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.

Consumo de drogas y prácticas sexuales de los adolescentes de la ciudad de Medellin (Colombia) / Drug use and sexual practices of teenagers in the city of Medellin (Colombia)

Se estudia la relación entre consumo de drogas y prácticas sexuales en adolecentes de la ciudad de Medellín (Colombia). Mediante muestreo probabilístico aleatorio y por conglomerados, se obtuvo una muestra representativa de 955 adolescentes entre los 14 y 17 años de edad pertenecientes a colegios públicos y privados de la ciudad de Medellín de los grados 9º, 10º y 11º. Los resultados muestran que la prevalencia general de relaciones sexuales bajo el efecto de alcohol o drogas es del 43,67%. Las drogas más usadas para tener prácticas sexuales son el alcohol, la marihuana, el popper, la cocaína y el éxtasis. Consumir alcohol o drogas y tener prácticas sexuales presenta una asociación estadística significativa (p= 0.001). Las practicas sexuales mas frecuentes bajo el efecto de sustancias psicoactivas son las exploratorias (manoseo, caricias) 71%; la penetrativa vaginal (63.67%), el sexo oral (45.30%) y la masturbación (19.59%). Con respecto a tener prácticas sexuales bajo efecto de alcohol o drogas y usar métodos de protección, el 55,9% de los jóvenes usan siempre el condón, el 37,3% lo usan algunas veces y el 6,8% nunca lo usan. Este estudio prueba lo ya constatado por otras investigaciones donde se muestra la alta asociación estadística que hay entre el consumo de drogas y las prácticas sexuales, pero da cuenta que no existe asociación estadística significativa entre tener practicas sexuales bajo efectos de alcohol o drogas y el uso o no uso de métodos de protección, lo que constituye su hallazgo mas importante(AU)

The purpose of this research project was to study the relationship between drug consumption and sexual practices in teenagers in the city of Medellin, Colombia. A transversal studied was designed in order to identify the variables related to having had sexual intercourse under the effects of drugs or alcohol. The sample was made up of 955 teenagers between 14 and 17, who were in 9th, 10th and 11th grades in public and private schools in the city of Medellin. The results show that the prevalence of drug and alcohol influence in sexual intercourse is 43,67%. The most common drugs used for sexual practices are alcohol, marihuana, popper, cocaine and ecstasy. Consuming alcohol or drugs and having sexual practices shows an associated meaningful statistic (p= 0.001). The more common sexual practices under psychoactive substances are the exploratory ones (caresses and touching) (71%), vaginal penetration (63.67%), oral sex (45.30%) and masturbation (19.59%). Regarding the protection methods during sexual intercourse under drug or alcohol influence 55,9% always use a condom, 37,3% sometimes use it, and 6,8% never do it. This study proves what had been previously established by other research projects that show a high statistic association between drug consumption and sexual practices, but realizes that there is no statistically significant association between sexual practices under the influence of alcohol or drugs and the use or non-use of protective methods, which is the most important finding (AU)

Actitudes hacia las mujeres de los esquemáticos frente a los no esquemáticos de género / Attitude towards women of gender schematic vs aschematic individuals

Tras la cuádruple tipología de género (década de los setenta), un nuevo modelo dual surgió en los ochenta: personas con esquema de género frente a las no esquemáticas. En el presente trabajo se examina la relación entre estas categorías y las actitudes hacia las mujeres, utilizando el Bem Sex Role Inventory y Attitudes Towards Women Scale. Se llevaron a cabo dos estudios con adolescentes (chicos y chicas) de 12 a 14 años: el primero (2001) con 359 participantes y el de réplica (2009) con 224. Se realizaron análisis factoriales y ANOVAS. Los resultados, de ambos estudios, apoyan la hipótesis de que las adolescentes muestran una actitud más favorable que los adolescentes hacia las mujeres. Las personas femeninas o andróginas respondieron de forma semejante, pero de modo diferente al resto. Los varones masculinos y las mujeres femeninas no mostraron diferencias en las actitudes hacia las mujeres frente a las personas sin esquema de género o de género cruzado. Respecto a las posibles diferencias entre los esquemáticos típicos frente a los atípicos y las de los esquemáticos frente a los indiferenciados, los resultados son discrepantes. Se establecen las implicaciones tanto para los instrumentos utilizados como para las teorías subyacentes (AU)

After the fourfold gender typology (1970s), a dual model -gender schematic versus aschematic individuals- emerged in the 1980s. In this research, the relationship between gender schemas and attitudes towards women’s rights were tested. Two studies were carried out (2001 and 2009) with adolescents (boys and girls) from 12 to 14 years old, with 359 participants in 2001 and 224 in 2009, using two instruments: the Bem Sex Role Inventory and the Attitudes Towards Women Scale. Factor analysis and ANOVAs were carried out. The results of both studies supported the hypothesis that girls maintain more favourable attitudes about themselves than boys do. Both studies supported the hypothesis that feminine and androgynous individuals display similar attitudes towards women, but they differ from the other gender categories. Masculine boys and feminine girls did not show differences in attitudes towards women in comparison to aschematic or cross-gendered adolescents. Inconsistent results were found between studies regarding the hypothesized differences between typical and atypical schematics in attitudes towards women, as well as between undifferentiated and gender schematic individuals. The implications of these results for the instruments used, as well as for theories, are considered (AU)

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.