Ediati Annastasia, Juniarto Achmad Zulfa, Birnie Erwin, Drop Stenvert L S, Faradz Sultana M H, Dessens Arianne B
Department of Clinical Psychology, Faculty of Psychology, Diponegoro University, Tembalang, Semarang, 50275, Indonesia,
Arch Sex Behav. 2015 Jul;44(5):1339-61. doi: 10.1007/s10508-015-0493-5. Epub 2015 Mar 27.
In most Western countries, clinical management of disorders of sex development (DSD), including ambiguous genitalia, begins at diagnosis soon after birth. For many Indonesian patients born with ambiguous genitalia, limited medical treatment is available. Consequently, affected individuals are raised with ambiguous genitalia and atypical secondary sex characteristics. We investigated gender identity and gender role behavior in 118 Indonesian subjects (77 males, 41 females) with different types of DSD in comparison with 118 healthy controls matched for gender, age, and residential setting (rural, suburban, or urban). In Study 1, we report on methodological aspects of the investigation, including scale adaptation, pilot testing, and determining reliability and validity of measures. In Study 2, we report on gender development in 60 children (42 boys, 18 girls), 24 adolescents (15 boys, 9 girls), and 34 adults (19 men, 15 women) with DSD. The majority of participants with DSD never received any medical or surgical treatment prior to this study. We observed a gender change in all age groups, with the greatest incidence in adults. Among patients who changed, most changed from female to male, possessed a 46,XY karyotype, and had experienced significant masculinization during life. Gender identity confusion and cross-gender behavior was more frequently observed in children with DSD raised as girls compared to boys. Puberty and associated masculinization were related to gender problems in individuals with 46,XY DSD raised female. An integrated clinical and psychological follow-up on gender outcome is necessary prior to puberty and adulthood.
在大多数西方国家，性发育障碍（DSD）的临床管理，包括生殖器模糊，在出生后不久诊断时就开始了。对于许多出生时生殖器模糊的印度尼西亚患者来说，可用的医疗治疗有限。因此，受影响的个体在生殖器模糊和非典型第二性征的情况下成长。我们调查了118名患有不同类型DSD的印度尼西亚受试者（77名男性，41名女性）的性别认同和性别角色行为，并与118名在性别、年龄和居住环境（农村、郊区或城市）相匹配的健康对照者进行了比较。在研究1中，我们报告了调查的方法学方面，包括量表改编、预试验以及确定测量方法的可靠性和有效性。在研究2中，我们报告了60名患有DSD的儿童（42名男孩，18名女孩）、24名青少年（15名男孩，9名女孩）和34名成年人（19名男性，15名女性）的性别发育情况。在本研究之前，大多数患有DSD的参与者从未接受过任何医学或手术治疗。我们在所有年龄组中都观察到了性别转变，其中成年人中发生率最高。在发生转变的患者中，大多数从女性转变为男性，具有46,XY核型，并且在生活中经历了显著的男性化。与男孩相比，被当作女孩抚养的患有DSD的儿童中，性别认同困惑和跨性别行为更为常见。青春期及相关的男性化与被当作女性抚养的46,XY DSD个体的性别问题有关。在青春期和成年期之前，对性别结果进行综合的临床和心理随访是必要的。
