Professional Help-Seeking in Men Experiencing Sexual Problems - The Role of Sexual Identity and Minority Stress.

BACKGROUND: Only a minority of men experiencing sexual problems will seek professional help and the proportion of gay or bisexual men can be even lower. AIM: To investigate if sexual identity and minority stress are related to professional help-seeking in Polish gay and bisexual men. METHODS: Sexual identity was measured with the standard question: "Do you consider yourself to be heterosexual, gay, or bisexual?" Men who provided a complete set of answers to the study tools and replied "yes" to the question: "Have you ever had a problem with sexual functioning that lasted at least several months?" were included (Ntotal =644, Nstraight = 203, Ngay = 324, Nbi = 117). A simple question on help-seeking was: "Did you seek professional assistance then?" Other data were gathered with the use of a self-constructed questionnaire. Minority stress processes, that is, internalized homophobia, expectations of rejection, and identity concealment, were measured with the subscales of the Sexual Minority Stress Scale. Bivariate analyses and multivariate logistic regressions were performed to test the statistical significance of sexual identity and minority stress processes as predictors of professional help-seeking. OUTCOMES: Contacting a specialist when experiencing a sexual problem. RESULTS: A total of 84.5% of all men did not seek professional help. Gay identity (OR = 0.58, P = .045), as opposed to bisexual identity, was significantly related to reduced odds of consulting a specialist. Age (OR = 1.03, P = .005), number of doctor's visits per year (OR = 1.51, P < .001), and a psychiatric diagnosis (OR = 1.65, P = .043) were positively related to help-seeking behaviors. Identity concealment significantly decreased the likelihood of consulting a specialist (OR = 0.94, P = .017). CLINICAL TRANSLATION: Specialists need to be aware that gay identity and identity concealment may prevent a proportion of men from seeking their help and thus should be publicly explicit about their inclusive and nonpathologizing approach to sexual diversity. STRENGTHS AND LIMITATIONS: The major strengths of the study include the use of a relatively large sample size and data from the little recognized Polish context characterized by a predominantly hostile anti-LGBT social climate, and exploration of a neglected topic of substantial significance at the public and individual levels. The major limitations are the use of nonprobability sampling, cross-sectional self-report design, and a single question to capture the presence of sexual problems with no measurement of associated distress. CONCLUSION: Gay men are at risk of avoiding help-seeking when experiencing sexual problems because of identity concealment. Grabski B., Kasparek K., Koziara K., et al. Professional Help-Seeking in Men Experiencing Sexual Problems - The Role of Sexual Identity and Minority Stress. J Sex Med 2022;19:1090-1097.

Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature.

BACKGROUND: The subject of gay and lesbian sexual health seems to be highly understudied, at least partially due to general limitations inherent in the studies of sexuality as well as heteronormative bias and difficulties in reaching out to these populations. AIM: To critically review the studies on gay and lesbian sexual health in order to identify the existing gaps and biases in the scope and general construction of the published research. METHODS: The dataset comprised 556 peer-reviewed articles identified through Medline search. Key studies characteristics were extracted according to the codebook developed for this study and analyzed descriptively. OUTCOMES: The outcomes included: research methodology, study design, sampling, research topic and diversity inclusion in studied populations. RESULTS: The majority of the studies were quantitative (70.5%), cross-sectional (83.6%) and used convenience sampling (83.2%). Most papers focused on HIV/STI risk behaviors, vulnerabilities and risk navigation (26.3%). The least often found topic captured the sexual function of gay and lesbian participants in older age (0.5%). Over 68% of papers relied on male samples and studies on female-only samples comprised less than 13%. Most studies did not recruit a specific age group (77.7%) and included information about ethnicity of study participants (62%). Information about education (58.7%) or other indicators of socioeconomic status (52.8%) was less often reported. CLINICAL TRANSLATION: The methodological limitations of prevailing study designs, sampling procedures and the composition of samples, as well as extensive areas of omission confine the clinical utility of existing research. STRENGTHS & LIMITATIONS: This study offers critical insights into the most significant challenges associated with studies on gay and lesbian sexual health. Medline-only database search, the inclusion of English-written papers exclusively and limited scope (gay and lesbian sexuality only) of the review constitute the most significant limitations. CONCLUSIONS: Gay and lesbian sexual health is an understudied field characterized by primary focus on HIV/STI and paucity of higher quality research including diverse subpopulations. Mijas M, Grabski B, Blukacz M, et al. Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature. J Sex Med 2021;XXX:XXX-XXX.

Exploring Health and Transition-Related Needs in Polish Transgender and Non-Binary Individuals.

BACKGROUND: Gender diverse individuals constitute a substantial yet still understudied population. Particularly little is known about gender non-binary people whose health needs have only recently gained attention from clinicians. AIM: To investigate needs for gender-affirming interventions, selected health indicators and determinants in Polish gender non-binary individuals as compared to transgender men and transgender women. METHODS: We analyzed a subset of data from an online study on health in members of the Polish LGBTQ community. The sample consisted of 53 persons who self-identified as non-binary and 45 transgender men and transgender women. The uptake and the desire for gender-affirming medical interventions as well as selected health indicators were compared in non-binary and transgender persons. Additionally, regression models were conducted for depression, self-esteem and somatic symptoms severity as dependent variables, age as a covariate, and perceived stigma exposure, resilience and discomfort associated with current gender expression as predictors. OUTCOMES: Outcomes such as desire for gender-affirming medical interventions and legal gender reassignment, symptoms of depression, resilience, physical symptoms severity, and perceived stigma exposure were captured in self-reported questionnaires. RESULTS: Compared to the transgender men and transgender women, the non-binary participants of the study significantly less often pursued or desired gender-affirming medical interventions and legal gender reassignment. The non-binary participants also felt significantly more discomfort with their current gender expression. They were also characterized by increased expectations of rejection, vicarious trauma associated with being an LGBTQ person, and by decreased resilience compared to the transgender men and transgender women. Non-binary identity and individual resilience predicted higher self-esteem and decreased depression in the sample. The severity of physical symptoms was predicted by perceived stigma exposure (positively) and by resilience (negatively). CLINICAL IMPLICATIONS: Polish non-binary individuals may constitute a vulnerable population in terms of greater perceived exposure to stigma and decreased individual resilience. Both transgender and non-binary individuals seek gender-affirming interventions and legal gender reassignment; the latter group, however, does so significantly less often. STRENGTHS & LIMITATIONS: We analyzed the data from a unique and understudied Polish population. By exploring the diversity within the transgender and non-binary community, we add to the ongoing discussion on transgender and non-binary health. The major limitations of the study are convenience sampling, cross-sectional design, and limited sample size. CONCLUSION: Non-binary individuals constitute a distinct population in terms of psychosocial and health-related characteristics. Clinicians should be aware of their needs and the challenges they face in association with living in a predominantly gender binary-oriented society. Koziara K, Mijas M. Wycisk J, et al. Exploring Health and Transition-Related Needs in Polish Transgender and Non-Binary Individuals. J Sex Med 2021;18:1110-1121.

Sexual Anal Pain in Gay and Bisexual Men: In Search of Explanatory Factors.

BACKGROUND: Sexual anal pain-or anodyspareunia-in gay and bisexual men is a scientifically and clinically neglected topic. More understanding of its origins and correlates is needed. AIM: To search for correlates of painful anal intercourse with the inclusion of minority stress processes. METHODS: The analysis is based on data collected in an Internet study on the sexuality of Polish gay, bisexual, and straight men. Multiple ordinal regression analysis was used to search for the correlates of painful receptive anal intercourse in a group of 1,443 nonheterosexual men who declared practicing this type of intercourse within the last 12 months. The investigated correlates included demographics, sexual patterns and experiences, experiencing minority stress, sexual problems, and mental and physical health. To assess the level of minority stress, we used the Sexual Minority Stress Scale based on Ilan Meyer's Minority Stress Model, with its subscales relating to internalized homophobia, expectation of rejection, concealment, and sexual minority negative events. Sexual problems were measured with single-item questions adapted from the National Health and Social Life Survey. Data on the remaining correlates were obtained using a survey that we developed. MAIN OUTCOME MEASURES: The intensity of pain during receptive anal sexual intercourse as rated on a 5-point Likert scale was a dependent variable. RESULTS: Age (odds ratio [OR]: 0.97; P < .001), performance anxiety (OR: 1.94; P < .001), and internalized homophobia (OR: 1.04; P < .001) were the only statistically significant predictors of the intensity of pain during receptive anal sexual intercourse. CLINICAL IMPLICATIONS: Clinicians addressing sexual anal pain should consider performance anxiety, internalized homophobia, and younger age as possible operating factors. STRENGTHS & LIMITATIONS: The major strengths of the study include the provision of additional data on this neglected topic derived from a large sample of participants from the little recognized Central European cultural context and the major limitations are the nonrepresentative sampling, retrospective data collection, cross-sectional design, Internet methodology, and lack of information on the clinical relevance of experienced pain, that is, distress or help-seeking, as well as its recurrent or persistent character. CONCLUSION: Painful sexual anal activity requires further investigation. Grabski B, Kasparek K. Sexual Anal Pain in Gay and Bisexual Men: In Search of Explanatory Factors. J Sex Med 2020;17:716-730.

Sexual Quality of Life in Homosexual and Bisexual Men: The Relative Role of Minority Stress.

BACKGROUND: Minority stress is an important risk factor for sexual problems in gay and bisexual men. It remains unclear whether and to what extent this stress is associated with the sexual quality of life in these groups. AIM: To investigate the significance of minority stress as a factor explaining the sexual quality of life in gay and bisexual men. METHODS: The analysis is based on data collected in an Internet study on the sexuality of Polish gay, bisexual, and straight men. Multiple regression analysis was used to investigate the importance of minority stress in explaining the sexual quality of life in a group of 1,486 non-heterosexual men in the context of other predictors, including demographics, the level of current sexual function, sexual patterns and experiences, and mental and physical health. We used the Sexual Minority Stress Scale based on Ilan Meyer's Minority Stress Model, with its subscales relating to internalized homophobia, expectation of rejection, concealment, and sexual minority negative events. The level of sexual functioning was evaluated using 2 scales, the International Index of Erectile Functioning and the Premature Ejaculation Diagnostic Tool. Data on the remaining predictors were obtained using a survey that we developed. MAIN OUTCOME MEASURES: The men's sexual quality of life as rated on the Sexual Quality of Life Scale for Men was a dependent variable. RESULTS: Internalized homophobia (ß = -0.28; P < .001) and sexual minority negative events (ß = -0.09; P < .001) were statistically significant predictors of sexual quality of life in non-heterosexual men. Internalized homophobia (ß = -0.28; P < .001) and erectile function (ß = 0.29, P < .001) turned out to be the strongest predictors. Sexual orientation (gay vs bisexual) and its interactions with individual processes of minority stress were statistically nonsignificant. CLINICAL IMPLICATIONS: To evaluate and improve the sexual quality of life of non-heterosexual men, it is necessary to consider not only their sexual function, but also the minority stress they experience, particularly internalized homophobia. STRENGTHS & LIMITATIONS: The major strengths of the study include a large sample size, a comprehensive assessment of minority stress, and the previously understudied Central European cultural context. The major limitations are the nonrepresentative sampling, retrospective data collection, and cross-sectional design. CONCLUSION: Internalized homophobia predicts poorer sexual quality of life in gay and bisexual men in Poland. Grabski B, Kasparek K, Müldner-Nieckowski L, et al. Sexual Quality of Life in Homosexual and Bisexual Men: The Relative Role of Minority Stress. J Sex Med 2019;16:860-871.

[Group psychoeducation in bipolar mood disorders - the influence on the cognitive representation of the illness. The results of the program "Taming the bipolar affective disorder"]. / Grupowa psychoedukacja w dwubiegunowych zaburzeniach nastroju - wplyw na poznawcza reprezentacje choroby. Wyniki programu "Oswajanie choroby afektywnej dwubiegunowej"

OBJECTIVES: To assess the influence of group psychoeducation in bipolar disorder on selected aspects of cognitive representation of illness. METHODS: 51 patients with bipolar diagnosis were included in the study, and 24 were included in the final statistical analysis. The participants took part in 8 meetings of group psychoeducation. The assessment of selected aspects of cognitive representation of illness, i.e. acceptance of illness, health locus of control, generalized self-efficiency, hope for success, therapeutic compliance, beliefs about bipolar disorder was conducted with validated questionnaires before, after, and 18 months after receiving psychoeducation to register possible changes. RESULTS: Statistically significant increase in acceptance of illness, perceived self-efficiency, hope for success, therapeutic compliance, and positive modification of beliefs about bipolar disorder were detected. The observed change occurred right after the intervention, but it was not sustained during the follow-up. CONCLUSIONS: Psychoeducation may exert a positive influence on virtually important cognitive variables, which seem to be clinically important. This influence may disappear with time, thus the interventions should either be repeated or the duration of intervention should be prolonged. The study shows new possible research directions in the field of searching for the mechanism of action of psychoeducation in bipolar disorder, as well as of its active components.

Is sexual identity associated with the risk of premature ejaculation? / Czy tozsamosc seksualna zwiazana jest z ryzykiem diagnozy wytrysku przedwczesnego?

OBJECTIVES: Some studies suggest that homosexual identity, compared to heterosexual, may be associated with a reduced risk of premature ejaculation (PE). The aim of this study was to test this relationship and to investigate possible underlaying mechanisms. METHODS: The present study drew on a database obtained from a cross-sectional online study of the sexuality of Polish heterosexual (HM; N = 1,121), gay (GM; N = 1,789) and bisexual (BM; N = 743) men. The dependent variable was the PE diagnosis based on the PEDT questionnaire. The explanatory variables were characteristics of sexual and partnership patterns, health and minority stress among GM and BM. Statistical one- and multifactor analyses were performed. RESULTS: Homosexual identity proved to be an independent negative predictor of PE diagnosis. The preference for insertive penetration activity (including vaginal), performance anxiety and financial difficulties increased the risk of PE, while the experience of insertive and receptive forms of oral and anal sex but not vaginal sex, a higher level of education, better general sexual functioning and regular physical activity reduced such risk. The predictive meaning of homosexual identity has not been present in multifactor models for group of men in relationships. CONCLUSIONS: Homosexual identity is associated with a lower risk of PE diagnosis. This may be due to the differences in sexualities of GM and HM, as well as other psychosocial factors.

Polish mental and sexual health specialists working with transgender and gender diverse persons - who are they and what is their background? / Polscy specjalisci i specjalistki w dziedzinie zdrowia psychicznego i seksualnego pracujacy z osobami transplciowymi i róznorodnymi plciowo ­ kim sa i jakie maja przygotowanie?

OBJECTIVES: This study aimed to present the demographic and professional characteristics of Polish mental and sexual health specialists (MSHS) and their experience in clinical work with transgender and gender diverse (TGD) people. METHODS: This cross-sectional study was conducted using the LimeSurvey platform. A total of 239 MSHS with a diverse professional background, at different stages of their careers, with experience of working with TGD patients, completed the survey. Participants were asked to provide demographic (e.g., gender and sexual identity) and professional (e.g., knowledge of leading standards and guidelines of care) data. Descriptive statistics were used. RESULTS: The mean age of participants was 39.5 years (SD 7.92) and the majority were assigned female at birth (73.2%). The sample was composed predominantly of psychotherapists (70%), then psychologists (53%), medical doctors (31%) and certified sexologists (5.9%). The majority (72%) practised in large cities (>500,000); 68.6% reported female gender identity, 24.7% a male identity and 6.3% were TGD; 63.2% were heterosexual, 12.1% homosexual, 12.6% bisexual, and 12.1% reported other sexual identity. Both the significance of religion and religious practice were significantly decreased compared to general Polish population. Most participants declared that they either do not know the basic guidelines of care for TGD people at all or know them very little. The majority of MSHS rated their professional training as insufficient. CONCLUSIONS: People providing clinical services to TGD patients are a professionally diverse group. There is an urgent need to expand and intensify professional training directed at MSHS on topics related to the health care dedicated to TGD people.

Erectile Problems in Polish Straight, Bisexual, and Gay Men: Does Sexual Identity Really Matter?

Erectile dysfunction (ED) is one of the most common sexual health diagnoses in men. Previous studies demonstrated that ED can be even more prevalent among sexual minority men. This study investigated whether sexual identity is related to erectile function (EF) and explored variables possibly contributing to the differences between Polish straight and sexual minority men. The study sample included 1,246 gay, 838 straight, and 535 bisexual men who participated in an online survey. First, the psychometric qualities of the IIEF-2-EF scale used in the study were examined through confirmatory and exploratory factor analysis; a correction to account for potential bias in the questionnaire was also applied. Next, a series of univariate and multivariable models accounting for predictors possibly contributing to the observed differences between the groups of men were conducted. It was demonstrated that gay and bisexual men were more likely to show poorer EF. However, as demonstrated in the subgroup of men who were in relationships, sexual identity lost its significance when the unique characteristics of minority men's sexuality (i.e., less focus on insertive penetrative sex in gay men and more frequent relational non-exclusivity in bisexual men) were controlled for. Erectile problems in minority men may benefit from clinical consideration in the unique context of their sexuality.

Psychometric assessment of the Polish Translation of the Transgender Positive Identity Measure (T-PIM). / Ocena psychometryczna polskiego tlumaczenia kwestionariusza Transgender Positive Identity Measure (T-PIM).

OBJECTIVES: Research conducted in transgender and gender diverse individuals focused mainly on the challenges and health disparities affecting this population. One reason for this situation is the lack of questionnaires capturing positive aspects and experiences related to being a transgender person. The Transgender Positive Identity Measure (T-PIM) is one of a very few measures designed to explore such experiences. The aim of the study was to investigate the structure, reliability and validity of the Polish translation of the T-PIM questionnaire. METHODS: A group of 89 transgender and gender diverse participants completed an online survey including the T-PIM questionnaire, resilience measurement scale (SPP-25) and depression (CESD-R) measures. Hierarchical item clustering method (ICLUST), Horn's parallel analysis and Velicer's minimum average partial test (MAP) were employed to investigate the structure of the questionnaire. RESULTS: The analyses showed that the Polish translation of the T-PIM questionnaire was characterized by a 5-factor structure consistent with the original publication (Authenticity, Intimacy, Community, Social Justice, Insights). Cronbach's alpha and Guttman's lambda-6 reliability coefficients reached satisfactory levels for all five factors and for the whole questionnaire. CONCLUSIONS: The Polish translation of the T-PIM questionnaire is characterized by satisfying psychometric properties and can be used in studies on transgender and gender diverse communities.

How the COVID-19 pandemic affects transgender health care - A cross-sectional online survey in 63 upper-middle-income and high-income countries.

Background: Due to the COVID-19 pandemic, access to medical care is restricted for nearly all non-acute conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments, transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. Methods: As an ad hoc collaboration between researchers, clinicians and 23 community organizations, we developed a web-based survey in German that was translated into 26 languages. Participants were recruited via community sources, social media channels, and snowball sampling since May 2020. The present sample is based on the data collected until August 9, 2020. We assessed demographical data, health problems, risk factors, COVID-19 data (e.g., contact history), and the influence of the COVID-19 pandemic on access to transgender health care services. To identify factors associated with the experience of restrictions, we conducted multiple logistic regression analysis. Results: 5267 transgender people from 63 upper-middle-income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding COVID-19 treatment due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% reported at least one mental health condition and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. Discussion: Transgender people suffer under the severity of the pandemic due to the intersections between their status as a vulnerable social group, their high number of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender people, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behavior, and suicidality.

Psychological gender of patients with polycystic ovary syndrome.

OBJECTIVE: We compared women with polycystic ovary syndrome (PCOS) to a control group with regard to intensity of hirsutism and psychological gender. DESIGN: Cohort study, 2005-2009. SETTING: Gynecological endocrinology clinic and gynecological practice, Silesian area, Poland. SAMPLE: 89 women aged 17-42 years with PCOS, in two groups (S1, S2) by age < or ≥31 years, and age-stratified controls of 45 healthy women. METHODS: We used the General Health Questionnaire (GHQ 12), Ferriman-Gallwey score and Psychological Gender Inventory, to assess masculinity and femininity through self-reported possession of socially desirable, stereotypical personality traits (masculine, feminine, androgynous, undifferentiated), supplemented by questions concerning social status (education, profession) and gynecological history. All questionnaires were anonymous and independently answered during clinic visits. MAIN OUTCOME MEASURES: Influence of PCOS and concomitant hirsutism on psychological gender. RESULTS: Hirsutism (moderate or severe intensity) was observed in a considerably higher number of women from both PCOS groups compared with controls (S1: 49.0 vs. 20.0%, p < 0.05, S2: 41.9 vs. 16.7%, p < 0.05, respectively). Women ≥31 years with PCOS more often viewed themselves as sexually undifferentiated compared with controls (31.8 vs. 6.7%, p < 0.01), less likely to identify with a female gender scheme (18.2 vs. 33.3%), and more likely to see themselves as androgynous (50.0 vs. 40.9%). CONCLUSIONS: Women with PCOS have, depending on age and severity of disease, problems with psychological gender identification. Duration and severity of PCOS can negatively affect the self-image of patients, lead to a disturbed identification with the female-gender scheme and, associated with it, social roles.

[Personality disorders--different outlooks and attempts at their integration]. / Zaburzenia osobowosci--róine spojrzenia i próby ich integracji.

The paper presents different approaches to personality disorders. The authors critically discuss the contemporary categorical psychiatrie (medical) classification and also present psychological approaches with the special attention put to personality trait theories and stemming from them the Five Factor Model (FFM). Due to the coming time of the publication of a new revision of the American classification DSM- 5 the detailed description of the proposals for the new system has been presented. The authors included the most updated version which has just recently been published on the DSM-5 APA web site on 11h June 2011. The proposed changes go forward to the voices of critique of present solutions, and create a hybrid system which will incorporate some elements of the dimensional approach to personality disorders.

[Stage models of homosexual identity formation. Implications for therapeutic practice]. / Stadialne modele formowania sie tozsamosci homoseksualnej. Implikacje dla praktyki terapeutycznej.

The authors discuss stage models of gay and lesbian identity formation first proposed during the 1970s within affirmative approaches to homosexuality. The process of developing homosexual identity is characterized here with linearly ordered stages distinguished around major developmental events leading to new self-definition. Among many stage proposals the authors have chosen and presented two: by Vivienne Cass and Susan McCarn with Ruth Fassinger. The presented models were analysed in terms of their usefulness in therapeutic practice aimed at promoting the formation of gay identity, for which they have been originally designed. An important part of this discussion is evaluation of the accuracy of developmental process descriptions contained in stage models.

[Mental health of homosexual and bisexual people--review of research and presentation of phenomenon]. / Zdrowie psychiczne osób homoseksualnych i biseksualnych--przeglad badan i prezentacja zjawiska.

The issues of mental health and psychological well-being of sexual minorities have become one of the ponderable scientific questions in recent years. Not only do they attract the attention of psychiatrists, psychologists or sexologists, but also of public health professionals. It is because psychiatric disorders in sexual minorities are not only the source of individual suffering and dysfunction, but also a big and so far unappreciated social problem. The research results in this field were mostly unreliable in the past, because they were based on the false paradigm, assuming that homosexuality unquestionably belongs in the realms of psychopathology. This became a major selection bias in which researchers tried to draw conclusion upon the mental status of the hole population of homosexual people only from studies of clinical populations. New studies analyse the mental status of this relatively big social group implementing data from epidemiological population-based studies, which allows the more realistic assessment of the problem. In this work we presented new data indicating the elevated risk of psychiatric disorders within the sexual minorities. The problem was discussed in the context of living in the reluctant and hostile environment (minority stress exposure).

[Mental health of homosexual and bisexual people--role of minority stress]. / Zdrowie psychiczne osób homoseksualnych i biseksualnych --rola stresu mniejszosciowego.

The results of the researches show that the prevalence of emotional problems among homosexual persons is higher in comparison with the general population. However, homosexual orientation should not be treated as a reason for that, which is stressed by the greatest associations of mental health, basing on research. The question of the causes of increased prevalence of mental disorders among members of the sexual minorities remains without a clear answer. The theory of minority stress seems to be a very interesting explanation. It integrates a variety of risk factors, which may influence the stress level. In the article we try to explain this concept, hoping that it will be useful in understanding the situation of homosexual people.

[Schizophrenia-like psychotic symptoms in a patient with confirmed Huntington's disease: a case report]. / Objawy psychotyczne sugerujace schizofrenie u pacjenta z potwierdzonym rozpoznaniem choroby Huntingtona--opis przypadku.

AIM: The aim of this study is to discuss diagnostic and therapeutic challenges in a patient with a mutation in the gene responsible for the development of Huntington's disease (HD) who presented schizophrenia-like psychotic symptoms. METHOD: A case report. RESULTS: A 35-year old man with genetically-confirmed HD who developed significant behavioural changes that occurred many years prior to the outbreak of choreic movements. There was a close temporal relationship between an onset of discrete involuntary movements and schizophrenia-like psychotic symptoms (delusions of persecution, reference and bodily change, as well as auditory pseudohallucinations of threatening and commanding voices). At admission (subsequently to a suicidal attempt) he was ambivalent, ambitendent and--periodically--agitated. Pharmacotherapeutic regime of olanzapine (20 mg qd) and amisulpride (400 mg qd) led to a gradual improvement of the patient's mental status. CONCLUSIONS: HD should always be included in the differential diagnosis of psychotic disorders. Patients with HD can exhibit various psychopathological symptoms (including psychotic ones) prior to the outbreak of movement symptoms. Both neurologists and psychiatrists should take part in the therapeutic process. Atypical antipsychotics seem to be effective in the discussed group of patients (although the evidence body consists mainly of scarce, low-quality data).

Characteristics and expectations of patients seeking help for gender dysphoria in one of the sexological outpatient clinics in Poland. / Charakterystyka i oczekiwania pacjentów szukajacych pomocy z powodu dysforii plciowej w jednej z poradni seksuologicznych w Polsce.

OBJECTIVES: The aim of the study was to present the characteristics of the convenience sample of the transgender people who registered in one of the sexological outpatient clinics, with particular emphasis on the needs of those seeking assistance. The division into persons with binary and non-binary identities was included. METHODS: A statistical analysis of the data obtained from the medical records of a group of 49 patients, including 35 patients declaring binary identity and 14 patients declaring non-binary identity, was conducted. The data included, among others, the reported gender identity, the process of its emergence and the range of expectations towards the outpatient clinic (hormone therapy, qualification for gender confirmation procedures, support in obtaining legal recognition of gender reassignment, assistance in the coming-out process, treatment of co-occurring psychiatric problems or psychological assistance). RESULTS: The results indicate a great diversity of the examined group in terms of the declared gender identity. In the group of non-binary persons, a different than in binary persons course of the emergence and consolidation of gender identity is noticeable. The expectations reported in terms of hormone therapy, surgical treatment, legal recognition, assistance in the coming-out process and mental health indicate that there are differences and heterogeneous needs in the study group. The results indicate that expectations for hormone therapy, gender confirmation surgeries and legal recognition are more common in binary patients. CONCLUSIONS: Despite the frequent perception of transgender people as a homogeneous group with similar experiences and expectations, the results indicate considerable diversity in the given range.

Gender confirmation hormonal treatment use in young Polish transgender binary and non-binary persons.

INTRODUCTION: Gender confirmation hormonal treatment (GCHT) is a cornerstone of medical treatments for persistent gender dysphoria, which is expected and required by many transgender binary and non-binary individuals. Many protocols have been published, and the qualification process is guided by the World Professional Association for Transgender Health Standards of Care. The standards and other documents such as the Endocrine Society Clinical Practice Guideline provide gender confirmation hormonal care also for minors. However, the issue of starting these treatments in younger populations is still marked by controversy. This preliminary study aimed to inquire into GCHT (medications used, timing of its initiation, its tolerance, and sources of information on the treatment) in a convenience sample of young Polish transgender binary and non-binary persons. MATERIAL AND METHODS: A total of 166 adult transgender participants answered our online questionnaire between November 2020 and December 2021. The population was divided into 2 groups: assigned male at birth (AMB, n = 37) and assigned female at birth (AFB, n = 126). Subsequently, division into binary and non-binary was applied to these groups. RESULTS: Most patients (91.9% AMB and 92.2% AFB) did not use gender confirmation medical treatments before the age of 18 years. The most common medication used for GCHT before the age of 18 was cyproterone acetate for AMB and testosterone for AFB. When asked about their opinion on the timing (age) of initiating GCHT, 73.1% of the AMB and 59.2% of the AFB participants shared the view that it had been initiated much too late. By far the most common source of information on GCHT and gender confirmation surgery (GCS) was the Internet (92.2%). CONCLUSIONS: These treatments (including pubertal blocking) seem to be rarely commenced in Poland before the age of 18 years. In adults, treatment consists mostly of either testosterone or oestradiol, and cyproterone acetate and, more seldom, spironolactone are used as antiandrogens in persons assigned male at birth. In turn, gonadotropin-releasing hormone agonists are barely used at all. Specialists need to be more aware that withholding treatment in minors with gender dysphoria is not a health-neutral option. Gonadotropin-releasing hormone agonists should also be more often considered as an alternative to cyproterone acetate in the context of long-term safety.

The diverse joys of sex and relationships in straight, gay, and bisexual Polish men. / Róznorodnosc relacyjna i przyjemnosc seksualna wsród polskich mezczyzn heteroseksualnych, homoseksualnych i biseksualnych.

OBJECTIVES: The purpose of this study was to describe sexual orientations, intimate relationships, sexual behaviours, and pleasure in self-identified straight, gay, and bisexual men. METHODS: The analysis drew on a database obtained from a cross-sectional online study of the sexuality of Polish straight (SM; N = 1,079), gay (GM; N = 1,704) and bisexual (BM; N = 713) men. This data was utilised to compare men from these three groups across their sexual orientations, intimate relationships and sexual behaviours, including the most pleasurable sexual activities. RESULTS: In general, the sexualities of GM and BM seem to be more diverse and less oriented to particular sexual activities. Sexual minority men (SMM) tended to be more often in open (nonexclusive) relationships, had more diverse sexual experiences, and enjoyed a greater variety of sexual activities. This particularly concerned BM. CONCLUSIONS: Present analysis revealed patterns and significant differences in sexual orientations, intimate relationships, sexual behaviours, and pleasure of SM, GM and BM. The results, pointing to a greater diversity of sexual expression and preferences in SMM, may both trigger reshaping of some of the stereotypical beliefs, as well as positively influence educational (sexual education, specialized teaching) and clinical practice (more accurate assessment of patients' needs and problems).