Psychosexual development and satisfaction with timing of developmental milestones among adult survivors of childhood cancer.

OBJECTIVE: To extend the limited research on psychosexual development among childhood cancer survivors, by not only focusing on the prevalence and age of milestone attainment, but also survivors' attitudes toward the timing of reaching such milestones. METHODS: Adult survivors of childhood cancer (N = 90; Mage  = 29.8, SD = 5.2), recruited from a US pediatric institution, completed online surveys indicating whether they had reached 5 milestones of psychosexual development (ie, first kiss, first boy-/girlfriend, first physical intimacy, sexual debut, first time in love), age at attainment, and perceptions about the timing (ie, right time, wished it had happened earlier, wished they had waited). RESULTS: Almost all survivors had reached each milestone (≥90%), except for sexual debut (83.3%). Survivors reported their first kiss as the earliest milestone at age 14.6 (N = 82, 92%) and falling in love as the latest milestone at age 18.8 (N = 80; 90%). This timing did not differ by sex/cancer-specific factors. Most survivors (~60%) felt they reached each milestone at the right time. Compared with US normative data, both male and female survivors were less likely to have experienced their sexual debut and were approximately 1.5 years older at sexual debut. Nevertheless, 59% of survivors felt that this timing was right and 31% wished they had waited longer. CONCLUSIONS: This is the first study to demonstrate that although childhood cancer survivors may delay some aspects of psychosexual development, most are satisfied with this timing. Research and clinical practice should emphasize survivors' perceptions/satisfaction toward psychosexual development rather than focusing only on normative milestone attainment.

Family, Peer, and Pubertal Determinants of Dating Involvement Among Adolescents.

This study examines the influence of family, peer, and biological contributors to dating involvement among early adolescents (11-14 years of age; n = 244). Further, we assess how parental monitoring may be modified by pubertal maturation and older sibling risky behavior. Data on delinquent peer affiliation, pubertal maturation, parental monitoring, older sibling risky behavior, and dating involvement were gathered through observations and surveys from adolescents, mothers, older siblings, and teachers. Results indicate that lower levels of parental monitoring and higher levels of older sibling risky behavior were related to adolescents' dating involvement through delinquent peer affiliation. Pubertal maturation was directly related to dating involvement for early daters. Findings emphasize the value of examining social and biological factors, in concert, over time.

[COMPREHENSIVE DIAGNOSTICS IN PATIENTS WITH GENOTYPE 47,XXY KLINEFELTER SYNDROME].

We undertook biochemical, hormonal, cytological analysis and sequencing CAG repetitions of androgen receptor gene in order to elucidate the cause of clinical polymorphism of Klinefelter syndrome. Elevated levels of LH (19.8 ± 4.2 E/l), FSH (22.7 ± 6.1 U/l), total cholesterol (6.8 ± 2.6 mmol/l), triglycerides (3.3 ± 1.0 mmol/l), and glucose (9.9 ± 3.8 mmol/l) suggested disturbances of lipid and carbohydrate metabolism. Two thirds of the patients had Klinfelter syndrome associated with mental retardation and psychic disorders. Patients with cleft palate and mental retardation and with psycho-social disorders had 45 and 43 CA G repetitions respectively, those without associations 38-40 repetitions. Increased frequency of CAG repetitions was directly proportional to the level ofpsychic development, social adaptation and professional activity but inversely proportional to the development of masculine sexual traits.

Penile length is a very important factor for cosmesis, function and psychosexual development in patients affected by hypospadias: Results from a long-term longitudinal cohort study.

Few studies of long-term outcome of hypospadias treatment in terms of voiding, surgical complications, sexual functioning, intimate relationships and cosmetic results have been investigated and contrasting results have been obtained so far. The aim of our study is to investigate the long-term outcome of urinary and sexual function, cosmesis and the quality of intimate relationships in a series of hypospadias. In this study, 42 patients who underwent surgery for hypospadias were prospectively followed for 15 years. Medical records provided the hypospadias data, the number of reconstructive operations and the reconstruction technique that was used. Patients underwent physical examination, including penile length measurement and completed International Prostatic Symptoms Score (I-PSS), International Index Of Erectile Function (IIEF 15) and the Penile Perception Score questionnaire (PPPS). Twenty patients agreed to participate in the study. At the enrolment, the median value of HOSE was 13, as regards PPPS, 18/20 (90%) were satisfied, while in 1998 only 80% were satisfied. No significant statistical difference has been reported from the results obtained at enrolment and those obtained at follow-up, in terms of PPPS (P = 0.81), IPSS and IIEF-15. Penile length was 6.5 cm flaccid and 10.5 cm stretched. Our data show how cosmesis, function and psychosexual development for these patients are highly connected to surgical outcome, which is understood to be a decrease in penile size.

Testing the Affiliation Hypothesis of Homoerotic Motivation in Humans: The Effects of Progesterone and Priming.

The frequency of homoerotic behavior among individuals who do not identify as having an exclusively homosexual sexual orientation suggests that such behavior potentially has adaptive value. Here, we define homoerotic behavior as intimate erotic contact between members of the same sex and affiliation as the motivation to make and maintain social bonds. Among both male and female nonhuman primates, affiliation is one of the main drivers of homoerotic behavior. Correspondingly, in humans, both across cultures and across historical periods, homoerotic behavior appears to play a role in promoting social bonds. However, to date, the affiliation explanation of human homoerotic behavior has not been adequately tested experimentally. We developed a measure of homoerotic motivation with a sample of 244 men and women. Next, we found that, in women (n = 92), homoerotic motivation was positively associated with progesterone, a hormone that has been shown to promote affiliative bonding. Lastly, we explored the effects of affiliative contexts on homoerotic motivation in men (n = 59), finding that men in an affiliative priming condition were more likely to endorse engaging in homoerotic behavior compared to those primed with neutral or sexual concepts, and this effect was more pronounced in men with high progesterone. These findings constitute the first experimental support for the affiliation account of the evolution of homoerotic motivation in humans.

Functional neuroanatomy of human cortex cerebri in relation to wanting sex and having it.

Neuroanatomical textbooks typically restrict the central nervous system control of sexual responsiveness to the hypothalamus, brainstem and spinal cord. However, for all its primitive functions human sex is surprisingly complex and versatile. This review aims to extend the neuroanatomy of sexual responsiveness by providing a comprehensive overview of the empirical evidence for cerebral cortical involvement. To this end I will structure relevant human brain research data to fit the sexual pleasure cycle template-wanting sex, having sex, inhibiting sex-arguing that going through these sexual response phases requires adequate shifting between functional cortical networks. The relevance of this notion for understanding certain sexual dysfunctions is discussed.

Anatomy of the clitoris and its impact on neophalloplasty (metoidioplasty) in female transgenders.

The current management of female to male transgender surgery is based on the advances in neophalloplasty, perioperative care and the knowledge of the female genital anatomy, as well as the changes that occur to this anatomy with preoperative hormonal changes in transgender population. Since the clitoris plays the main role in female sexual satisfaction, its impact on the outcome in female to male transgender surgery is predictable. Although female genital anatomy was poorly described in majority of anatomical textbooks, recent studies have provided a better insight in important details such as neurovascular supply, ligaments, body configuration, and relationship with urethral/vaginal complex. This article aims to review current state of knowledge of the clitoral anatomy as well its impact on clitoral reconstruction in female to male sex reassignment surgery.

Hormonal and developmental influences on adolescent suicide: a systematic review.

BACKGROUND: Teen suicide is a major public health problem. In the United States, it is the third cause of death among the 10-24 year olds. Adolescence involves numerous changes, whether physical, social, emotional or hormonal. At a neurobiological level, a teenager's nervous system is also affected and undergoes significant modifications. SUBJECTS AND METHODS: We conducted a systematic review of electronic literature published between January 1990 and August 2014 via MEDLINE, PubMED and PsychINFO to list articles concerning the risk of teen depression and suicide risks in adolescents as well as those relating to the adolescent's neuro-anatomical brain and the effect that puberty has on it. RESULTS AND DISCUSSION: When analyzing the various studies, it is clear that all support the idea that adolescence is a special period, both at neuroanatomical and biological levels. The risk of impulsiveness and depression is explained, anatomically, by a faster maturation of the limbic system, and biologically, by a higher sensitivity of the serotoninergic system and to glucocorticoids, which themselves are influenced by the specific hormonal environment during this period. Moreover and above all, adolescence is a vulnerable time for many reasons: physical, hormonal, social, cognitive, and emotional changes, self-development, etc. We should not restrict it to structural neurological changes without taking into account the other factors or compartmentalize young people into a reductive model based on determinism. CONCLUSIONS: Adolescence is a time of change, transformation, and adaptation. The hormonal events that occur during this period have significant effects on brain development, neuro-cerebral chemistry, adolescent behavior and risks of depression. It is important to try to prevent suicide and depression in adolescents considering its entirety and complexity but also by paying attention to neuro-biological factors even if, at present, many research projects are currently underway to develop an appropriate drug therapy strategy.

"I had twenty-five piercings and pink hair when . . .": adolescence, transitional hysteria, and the process of subjectivization.

The author discusses adolescent and preadolescent development as a transformative experience. The role of the ego ideal in this process, as distinct from the ideal of the ego, is highlighted, and idealization, narcissism, and symbolization are also discussed. Changing representations contribute to what the author describes as a process of subjectivization. An illustrative clinical vignette is presented: that of a 12-year-old girl who developed neurological symptomatology during a crucial period of psychosexual transformation, and whose symptoms rapidly receded after only a few psychoanalytically oriented treatment sessions. The author emphasizes his view of preadolescence as an important passage for the individual's knowledge of the plurality that characterizes him, noting that the recognition of one's own internal multiplicity is characteristic of the psychoanalytic process.

Psychosexual development in children with disorder of sex development (DSD)--results from the German Clinical Evaluation Study.

Psychosexual development is influenced by biological and psychosocial factors. Human beings show a great variability in psychosexual development both between and within gender-groups. However, there are relatively stable gender-related behaviors and self-perceptions, in which males and females differ distinctly. There is strong evidence that high concentrations of androgens lead to more male-typical behavior and that this also influences gender identity. Disorders of sex development (DSD) provide the opportunity to analyze the role of different factors on psychosexual development. We examined 166 children age 4 to 12 with DSD using instruments concerning gender role behavior, gender identity, and friendship. Results underline the hypothesis, that androgens play a decisive role in the masculinization of gender role behavior in children. There are also some relations between the experience of gender change and psychosexual outcomes which have to be discussed. Nevertheless, results indicated a high congruence between the children's gender identity and gender of rearing.

Problematic Sexual Behavior in Children.

It is important for health care professionals to have a strong knowledge base of childhood sexual development, to know how to differentiate between problematic and normative sexual behaviors, and counsel parents accordingly given their assessment of the behaviors. A review of the literature suggests that sexual behaviors are a common occurrence in childhood, though some behaviors are rare regardless of age. Frequency of the behavior, developmental considerations, and the level of harm may help health care professionals assess whether the sexual behavior is typical or problematic. Research suggests that the development of problematic sexual behavior is related to a variety of child, family, developmental, and social factors. Recommendations for clinical care for this population are offered, and a case study highlights a health care professional's appropriate assessment and decision making.

Brain pathology in pedophilic offenders: evidence of volume reduction in the right amygdala and related diencephalic structures.

CONTEXT: Pedophilic crime causes considerable public concern, but no causative factor of pedophilia has yet been pinpointed. In the past, etiological theories postulated a major impact of the environment, but recent studies increasingly emphasize the role of neurobiological factors, as well. However, the role of alterations in brain structures that are crucial in the development of sexual behavior has not yet been systematically studied in pedophilic subjects. OBJECTIVE: To examine whether pedophilic perpetrators show structural neuronal deficits in brain regions that are critical for sexual behavior and how these deficits relate to criminological characteristics. DESIGN: Amygdalar volume and gray matter of related structures that are critical for sexual development were compared in 15 nonviolent male pedophilic perpetrators (forensic inpatients) and 15 controls using complementary morphometric analyses (voxel-based morphometry and volumetry). Psychosocial adjustment and sexual offenses were also assessed. RESULTS: Pedophilic perpetrators showed a significant decrease of right amygdalar volume, compared with healthy controls (P = .001). We observed reduced gray matter in the right amygdala, hypothalamus (bilaterally), septal regions, substantia innominata, and bed nucleus of the striae terminalis. In 8 of the 15 perpetrators, enlargement of the anterior temporal horn of the right lateral ventricle that adjoins the amygdala could be recognized by routine qualitative clinical assessment. Smaller right amygdalar volumes were correlated with the propensity to commit uniform pedophilic sexual offenses exclusively (P = .006) but not with age (P = .89). CONCLUSIONS: Pedophilic perpetrators show structural impairments of brain regions critical for sexual development. These impairments are not related to age, and their extent predicts how focused the scope of sexual offenses is on uniform pedophilic activity. Subtle defects of the right amygdala and closely related structures might be implicated in the pathogenesis of pedophilia and might possibly reflect developmental disturbances or environmental insults at critical periods.

Physical and psychosexual pubertal development: physiology and pathophysiology of puberty with lessons learned from those with disorders of sex development.

This review updates information concerning control of puberty, diagnosis and treatment of precocious puberty and behavioral changes, which appear to be related to environmental changes, rather than physical timing of changes. The relative role of hormone exposure during fetal life or later are still unclear.

Sexual differentiation of behavior: the foundation of a developmental model of psychosexuality.

The sexual differentiation of the brain and behavior occurs as the result of prenatal hormonal influences. Knowledge of this area is helpful for the construction of an appropriately modern psychoanalytically informed developmental paradigm of psychosexuality.

Caring for individuals with a difference of sex development (DSD): a Consensus Statement.

The term differences of sex development (DSDs; also known as disorders of sex development) refers to a heterogeneous group of congenital conditions affecting human sex determination and differentiation. Several reports highlighting suboptimal physical and psychosexual outcomes in individuals who have a DSD led to a radical revision of nomenclature and management a decade ago. Whereas the resulting recommendations for holistic, multidisciplinary care seem to have been implemented rapidly in specialized paediatric services around the world, adolescents often experience difficulties in finding access to expert adult care and gradually or abruptly cease medical follow-up. Many adults with a DSD have health-related questions that remain unanswered owing to a lack of evidence pertaining to the natural evolution of the various conditions in later life stages. This Consensus Statement, developed by a European multidisciplinary group of experts, including patient representatives, summarizes evidence-based and experience-based recommendations for lifelong care and data collection in individuals with a DSD across ages and highlights clinical research priorities. By doing so, we hope to contribute to improving understanding and management of these conditions by involved medical professionals. In addition, we hope to give impetus to multicentre studies that will shed light on outcomes and comorbidities of DSD conditions across the lifespan.

Sexual differentiation of the brain and behavior.

During the intrauterine period the human brain develops in the male direction via direct action of a boy's testosterone, and in the female direction through the absence of this hormone in a girl. During this time, gender identity (the feeling of being a man or a woman), sexual orientation, and other behaviors are programmed. As sexual differentiation of the genitals takes places in the first 2 months of pregnancy, and sexual differentiation of the brain starts during the second half of pregnancy, these two processes may be influenced independently of each other, resulting in transsexuality. This also means that in the case of an ambiguous gender at birth, the degree of masculinization of the genitals may not reflect the same degree of masculinization of the brain. Differences in brain structures and brain functions have been found that are related to sexual orientation and gender.

The mind of the sexual predator.

PURPOSE OF REVIEW: This review reports recent articles in the criminological literature that may be of help in understanding the psychodynamics of sexual predators in the hope of better defining them and preventing recidivistic behavior. RECENT FINDINGS: Recent literature presents the motivations behind sexual offending, attempting to explain in a psychodynamic way the complex problem of the aberrant sexual drives of the sexual predator. Recent civil commitment laws and their implications are touched upon. SUMMARY: The literature presented will enable the criminology practitioner to reach a more holistic understanding of the sexual predator and better detection of them.

Psychosexual development management of bladder exstrophy epispadias in complex patients.

INTRODUCTION: Bladder-exstrophy-epispadias complex (BEEC) represents a spectrum of urogenital step-wise malformations: epispadias, complete exstrophy, and cloacal exstrophy. Psychosexual development in adolescent patients with BEEC may become especially problematic. At present, there are few contributions in the literature investigating the validity of psychosexual treatment in order to tackle this particularly emotional and personal development phase. OBJECTIVE: The study aimed at verifying the efficacy of an intervention methodology for psychosexual support of a group of adolescents with BEEC. The main goal of the intervention program was to educate the adolescents and re-frame how they see themselves or feel about themselves, especially in relation to BEEC. In particular it was predicted that the program could: (1) improve the perception of pleasure concerning the body, particularly regarding the genital area, giving proper and specific information on pleasure, masturbation and medical history of BEEC; and (2) elicit a more relational-affective perspective on sexuality. STUDY DESIGN: 13 adolescent patients took part in the 1-year program. The effects of the intervention program were verified through a test-retest methodology using Sexuality Evaluation Schedule Assessment Monitoring (SESAMO). RESULTS: The results showed that participants changed their attitude in several psychosexual areas, more specifically: psycho-environmental situations, body experience, areas of pleasure, medical and sexual history, and motivation and conflict areas (Summary Table). DISCUSSION: This study demonstrated, for the first time, that a targeted program may significantly improve the psycho-sexual condition of adolescents with BEEC. In particular, this research showed that adolescents need to be able to discuss and tackle topics of a psychological and sexual nature, as well as receive understandable answers that can be put into practice in their everyday lives. The study had several methodological limitations, especially owing to the limited number of participants, the absence of a follow-up period of a few months after the intervention, and the overall exploratory nature of the program. CONCLUSION: This intervention methodology may be considered a first attempt at improving the self-esteem of adolescents with BEEC, by contrasting forms of psychological difficulties in order to improve the quality of life of these young people.