate), and high levels of gonadotrophin (hormone which is involved in growth of the testes). In 1949, Barr and Bertram discovered in the nerve cell nuclei of female cats there was a dense chromatin mass. This mass was later became known as a Barr body and is only found in females. This discovery led to the use of stained cell smears to determine if an infant’s genetic sex matched the infant’s phenotypic sex (apparent or sex the infant physically appeared to be). If the stain has a Barr body the infant’s sex would be female. In 1959, however, a patient with Klinefelter Syndrome was shown having 47 chromosomes, as well as an extra X chromosome. This proved that the Barr body seen in the syndrome represented an extra X chromosome. The main cause of Klinefelter Syndrome is thought to be this extra X chromosome.

Causes

The extra X chromosome causing Klinefelter Syndrome occurs because of an error in parental gametogenesis. During parental gametogenesis the production of male or female germ cells, spermatozoa or ova takes place. Each parent supplies half the chromosomes to a new fetus, the number of chromosomes in the germ cell must be condensed through meiosis. During this process, non disjunction or the failure of homologous chromosomes to separate correctly causes a sperm or an egg to carry an extra X chromosome as well as the standard single sex chromosome.

Mayer-Rokitansky-Küster-Hauser syndrome
Mayer-Rokitansky-Kuster-Hauser Syndrome, sometimes known as Mullerian Agenesis syndrome, is a sexual disorder that occurs during fetal development in approximately 1 out of every 4500 females. In females that exhibit this syndrome, the vagina may be very short or absent, and the uterus may be also absent or misformed. All other female development is normal, including functional ovaries. It occurs as a malfunction in the mullerian tract development, but what caused this to happen was not known until recently. New research suggests that a defect in certain HOX genes, which are essential in organ development, may be the cause of this syndrome (Guerrier et al., 2006). The syndrome is not commonly diagnosed until after puberty because no symptoms arise until then, when menstruation is noticeably absent. There are two treatment options for the short or absent vagina; one is a surgical procedure, and the other method involves a series of plastic dilators that stretch the area. Using this method, patients may have a normal vagina in four to six months. Unfortunately, due to the undeveloped or missing uterus, a female with this disorder will be unable to bear children.

Swyer Syndrome
Swyer Syndrome, also known as gonadal dysgeneses results fromone of the earliest stages of male sexual differentiation. Patients with Swyer syndrome fom streak gonads due to two different situations. Carr, Blackwell, and Azziz (2005) identify that this can happen in two different ways. One way that Swyr syndrome can happen is when the germ cells fail to integrate into the genital ridge. Another way that Swyer syndrome can happen is by a mutation of one of the genes that directs testicular differentiation. This results in the organization of the germ cells in the ovarian cortex rather than the medullary region. In 15 percent of individuals with Swyer syndrome the gene mutation is in the SRY gene. However, it is thought that mutations exist in other genes that involve testicular morphogenesis if the SRY gene is not mutated. Females that have Swyer syndrome show delayed pubertal development rather than genital ambiguity. Also, the females who develop Swyer syndrome have a tendency to be taller than females without Swyer syndrome. There are two reasons why this tends to occur. One reason is that the bony epiphyses remains open longer due to undiagnosed or untreated sex steroid production. Another possibility for increased height is due to Y chromosone-related statural genes. In patients with a Y cell line as well as having dysgenetic testes, there is a 25 to 35 percent greater risk of forming malignant transformation of their gonadal streaks (Carr, Blackwell, & Azziz, 2005). Carr, B. R., Blackwell, R. E., & Azziz, R. (2005). Essential reproductive medicine. Columbus, OH: McGraw-Hill Companies.

XYY Syndrome
47, XYY syndrome is an aneuploidy (trisomic) sex chromosome disorder in which a male receives an extra Y chromosome from his father. This disorder has a 1:1000 incidence of affected male births though many go undiagnosed. Ross et al. (2009) conducted a variety of studies that examined a group of males who have XXY to a control group on a comprehensive level. The tests concluded XXY males had mild generalized cognitive impairment, with impaired language verbal memory, attention, visual-motor, and motor function (Ross, Zeger, Kushner, Zinn, & Roeltgen, 2009). These males are associated with a tall stature due to an increased expression of three SHOX genes (height determining gene). However, no males were diagnosed with testicular failure due to abnormal testosterone levels.

Hermaphroditism and Pseudo-Hermaphroditism
According to A.F. Bromwhich of the British Medical Journal, an individual who has both ovarian and testicular tissue is a true hermaphrodite. Proof of the presence of both types of gonad in the same individual is histological, as the secondary sex characters may be affected by other factors, such as overactivity of the adrenal cortex. Also, there are pseudo-hermaphrodites who do not have both sex organs, but have 1 of each. A female pseudo-hermaphrodite will have an enlarged clitoris and a uterus with raised urinary 17-ketosteroid level. A male pseudo-hermaphrodite will have no uterus and a normal urinary 17-ketosteroid level for his age. These two conditions can be differentiated by the outside genitals. A true hermaphrodite will have a uterus, and phallus medium size between penis and clitoris and the 17-ketosteroid is not raised. Diagnosis is made by laparotomy and biopsy of the gonads.=== ===

Sexual Dysfunction
According to Butcher and Ling (2008) sexual dysfunction is defined as any malfunction of the reproductive organ or structure. Results from a survey conducted by the National Health and Social Life found 43% of women in the United States have some type of sexual dysfunction. Of these 43% only 50% actually admit they suffer from one of the various dysfunctions causing treatment to be more of a challenge. A few sexual dysfunctions include:
 * Vaginismus which is the random or continuous contractions of perineal muscles. This dysfunction can cause penetration to be difficult or unfeasible.
 * Dyspareunia is genital discomfort which occurs before, during, or after participating in sexual intercourse
 * Vulvodynia is persistent distress of the vulva such as raw, burning, stinging, and irritation in which can be broken up into two categories:
 * Vulvar Vestibulodynia which is the woman experiences intense pain during vestibular touch or vaginal entry
 * General Vulvodynia which can be found anywhere near the vulva and symptoms can be experienced during and after sexual intercourse or with other factors such as tampon insertion or even prolonged sitting.
 * Vulvovaginal Atrophy is a disorder in which the woman experiences thin vaginal mucosa causing, vaginal soreness, positcoital spotting and burning, and dyspareunia.
 * Abnormalities of the Hymen is characterized when the woman’s hymen does not contain the normal opening in which it could be absent or contain multiple small holes
 * Vulvovaginitis is inflammation or edema surrounding or on the vulva

Identifying Sexuality

Most people view and teach genetics and how it relates to our individual sexuality as a hard-fast rule. If you have male genitalia (penis) your considered male and female genitalia (vagina) you’re female. Although this is true for most of the population, for an estimated .25 percent of the population it’s not. A person’s gender identity is how they feel about their sexuality on the inside, not out. A majority of the population are cisgendered meaning their gender identity will match their genitalia. For the minority that does not fit into this category are considered to have GID or Gender Identity Disorder. This category includes people who consider themselves as both male and female, having no gender at all, and for those who consider themselves the opposite of their genitalia (which is also considered Gender Disphoria).

Androgyny
The expression androgyny, meaning “having characteristics of both sexes,” is derived from the Greek roots “andr,” meaning “man” and “gyne-,” meaning “woman“. The term refers to the elasticity of gender roles and is used in different situations. People with androgynistic behavior take on both gender roles. This can mean that masculinity and femininity blend together and become interchangeable (Health and Age). Traits like aggressiveness and boldness can coincide with compassion and passive behaviors. Androgynistic people are usually not labeled in the norms of specific or dominant gender roles brought on by social bias. However, androgynous people often do have a more independent aspect towards their identity.

Androgynous people are not limited by gender stereotypes; having incorporated aspects of masculinity and femininity into their personality and performance allows them to express the appropriate behavior for any given situation. Androgyny offers the choice of expressing whatever behavior seems suitable in a given state of affairs, instead of restricting the response to those considered gender appropriate. Androgynous males and females might be self-confident on the job but nurturing to acquaintances, family members, and loved ones. Many men and women have characteristics consistent with customary gender assumptions but also have interests and behavioral tendencies that are typically credited to the other gender.

The social psychologist Sandra Bem (1974,1993) developed a paper-and-pencil method for measuring the amount of masculine or feminine behavior or a combination thereof an individual expresses. There have been similar devices developed since Bem’s pioneering work (Spence & Helmreich,1978). Armed with these strategies for measuring androgyny, numerous researchers have investigated how androgynous individuals balance with strongly gender-typed people. (Our Sexuality 2008).

What has been found regarding these differences is that androgynous men and women are now considered to be more creative individuals. In 2000, 163 men and women participated in a study to show the relationship between androgyny and creativity. Two tests, the Creative Functioning Test (CFT) and the Bem Sex Role Inventory (BSRI) (Jonsson, & Carlsson, 2000), were used to measure the correlation. The findings showed that women and men that had a balanced amount of femininity and masculinity were the most creative and well-rounded, with the males scoring an average of 3.54 out of 6 on the CFT and females scoring 2.41 out of 6. The unbalanced individuals had lower scores, with the one-sided individuals (Male-Typed or Female-Typed) being the lowest.

Transgenderism
During childhood and adolescence, some individuals come to question whether or not the male/female label given to them at birth accurately describes their “gender”. In some cases, the individual may decide to change their “sex” to match what they think best fits their “gender” through a procedure known as gender reassignment surgery. When someone is trans-gender, telling their peers and getting responses from them is an important issue. In 1974 When Bem Introduced The Concept of Psychological Androgyny she asserted that the traditional sex role dichotomy was outdated. Instead of being either feminine or masculine people might be both. Bem said that instead psychologically androgynous people might have the ability to use behavior that is both instrumental and expressive, both assertive and yielding, both feminine and masculine. Bem's Balanced Model was later criticized by Spence, Helmreich, and Stapp in 1975. The Three were concerned that the androgynous category in which they argued was too heterogeneous. Instead They Proposed The individuals scoring high on both the M and F scale would be considered androgynous, and individuals scoring low on both scales would be considered Undifferentiated. Scandinavian Journal of Psychology. 2000 Scandinavian Psychological Associations. Published By Blackwell Publishers

While the child is going through struggles the parents may also have a hard time with the change of gender in their child.“Some parents struggle with their own feelings related to their child’s transgender identity and should be placed in touch with an appropriate support group. Parents may benefit from hearing the experiences of other parents with transgender children to a certain extent because each child thinks and operates differently, depending on their comforting environment.

This provides a sense of normalization of their experience, so they can be a better resource for their children and more effectively engage in honest and open dialogue." Other studies reported that "although it may be extremely difficult to come to terms with the trandsgenderism of one's child, it is possible;" Many parents also struggle with challenges beyond the transgender of their child like being worried about gossip, rejection of their family, and also rejection of their community, they also reported that transgender as being relatively unheard of and had a fear of the unknown. All and all despite these worries, "Parents felt that success would entail holding onto the essence of the love they had for their children and the moral worth of their children."  (Morris, 2006).” Parents can also cause their child to shun away from the situation because of lack of acknowledgemet of their transgenderism. Having a strong support system during and after the transgender individuals’ gender identity confusion is very important. A lot of transgender individuals feel self-conscious and abnormal and people abuse them physically and emotionally because they do not fit into what society defines as “normal” making them feel even more like an outsider. Sometimes the abuse comes from those closest to them. Larry Nuttbrock et al.(2010) conducted a survey of 571 transgender individuals to study the psychological effects that abuse has on them. They concluded that transgender individuals are at a higher risk of committing/attempting suicide, being depressed, having Axis I disorders and more body image disturbances then the general population, and the individuals within that study that were abused were at an even higher risk.

Many children develop the sense of being in the wrong body before they reach puberty, and many seek to change their gender. Many studies have been conducted by using hormones, such as gonadotropin-releasing hormone agonist, to prolong the effects of puberty, so those children can have a chance to become certain that they wish to change their gender. Those who decide to change their gender require special treatment from caretakers including, teachers, parents, nurses, etc. In order for one to change their gender they must undergo extensive surgery, as with Male to female genders who undergo many surgeries. These surgeries include: breast surgery, orchidectomy, penectomy, vaginoplasty, labiaplasty, and clitoroplasty. Nurses specifically are responsible for the physical and psychological aspects of the patient’s recovery. Nurses are ethically bound to administer treatment in a compassionate and non-judgmental manner. Many researches have been undertaken as a way to serve and educate "pediatric nurses to be there for children and their families while modeling the empathy and support every child needs and deserves."(Gibson & Catlin, 2010).

In a study of interpersonal acts of gender affirmation, 571 male-to-female (MTF) transgender people located in the New York Metropolitan Area were selected by L.A. Nuttbrock et al.(2009). Although all the participants were born male, they did not regard themselves as “completely male” in certain situations throughout their life. The participants were interviewed for 90 minutes about every aspect of their lives, including social, behavioral, economic and psychiatric questions. Studies found that regarding sexual orientation, 68.6% were attracted only to men, 12.5% were attracted only to females, 16.8% were attracted to both males and females, and 2.1% were attracted to neither males nor females.

Coming Out
Most people's gender identity is as expected, according to their assigned sex. Realising one is transgender often takes many years. At this point someone may decide to 'come out' and tell others their gender identity. Awareness of other transgender people often comes through the media. Today, the internet is providing greater access to information and people are gaining this awareness at a younger age.4 Understanding various identities and treatment options through contact with others is essential5 and contacting others allows expression of suppressed feelings. A supportive practitioner can help to identify information and local support. Some gender clinics accept self-referrals. Most require psychiatric assessment locally, where awareness varies greatly, to exclude reversible causes of seeking gender reassignment.

Transsexualism
The term transsexual means the desire to live as the opposite sex because an individual is physically one sex, but mentally feels like the opposite sex. Also known as Gender Identity Disorder (GID), it describes “individuals who show strong and persistent cross-gender discomfort with their anatomical sex; or alternatively, a sense of inappropriateness in this gender role, as manifested by a preoccupation with getting rid of one’s sex characteristics or the belief of being born with the wrong gender. The DSM-IV diagnostic criteria for GID combine the three separate disorders contained within ICD-10; i.e.childhood gender identity disorder, dual-role transvestism and transsexualism.”

Gender reassignment surgery (GRS) attempts to release this discomfort. Patients have to be examined before the process of surgery begins and after to make sure that the patients are psychologically stable. The Symptom Check List-90R gives doctors something to compare their observations of their patients’ psychological conditions. Researchers studied the psychological conditions of 40 patients for 6 months before and after their surgery. In this sample of male-to-female transsexual patients, there was no difference pre- and post-operatively on any of the scales and the overall results showed that GRS had no significant effect on psychological functioning, but some became more sociable and comfortable post-surgery. Most of the participants did not have a dramatic change, but for some it helped them feel better as a person.

Core and Periphery Groups
In Japan biological male with GID are put into two subgroups known as Core & Periphery. Patients are submitted in on the basis of their case history towards their own gender identity in interviews.

Core groups: are composed of men who were while being interviewed answered "because I felt that I was a girl" when asked the reason why they desired to be a woman. Also while entering puberty patients of the core group could no longer just long to be females. They would have a uncomfortable experience with their secondary sexual characteristics (masculinity of the bodies). 78.6% of the group felt discomfortable with one's sex. Patients of the group will have a tendency to dress as a woman and eventually desire a sex change.

Periphery groups: are composed of men who were also interviewed and asked the same question, and answered "I'm not really sure". They would have an uncomfortable feeling about ones sex which did not occur until adolescence. During puberty they withdraw psychologically and couldn't acquire their identity of belonging to the "male sex".

Most people think of transsexuals as only being adults, but incidence of Gender Identity Disorder (GID) is rising in children and adolescents. Although it is unclear how common GID is among children, many adult transsexuals say that they felt they were in the wrong body at a very young age. Some professionals see transsexualism as a psychological condition while others as a biological one. When puberty hits, the secretion of a hormone called gonadotrophin-releasing hormone (GnRH) triggers the release of other hormones which leads to the production of the sex hormones, causing many changes. Puberty can be very hard, but it is even more difficult when a child believes they are in the wrong body. Adults are able to undergo sex changes involving surgery and therapy, but until recently this has not been the case for anyone under 18. Some doctors have begun treating adolescents with drugs called GnHR blockers, but this has caused great debate among specialists. GnHR blockers stop the production of natural sex hormones, before taking hormones of preferred gender. The best approach to treating adolescents for possible GID has yet to be discovered.

Additionally, there are problems and questions about the validity and reliability of GID diagnosis for children and adolescents. For example, Hill et al. (2006) examined the responses to Zucker and Bradley’s results. They found that they could correctly classify children who met all of the DSM-III criteria 83% of the time, but only 69% of children who did not meet the criteria. This suggests that many children who do not meet all DSM criteria are diagnosed with GID. Therefore, this information suggests that GID is gender confusion and not a mental disorder, as it is possible this may be a condition that some children grow out of. Medical treatment for children who exhibit GID-like symptoms should be provided, however, medical diagnosis should not be permitted until after the age of 16.

Transsexualism in Poland
Dulko, Stanislaw, Anna Grabowska, Anna Herman-Jeglinska (2000) examined the relationship between sex and gender identity in a Polish transsexual population consisting of at least fifty members. This population holds more female-to-male transsexuals, unlike Western countries where the idea of male-to-female transformation is more dominant. The study revealed that male-to-female transsexualism is not much like female-to-male transformation. Male-to-female calls for a more extreme condition in the identification with feminine characteristics versus masculine personality traits. The process is usually longer for male-to-female transformation in comparison to a female-to-male.

Dulko, Stanislaw, Anna Grabowska, Anna Herman-Jeglinska (2000) examined the relationship between sex role and gender identity in a Polish transsexual population where, unlike in Western countries, male-to-female (MF) transsexualism is much less common than female-to-male (FM) transsexualism. When they describe a man as feminine, they mean that the individual has some attributes more typical of the other sex. In other words, his sex role is more feminine than that of other men. Thus, sex roles refer to those behaviors, attitudes, and personality traits that a society designates as masculine or feminine that are more “appropriate”for, or typical of, the male or female social role (Bailey,1996).

Transsexualism and Religion
In the article “Transexualism: Some Theological and Ethical Perspectives,” James M. Childs mentions that both men and women deal with transexualism, women will perceive themselves as men and men will perceive themselves as women. Transexualism has been around for many years now and is still a controversy in today’s society. Transexualism, which is also known as gender identity disorder, is a distress when one believes that their gender identity doesn’t match their biological sex. Like any other disorder, people who do suffer from transexualism face many challenges. Most issues that arise with someone dealing with transexualism are ethical and theological. A questioned that is commonly asked is if homosexuality a learned sexual trait or is it a biological make up. This question has stirred around society, and causes not just problems in society, but also when it comes down to religious views. Childs mentions that the controversy within church’s are not accepting them, but the problem occurs when dealing with marriage. Some people believe that it’s a sin; others believe that it is the house of Lord welcomes all people no matter what sexuality they are. The conflict between t religion and sexual views has been around for many year and is still continuing in today’s society. Religion is not only a problem when it comes to sexuality, Child mentions that other issues are legal and practical issues as well.

Causes
One of the biggest debates at present is whether or not sexual orientation is a choice or built into our DNA. Several researchers have studied this and concluded that multiple factors play a role in determining sexual orientation. There is no “gay gene,” nor is there any evidence supporting that it is solely environmental. A population of researchers, including Gilbert Herdt, Evelyn Hooker, and Richard Green, have come to the conclusion that all of the named factors—genetic, hormonal, psychological, and social—affect one’s sexual orientation.

There are two major schools of thought on the emergence of homosexuality in an individual. Essentialist, or biological, theories promote the idea that homosexuality is an innate trait. Essentialist theorists suggest that sexual orientation is a result of physiological influences from differences in the brain, genetics, hormones, and physical traits. Constructionist theories suggest that homosexuality develops over time from a variety of exterior social forces.

Acceptance
As much as the term "acceptance" is used, do people really understand what it means to be accepting of the fact that another person, maybe someone very close to them, is a member of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community? As you will later read it is most difficult for parents cope with this and fully accept it because they go through a complete cycle of blaming themselves and finding it their fault and then coming to realize that this is the choice of their child and they have to eventually accept that. This is wrong and where many heterosexuals may possibly never fully grasp the understanding between being more or less born with the "homosexual gene" and choosing to be a homosexual. Would you choose to be that way? This is what continually makes it difficult for homosexuals to come out to their families. Michael P. Burk compared coming out to the major stages found in 'Grieving with Death' by Elisabeth Kübler-Ross. First comes self-denial and isolation, then anger to the world often God, bargaining to God so that he may change them, depression, and then finally acceptance. Believe it or not the ones who have the most trouble with this are the ones who have to deal with it, mostly teenagers and pre-teens then the parents and friends, those of which who didn't already expect it.

Attitudes, beliefs and stereotypes regarding homosexuality correspond with the way the human mind understands sexual preference. In fact, Sigmund Freud’s theory of homosexuality was that all humans are innately bisexual and individuals become homosexual during adolescence. A little over 20 years ago, homosexuality was viewed as a mental disorder. After it was removed from the DSM-IV-TR, it was interpreted as a sexual preference.I felt whoever wrote this text above me did not know what they were talking about. After reading my reference Human Sexuality: a comparative and developmental perspective, to me it seemed as though they have nothing to do with each other. What they wrote about Sigmund Freud was not even in the reference I had to read. Roger W. Libby, PhD Center for the Family University of Massachusetts Amherst Mass. 01003  This said, there are still questions as to how people “become” homosexual. Are homosexuals are born naturally attracted to the same gender? Scientists have made efforts to test certain mammals to see if homosexuality could be prevented by prenatal hormone manipulation. There are also studies on Fruit Flies which are among the most "sexually proficient creatures on earth". They have found that if they insert a gene into the flies that is apparent in human beings, they can alter their sexual preference. When inserted the males no longer pursue females but form a line of flies (males) and rub genitals together. The scientists that performed these experiments do not believe that this gene alone can control human sexual preference, but believe that it may yield new insights to how genetic make-up may influence your sexuality. These studies are not completely accepted among the gay community, many heterosexuals believe homosexuality is a choice rather than something that was genetically predetermined or acquired through nurture.

Typical metamorphosis in the human body structure, his or her cognitive functioning, and even environmental settings throughout adolescence have an effect on the way a child responds to his or her own sexuality. Even with puberty, issues of sex and sexuality become significant and the press for heteronormativity is quite strong. With these factors, intergroup contact may function very differently in adolescence than it does in adulthood. According to Heinze, J. E., Horn, S. S. (2009)1,069 fourteen through eighteen year olds completed questionnaires about their acceptability of homosexuality, levels of comfort around gays and lesbians, and their different types of social interactions with homosexual peers. Research yields that having a friend who is homosexual is related to a more positive attitude in regards to homosexuality. This research proves environmental settings effects a child's outlook on sexuality. Within the United States, protecting the rights of lesbian, gay, bisexual, and transgender (LGBT) students in school elicits much controversy and debate. On one side is the argument that all students should be able to receive an education free from discrimination, harassment, and harm. On the other side is the argument that by protecting LGBT students' rights, schools are infringing on the rights of others to their individual beliefs about homosexuality. To investigate these competing arguments, we surveyed high school-aged heterosexual adolescents (N = 1,076) regarding their beliefs and attitudes about sexual orientation and the rights of gay and lesbian peers. Results suggest that adolescents differentiate between their individual beliefs about homosexuality and the rights of others to be safe in school. Further, the results provide additional support for the idea that attitudes and beliefs about sexual orientation and the rights of gay and lesbian peers are multifaceted and draw from multiple domains of social knowledge. The implications of these findings will be discussed in relation to the rights of LGBT students and the obligations that schools have to create safe and supportive learning environments for all students regardless of sexual orientation or gender identity(Journal of Social Issues; Dec2008, Vol. 64 Issue 4, p791-813, 23p, 3 Charts).

Homosexual parents face issues of acceptance, as well. Even with the ever increasing acceptance of those in the LGBTQ community, there is still enormous pressure placed upon those in that community who are raising children to raise their children as heterosexuals even though no evidence exists that same-sex parents have a different impact on the sexuality of the child being raised. For example, a study was done by Tasker and Golembek (1997) to find if lesbian mothers "differ" from heterosexual ones. The study showed that not only was the parenting the same, but that the children seemed unaffected by their parents in terms of sexual preference.

Some believe that they can correctly discern another person’s sexual orientation just by looking at someone. This is known as having 'gaydar'. However false this may seem, there have been many studies done to prove the legitimacy of this suggested ability. In studies put on by Rule and Ambady in 2008 and Ambady, rule and Hallet in 2009, both gay and straight males and females were able to correctly identify a man’s sexual orientation by viewing a photograph of him in less than one second. The study consisted of images of males faces, showing only facial features, hair was removed to prevent biases of participants on hairstyles or other aspects of the individual. In addition to heterosexuals claiming to have this ability, other research suggests that homosexuals informally learn the gaydar skill in order to identify other homosexuals. Although there is evidence to prove the legitimacy of this skill, one can not accurately discern another individual’s gender identity without the confirmation from them.

Cass's Six Stage Model of Same Gender Sexual Orientation
Vivienne Cass was a clinical psychologist that made a six stage model of discovering one's sexual orientation. She based her work on the research she did in Australia working with gays and lesbians. Cass's model goes through each emotional and psychological stage that a homosexual person may experience.


 * Stage 1- Identity Confusion:Identity Confusion: Identity Confusion is when a person may begin to recognize thoughts or behaviors and view them as immoral or wrong. They may then begin doing research and finding information on homosexuality.


 * Stage 2- Identity Comparison:Identity Comparison: Identity Comparison is when a person accepts the possibility that he/she is a homosexual. They then may accept their behavior as homosexual but declines a homosexual identity. He/she may also accept the identity but not act on it.


 * Stage 3- Identity Tolerance:Identity Tolerance: Identity Tolerance is when a person accepts being homosexual and recognizes their sexual and emotional needs. He/she may begin to find other gays/lesbians and builds their on community.


 * Stage 4- Identity Acceptance:Identity Acceptance: Identity Tolerance is when a person accepts being homosexual and recognizes their sexual and emotional needs. He/she may begin to find other gays/lesbians and builds their on community.


 * Stage 5- Identity Pride: Identity Pride: Identity Pride is when a person begins to have less interaction with heterosexuals and is deeply absorbed in the homosexual community. Their view divides the world as "gay" or "not gay." They also tell their family, friends, and co-workers


 * Stage 6- Identity Synthesis:Identity Synthesis: Identity Synthesis is when a person merges all aspects of life together, the homosexual and the heterosexual. He/ she can point out the people who are supportive with their homosexual identity and the sexual identities of others are not important factors in building relationships.

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In addition to Cass’s six stage model of same gender sexual orientation, Kinsey developed his seven-point Sexual Orientation Scale. His scale describes sexual orientation on a continuum rather than just being completely homosexual or heterosexual. The continuum promoted that there is more to sexual orientation than behavior alone. Alfred Kinsey stated “Males do not represent two discrete populations, heterosexual and homosexual. The world is not to be divided into sheep and goats… The living world is a continuum in each and every one of its aspects” to describe that males sexual identity lies on a continuum. The orientation scale has seven different descriptions on feelings and actions related to gender identity. The seven points are:


 * 1) Exclusively heterosexual,
 * 2) Predominantly heterosexual, incidental homosexual
 * 3) Predominantly heterosexual, more than incidental homosexual
 * 4) Equally heterosexual and homosexual
 * 5) Predominantly homosexual, more than incidental heterosexual
 * 6) Predominantly homosexual, incidental homosexual
 * 7) Exclusively homosexual

Other continuums such as the Klein Sexual Orientation Grid suggest that sexual orientation is not only on a continuum but that ones sexual orientation may change on the continuum over time. The Klein Sexual Orientation Grid includes seven different dimensions of sexuality combined with past, present and ideal orientation over time.

HIV and Homosexuals
For decades, HIV has been a growing concern among homosexual males who engage in promiscuous acts of sexual behavior, as most are unaware of their partners’ HIV status. For example, Kelly et al.(1991) examined the responses of 470 men who attended gay bars or social organization meetings. "Forty-five percent of men were classified as ‘laspsers’ (those who have had unprotected anal intercourse in the previous 6 months) and 24% were classified as ‘resisters’ (those who successfully resisted urges to engage in this behavior)." Results showed that well over 80% said that they had used condoms, including lapsers half the time. However, most acts of spontaneous behaviors happened with acquaintances who had claimed to be HIV free. Homosexual men who continue these high risk behaviors are in danger of obtaining HIV and spreading it without knowing it. One interesting finding was that 2/3 of the respondents had no knowledge of their partners’ or their own HIV status.

Risks for homosexuals, especially men who have sex with men (MSM), who have unprotected sex are growing increasingly due to Highly Active Antiretroviral Therapies (HAART) that are give to people who are HIV positive. The HAART treatments are a way to prolong one's life once testing positive for HIV however, more readily available HAART treatments means that more HIV positive men are staying alive and sexually viable longer. With the HAART treatments prolonging the life of so many people we see a rise in the number of people with HIV and especially in the homosexual community. The issue of HIV disclosure comes into play more so now that there are more people who have contracted the disease, especially in populations of high-risk.

The greatest group of HIV is in men who have sex with other men. The study by Rosser et al. (2009) found that 20% of their MSM participants did not identify themselves as gay. Those individuals with HIV may feel that they already have the infection so they no longer worry about participating in high risk behavior.

HIV and MSM in United States
According to the Department of Health and Human Services Centers for Disease Control and Prevention, In 2006, more than 30,000 MSM and MSM-IDU were newly infected with HIV. Among all MSM, whites accounted for nearly half (46%) of new HIV infections in 2006. The largest number of new infections among white MSM occurred in those aged 30–39 years, followed by those aged 40–49 years. Among all black MSM, there were more new HIV infections (52%) among young black MSM (aged 13–29 years) than any other racial or ethnic age group of MSM in 2006. The number of new infections among young black MSM was nearly twice that of young white MSM and more than twice that of young Hispanic/Latino MSM. Among all Hispanic/Latino MSM in 2006, the largest number of new infections (43%) occurred in the youngest age group (13–29 years), though a substantial number of new HIV infections (35%) were among those aged 30–39 years.

Views on Homosexuality in South Africa
After the end of the Apartheid, the new constitution in South Africa called for equal rights regarding homosexuality. With the introduction of the new constitution there was an uproar of opinions on the topic of homosexuality. Mwaba et al. (2009) distributed an 18 item questionnaire to 150 undergraduate students (83% female) from a university in the Western Cape Province of South Africa regarding their views on homosexuality and same-sex marriage in order to gain insight on how some of the people of South Africa felt about the subject. The Majority of the students (44%) believed that homosexuality was not acceptable; however, 51% did believe that homosexual marriages should be recognized. Interestingly enough, 71% of the students thought that homosexuality was strange but still held fairly evenly split opinions on whether their rights should be respected or not.

Views on Homosexuality in the United States
Homosexuality today is more tolerated and accepted than it was just a few years ago, though there is still some resistance. More than ever homosexual couples are having or adopting children, more employers are extending health care benefits to same-sex partners, and homosexuals are becoming more politically involved. Even with these steps forward, discrimination still exists. The federal government of the United States does not recognize same-sex marriages, hate crimes occur on a day-to-day basis ranging from verbal harassment to actual physical confrontation, and there is a continuing belief among many people that homosexuals should not be treated equally. In a poll distributed by Newsweek (2000) 57% of people opposed same-sex marriage, 50% said homosexuals should not adopt, and 35% opposed gays serving in the military.Though tolerance for homosexuality in the United States has come a long way from the past, it is clear that there are still negative feelings towards it.

Underlying causes of sexual diversity
While body differences between men and women are due to differences in their chromosomes, no one-to-one correlation between genes and sexual orientation was found. Pre- and post-natal concentrations of sex hormones affect the development of the sex organs, but no correlation was found between the concentration levels of hormones and sexual orientation. Concentration of sex hormones may affect the libido and other emotional traits such as aggressiveness, but they do not alter sexual orientation. There is no correlation between the family-structure of the child (mother and father, a single parent, two parents of the same sex) and the sexual orientation of the grown-up child.

Differentiation of some brain structures has been correlated with sexual orientation. For instance, the size of the INAH-3, which is a part of the hypothalamus, a brain area that among other things controls physical aspects of sexual activity, is larger in gay men than in heterosexual men and women. The hypothalamus also reacts to certain chemical compounds in accordance with the sexual orientation of the individual. The amygdala, a brain area involved in emotional activities such as fear, was found to be involved in sexual activities. The inner ear shows sex and sexual orientation differentiations. The cochleae of human females are 8-13% shorter than those of males. Otoacoustic emission (OAE), which is sound generated by the cochlea in response to external sound, was found to have sex differences even in newborns, and in adult women such differences correlate with sexual orientation. Auditory evoked potentials, which are presumed to correspond to populations of neurons from the auditory nerve through auditory cortex, showed differences in mean latency or amplitude that correlate with sex and with sexual orientation of women.

Biological Differences
While much of this chapter focuses on the socially constructed differences between men and women, it is also important to note there are some clear physiological differences between the two sexes. In addition to different sex organs and sex chromosomes, the average male is 10 percent taller, 20 percent heavier, and 35 percent stronger in the upper body than the average female Some researchers believe that these physiological differences may have been influenced by social/cultural decisions in our evolutionary past. Even so, when measured against their own body size, rather than on an absolute scale (e.g., how much women can carry relative to their body size versus how much men can carry relative to their body size), actual strength differences are minimal.

Women, for reasons still somewhat undetermined, tend to outlive men. Women's life expectancy in the U.S. is 79.8 years; men's is 74.4. Some believe this difference is due to the riskier lifestyles of men, especially earlier in life, combined with their typically more physically stressing occupations.

Behaviorally, age of sitting, teething, and walking all occur at about the same time in men and women. However, men enter puberty on average two years later than do women. There are no significant differences in intelligence, happiness, or self-esteem between men and women. However, women are, statistically, twice as vulnerable to anxiety disorders and depression, but only one-third as vulnerable to suicide and one-fifth as vulnerable to alcoholism. Women attempt suicide more often than men but have lower rates of "success", because their preferred methods do not involve firearms, unlike men. Women are also less likely to suffer hyperactivity or speech disorders as children or to display antisocial personalities as adults. Finally, women have slightly more olfactory receptors on average and are more easily re-aroused immediately after orgasm.

Much evidence has shown that there are differences in male and female brains. In fact, the temporal lobe, which is the part of the brain associated with language and emotion, develops up to 4 years earlier in girls in comparison to boys On the other hand, the left parietal lobe, which is associated with mathematical and spatial reasoning, is thought to develop up to 4 years earlier in boys. This difference could account for the fact that girls are sometimes thought to be better when it comes to language and are more emotional, while boys are thought to be better in math. As well, some say that girls are better at hearing than boys. A typical teenaged girl hears up to 7 times better than a typical teenaged boy. This could possibly explain why boys are diagnosed with ADHD more often. . Lastly there is a difference between sight for girls and boys. Girls are able to see facial expressions / emotions better while boys are able to see motion better. Girls use the p-cells in the retina, which are associated with texture and color, while boys use m-cells, which are associated with motion.