Clinical Review ABC of sexual health

Gender related disorders

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7466.615 (Published 09 September 2004) Cite this as: BMJ 2004;329:615
  1. Kevan Wylie

    Introduction

    Gender identity disorder is being given greater attention and importance by the medical profession. Although its aetiology is unclear, some evidence suggests that it has a neurobiological basis. The condition is no longer confused with sexual orientation preference and other gender related disorders. Social stigma remains, and patients need multidisciplinary assessment and care.

    Terminology

    The designation of sex has always been established by looking at the anatomical sex, and the term gender identity describes whether a person senses himself or herself to be masculine or feminine. Gender role describes how people publicly express themselves in their clothing, use of cosmetics, hairstyle, conversation, body language, appearance, and behaviour. Usually, gender identity and gender role are congruous, but in people with gender identity disorder, severe incongruity exists between anatomical sex and gender identity, and the person has persistent discomfort with his or her anatomical sex, usually from childhood. A sense of inappropriateness is felt in the gender role of that sex, and such people have a strong, ongoing, crossgender identification, with a desire to live and be accepted as a member of the opposite sex. Usually they have a desire for hormonal therapy and surgery to make their body as congruent as possible with the desired gender identity.

    It is essential to recognise that sexual orientation—the sex someone finds erotically attractive—is distinct from gender identity and role, and it may be heterosexual, homosexual, or bisexual. The proportion of heterosexual, bisexual, and gay people is no different in transgendered people than in non-transgendered people, and most studies suggest that heterosexuality occurs after surgical reassignment.

    These people are not transvestites or transsexuals. They are Sylhet kothis, from South Asia. Although men, they see themselves as feminine and adopt mannerisms to attract panthis—real men. Sociocultural, religious, and family pressures ensure that most kothis eventually …

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