Pessoas Transexuais e Travestis em uma unidade de referência da Secretaria de Saúde do Rio de Janeiro: Estratégia em saúde para facilitação do acesso no atendimento / Transsexuals and Transvestites in a reference unit of the Health Department of Rio de Janeiro: Health strategy to facilitate access to care

O objetivo geral deste estudo foi conhecer as narrativas de vida das pessoas transexuais e travestis assistidas no Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE), com ênfase no acesso à saúde para acompanhamento hormonal na unidade de referência estadual. Como método, foi utilizada a pesquisa qualitativa e descritiva, que consistiu em duas etapas: as entrevistas, de uma forma particular, que se deram através das narrativas de vida de Daniel Bertaux e a caracterização do perfil sociodemográfico das pessoas transexuais e travestis atendidas pelo Serviço Social no Ambulatório Multidisciplinar de Identidade de Gênero (AMIG). Foram entrevistadas 16 pessoas, dentre elas: 6 mulheres transexuais, 2 travestis e 8 homens transexuais, mediante a assinatura do Termo de Consentimento Livre e Esclarecido. Para a caracterização do perfil foram coletados os dados dos prontuários de 458 pessoas. Nos resultados e discussão, identificou-se a dificuldade no acesso associados à falta de qualificação dos profissionais de saúde para o acolhimento e regulação, a falta de um protocolo padronizado para regulação, a rotatividade dos profissionais da atenção primária de saúde, e a centralização do atendimento realizado pela unidade de referência.

COVID-19-Related Stressors, Sex Behaviors, and HIV Status Neutral Care Among Black Men Who Have Sex With Men and Transgender Women in Chicago, USA.

BACKGROUND: COVID-19 has disproportionately impacted vulnerable populations, including Black men who have sex with men (BMSM) and transgender women (BTW). We investigated associations of COVID-19 stressors and sex behaviors with pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among BMSM and BTW. METHODS: As part of the Neighborhoods and Networks (N2) study, we conducted virtual interviews during peak COVID-19 infectivity in Chicago among BMSM and BTW (April-July 2020). Survey questions included multilevel COVID-19 stressors, sex behaviors, and current PrEP/ART use and access. Poisson regressions were used to examining relationships between COVID-19 stressors, sex behaviors, and PrEP/ART use/access. RESULTS: Among 222 participants, 31.8% of participants not living with HIV reported current PrEP use and 91.8% of participants living with HIV reported ART use during the pandemic. Most (83.3% and 78.2%, respectively) reported similar or easier PrEP and ART access during the pandemic. Physical stress reaction to COVID-19 [adjusted prevalence ratio [aPR] = 2.1; confidence interval (CI): 1.3 to 3.5] and being in close proximity with someone diagnosed with COVID-19 (aPR = 1.7; CI: 1.1 to 2.8) were associated with current PrEP use. Intimate partner violence (aPR = 2.7; CI: 1.0 to 7.2) and losing health insurance (aPR = 3.5; CI: 1.1 to 10.7) were associated with harder ART access. Travel-related financial burden was associated with harder access in PrEP (aPR = 3.2; CI: 1.0 to 10.1) and ART (aPR = 6.2; CI: 1.6 to 24.3). CONCLUSIONS: Multiple COVID-19 stressors were found to interfere with PrEP and ART use and access among BMSM and BTW. Contextually relevant strategies (eg, promoting telehealth and decreasing transportation burden) to address COVID-19 stressors and their sequelae should be considered to minimize disruption in HIV biomedical interventions.

Origens do(s) sexo(s) e a rainha dos problemas da biologia evolutiva / Origins of sex(es) and the queen of problems of evolutionary biology

A reprodução sexuada já foi considerada universal, e posteriormente, a forma mais perfeita de reprodução. Todavia, a partir de meados do século XIX, pesquisas no nível celular colocaram em xeque a ideia de que tipos de reprodução assexuadas fossem primitivos ou inferiores. Ao longo do século XX, e adentrando no XXI, hipóteses foram levantadas para explicar as vantagens da reprodução sexuada sobre a assexuada assim como o que permitiria a reprodução sexuada se manter quando seria mais vantajoso se reproduzir de forma assexuada. A mais importante e conhecida é a hipótese da Rainha Vermelha. Paralelamente, vários trabalhos procuraram entrever as pressões ecológicas que permitiram e favoreceram o aparecimento da reprodução sexuada em um cenário situado há cerca de dois bilhões de anos. O objetivo desse trabalho é revisar respostas históricas que marcaram o estudo da origem, da evolução e da manutenção da reprodução sexuada, identificando algumas das principais questões que a comunidade científica elaborou nos últimos duzentos anos.

Sexual reproduction has already been considered universal, and subsequently, the most perfect form of reproduction. However, since the mid-nineteenth century, research at the cellular level has questioned the idea that asexual reproduction types are primitive or inferior. During the twentieth century, and entering the XXI, hypotheses were raised to explain the advantages of sexual reproduction over the asexual as well as what would allow sexual reproduction to be maintained when it would be more advantageous to reproduce asexually. The most important and known is the Red Queen hypothesis. At the same time, several studies have sought to understand the ecological pressures that allowed and favored the appearance of sexual reproduction in a scenario that was around two billion years ago. The aim of this work is to review historical responses that marked the study of the origin, evolution and maintenance of sexual reproduction, identifying some of the main questions that the scientific community has elaborated over the last two hundred years.

Sexual preferences and associated disorders: toward an extended model for description. / Preferencje seksualne i zwiazane z nimi zaburzenia: w strone rozszerzonego modelu opisu.

The notion of human sexual preferences relates to relatively stable patterns of sexual response and to directing sexual behaviors toward specific arousing stimuli, which are also important for sexual satisfaction. The preferences may pertain to the properties of the object or the sexual activity itself. Diagnosing sexual preferences, in its basic form, is conducted with the use of disorder criteria defined in diagnostic classifications (ICD-10, DSM-5). However, while employing these criteria enables the categorization of the patient's sexual preferences as normal or pathological, they seem clearly insufficient for describing complex sexual interest patterns in a comprehensive manner. The goal of this article is to present a detailed dimensional model for describing sexual preferences. This proposal assumes the description of two aspects of preference: a contentual aspect, defining the individual hierarchy of sexually attractive and aversive stimuli, and a formal aspect. The latter involves four dimensions: the diversity of stimuli falling within the pattern of the patient's sexual interest, preference changeability in time, the coherence between individual components of responding to sexual stimuli, and insight into one's own preferences. The proposed model supplements the basic description of sexual preferences conducted on the basis of diagnostic criteria. The model can be a tool useful for diagnostic practice, particularly in precise characterization of various difficulties experienced by patients in relation to the properties of their sexual interests. It can also inspire new research on features of human sexual response patterns which have been neglected in previous analyses.

Towards a taxonomy of sexuality following traumatic brain injury: A pilot exploratory study using cluster analysis.

INTRODUCTION: Clinicians need to understand the heterogeneity of sexual problems following traumatic brain injury (TBI) for their adequate identification and treatment. OBJECTIVE: To systematically identify groups of individuals with TBI showing similar patterns of sexual functioning. METHODS: Forty-two individuals with TBI with a mean age of 37.9 years (SD = 9.7) and an average of 3.3 years post-injury (SD = 4.3). We included four primary measures in the cluster analysis (sexual quality of life questionnaire, sexual desire inventory, generalized anxiety disorder scale, and the patient health questionnaire for depression) and two secondary measures for cluster validation (post-concussion symptom scale and dysexecutive questionnaire). RESULTS: A hierarchical cluster analysis using the Ward method revealed the existence of two groups of individuals with TBI: a) with sexual problems who were older, showed lower levels of sexual quality of life and sexual desire, with significant symptoms of anxiety and depression, and b) without sexual problems who were younger, showed high levels of sexual quality of life and sexual desire, as well as low complaints of anxiety and depression. CONCLUSIONS: Clinicians must be more proactive in assessing sexual concerns, mostly when emotional and cognitive difficulties are present in older individuals with TBI, regardless of gender, chronicity and injury severity.

The problem of sexual imbalance and techniques of the self in the Diagnostic and Statistical Manual of Mental Disorders.

This article examines the problematization of sexual appetite and its imbalances in the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the twentieth and twenty-first centuries. The dominant strands of historiographies of sexuality have focused on historicizing sexual object choice and understanding the emergence of sexual identities. This article emphasizes the need to contextualize these histories within a broader frame of historical interest in the problematization of sexual appetite. The first part highlights how sexual object choice, as a paradigm of sexual dysfunctions, progressively receded from medical interest in the twentieth century as the clinical gaze turned to the problem of sexual appetite and its imbalances. The second part uses the example of the newly introduced Female Sexual Interest/Arousal Disorder in the DSM-5 to explore how the Manual functions as a technique for taking care of the self. I argue that the design of the Manual and associated inventories and questionnaires paved the way for their interpretation and application as techniques for self-examination.

Quality of Life in Female Epispadias.

Introduction and Aim Female epispadias is a rare congenital anomaly associated with significant urinary incontinence. This study aims to evaluate the results of its treatment in terms of continence, sexuality, and impact of incontinence on quality of life. Materials and Methods We retrospectively reviewed nine patients (5-39 years) treated of female epispadias in our hospital during the period 1976-2013. Urinary continence (ICIQ-SF), sexuality, impact of incontinence on quality of life (Potenziani-14-CI-IO-2000-QOL), and overall quality of life (SF-36) were evaluated. Results All nine women were treated by bladder neck reconstruction (Young-Dees-Leadbetter) and genitoplasty; four received 2.5 (R = 1-5) endoscopic bladder neck injections; one required enterocystoplasty, urinary diversion, and bladder neck closure because of persistent incontinence; five performed pelvic floor rehabilitation; and two took anticholinergics. Three achieved continence; five had mild urinary incontinence; and 1 had moderate urinary incontinence and was awaiting an endoscopic injection. Of the seven who were older than 18 years, five answered the questionnaires of quality of life and sexuality. All had a general quality of life (SF-36) that does not differ from the normal population and had a slight impact (7 [0-15] points) of incontinence on quality of life (Potenziani-14-CI-IO-QOL-2000). Four had a normal sex life, and the fifth had lack of self-confidence due to her incontinence. Conclusion Patients with female epispadias have good long-term results regarding quality of life and sexuality, despite having some degree of urinary incontinence.

Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms.

The simultaneous revision of the two major international classifications of disease, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, serves as an opportunity to observe the dynamic processes through which social norms of sexuality are constructed and are subject to change in relation to social, political, and historical context. This article argues that the classifications of sexual disorders, which define pathological aspects of "sexually arousing fantasies, sexual urges or behaviors" are representations of contemporary sexual norms, gender identifications, and gender relations. It aims to demonstrate how changes in the medical treatment of sexual perversions/paraphilias passed, over the course of the 20th century, from a model of pathologization (and sometimes criminalization) of non-reproductive sexual behaviors to a model that reflects and privileges sexual well-being and responsibility, and pathologizes the absence or the limitation of consent in sexual relations.

Hebephilia: A Postmortem Dissection.

In 2008, the concept of hebephilia, which denotes an erotic preference for "pubescent children," was suggested by Blanchard and his team for inclusion in the DSM-5 (Blanchard et al., 2009). Four years later, the APA's Board of Trustees opted for the status quo and rejected that proposal. This essay sheds light on the reason for this rejection. I consider three important questions related to hebephilia: Does hebephilia exist? Is it a disease? And what would have been the social consequences of including it in the DSM? I argue that if Blanchard failed to convince others that hebephilia should be included in the DSM-5, it is not because he focused too much on the first question and was unable to offer a convincing answer to the second one, but because he made the mistake of dismissing the third one as extraneous. The DSM is not intended to be a pure research manual, and a category like hebephilia cannot be evaluated without taking into account its potential forensic impact. In part or in whole, the decision to include a new diagnostic category in the DSM is, and always should be, a political decision.

Freedom, invisibility, and community: a qualitative study of self-identification with asexuality.

A significant body of research is now emerging on the subjective meaning of asexuality. This study explored how self-identification as asexual is managed, both as a threat to the self-concept and a source of personal meaning. A total of 66 self-identified asexuals were recruited from an asexuality internet community and responded to open-ended questions on an online survey. Of these, 31 participants identified as female, 15 as male, 18 gave a different label such as genderqueer or androgynous, and two did not provide information on gender. A thematic analysis of the transcripts resulted in three themes. Socially, asexuality attracted denial and resistance due to incompatibility with heteronormative societal expectations. Despite the threat to self-integrity arising from asexuality being socially rejected, it was typically assimilated as a valued and meaningful orientation on an intra-personal level, aided by information and support from the online community. A second level of threat to self arose whereby other self-identifications, especially gender, had to be reconciled with a non-sexual persona. The accommodation made to other elements of the self was reflected in complex sub-identities. The findings were interpreted using identity process theory to understand how threats arising from self-identifying as asexual are managed. Although asexuality emerges as an orientation to sexuality that can be reconciled with the self, its invisibility or outright rejection in society constitute an on-going challenge.

Matters of sex and gender in F. J. Gall's Organology: a primary approach.

The originator of phrenology, F. J. Gall (1758-1828), saw himself as a natural scientist and physiologist. His approach consisted of brain anatomy but also of palpating skulls and inferring mental faculties. Unlike some of the philosophical principles underlying Gall's work, his conception of sex/gender has not yet been examined in detail. In this article, I will focus on Gall's treatment of men and women, his idea of sex differences, and how far an assumed existence of dichotomous sexes influenced his work. In examining his primary writings, I will argue that Gall held some contradictory views concerning the origin and manifestation of sex/gender characteristics, which were caused by the collision of his naturalistic ideas and internalized gender stereotypes. I will conclude that Gall did not aim at deducing or legitimizing sex/gender relations scientifically, but that he tried to express metaphysical reasons for a given social order in terms of functional brain mechanisms.

Heterosexual and nonheterosexual young university students' involvement in traditional and cyber forms of bullying.

Research has consistently found that school students who do not identify as self-declared completely heterosexual are at increased risk of victimization by bullying from peers. This study examined heterosexual and nonheterosexual university students' involvement in both traditional and cyber forms of bullying, as either bullies or victims. Five hundred twenty-eight first-year university students (M=19.52 years old) were surveyed about their sexual orientation and their bullying experiences over the previous 12 months. The results showed that nonheterosexual young people reported higher levels of involvement in traditional bullying, both as victims and perpetrators, in comparison to heterosexual students. In contrast, cyberbullying trends were generally found to be similar for heterosexual and nonheterosexual young people. Gender differences were also found. The implications of these results are discussed in terms of intervention and prevention of the victimization of nonheterosexual university students.

Diversidade sexual no contexto escolar: percepção e atitudesdos educadores / Sexual diversity in the school context: perception and attitudes ofthe educators / Diversidad sexual en el contexto escolar: percepción y actitudes delos educadores

O presente estudo constitui-se de uma pesquisa qualitativa feita com o objetivo de analisar a percepção e asatitudes dos educadores do Ensino Fundamental quanto à diversidade sexual no cenário escolar. Elegeu-se oGrupo Focal como técnica de investigação, tendo participado vinte e três educadores de duas escolas públicasde Cajazeiras-PB. O material empírico obtido foi submetido à técnica de análise de conteúdo, modalidadetemática. A suposta tranquilidade com que alguns educadores aceitam comportamentos homoafetivos escondeuma diversidade de práticas e sentimentos. A postura do educador volta-se para re(orientar) acriança/adolescente, atribuindo à orientação sexual desse indivíduo a condição de doença e/ou desvio docomportamento. As condutas revestem-se de penalizantes insistências sobre que formas de masculinidade efeminilidade devem ser estabelecidas como rigidamente opostas, reforçando o paradigma heteronormativo econvocam à reflexão sobre as consequências e prejuízos da intolerância social, sinalizando que o enfrentamentoda discriminação fundamenta-se na adoção de políticas públicas que defendam a igualdade de direitos e respeitoà diversidade sexual.

This is a qualitative study with the purpose of analyze perceptions and attitudes of primary school educators,regarding the sexual diversity in the school scenario. The Focus Group was applied to twenty-three educators oftwo public schools of Cajazeiras–PB. The obtained empiric material was submitted to the Technique of ContentAnalysis, thematic modality. The supposed tranquility which some educators accept homo-affective behaviorshides a diversity of practices and feelings. The posture of the educator is directed to re-(orient) thechild/adolescent, attributing the sexual orientation of this individual as disease and /or deviation of behavior. Theprocedures are permeated with punitive insistence regarding which male or female forms should be establishedas rigidly opposite, reinforcing the hetero-normative paradigm. It calls to the reflection about the consequencesand damage of the social intolerance, signing that the facing of the discrimination is founded in the adoption ofpublic policies that defend the equality of rights and respect to the sexual diversity.

El presente estudio se constituye de una investigación cualitativa hecha con el objetivo de analizar la percepcióny las actitudes de los educadores de lo Enseñanza Primaria en cuanto a la diversidad sexual en el escenarioescolar. Se eligió el Grupo Focal como técnica de investigación, con veintitrés educadores de dos escuelaspúblicas de Cajazeiras – PB. El material empírico obtenido fue sometido a la técnica de análisis de contenido,modalidad temática. La aparente tranquilidad con que algunos educadores aceptan comportamientoshomoafectivos, en realidad enmascara una diversidad de prácticas y sentimientos. La postura del educador sevuelve hacia un esfuerzo por re(orientar) al niño/adolescente, atribuyendo a la orientación sexual de eseindividuo la condición de enfermedad y/o desvío de comportamiento. Las conductas se revisten de penosasinsistencias sobre qué formas de masculinidades y femenilidades que deben ser establecidas como rígidamenteopuestas, reforzando el paradigma heteronormativo. Se llama la atención para la necesidad de una mayorreflexión sobre las consecuencias y perjuicios de la intolerancia social, señalando que el enfrentamiento de ladiscriminación está fundamentado en la adopción de políticas públicas que defiendan la igualdad de derechos yel respeto a la diversidad sexual.

[Specifics of relations in homosexual couples]. / Specyfika relacji w parach homoseksualnych.

While working with homosexual couples, professionals have to recognize specific conditions they live in and the characteristics of their relation dynamics. Patterns elaborated for working with heterosexual couples are often useless in the case of homosexual couples and may even lead to a misunderstanding of their behaviours. This especially refers to the roles they play in the couples, the problem of acceptance of their sexuality, experiences connected with the process of sexual orientation disclosure and others. Taking into consideration differences between homosexual and heterosexual couples is crucial while dealing with their problems.

Algunas observaciones críticas sobre la "moda género" / Some observations regarding the category 'gender'

En el presente trabajo se efectúa un análisis crítico del empleo indiscriminado de la categoría género, realizando una puntuación de los distintos problemas derivados de la misma. Dichos problemas se presentan en distintos planos, acentuándose en algunos su carácter ontológico-epistemológico y en otros su aspecto praxiológico o político. Finalmente se esbozarán ciertos interrogantes para seguir pensando su utilización disciplinar y el valor heurístico de dicha implementación.

In the present work a critical analysis of the indiscriminate use of the category "gender" is carried out, pointing out the different problems derived from it. The mentioned problems appear at different levels, their ontological-epistemological character being accentuated in some and their practical or political aspects in others. Finally, certain questions will be outlined as to continue thinking their scientific use and the heuristic value of their implementation.

Assessment of sexual health in older adults.

Sexuality is a continuing human concern, regardless of a person's age. Even as normal and pathologic changes affect their sexual health, older adults have an ongoing interest in sexual activity, which holds many benefits for them. Nurses have a role in assessing sexual health and in developing plans for managing sexual problems. Watch a free video demonstrating the best practices for assessing sexual health in older adults at http://links.lww.com/A276.