Individuals who experience Gender Dysphoria and feel that their gender identity is incongruent with their sex assigned at birth experience psychological distress due deviation from the societal norm, and Compassion-based Art Therapy combined with mindfulness can help build self-compassion and greater resilience

Mindfulness-Based Art Therapy for Gender- Variant Individuals

Gender dysphoria is a condition listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that is characterized by an individual feeling distress due to their gender identity being different than their sex assigned at birth.

Gender Dysphoria

Intersex is a term used to describe when an individual's sex traits, hormones, or reproductive anatomy differ from the two ways humans usually develop. Sometimes intersex is recognized at birth, but it can also show up later in life. Intersex and transgender are terms that are not interchangeable.

Intersex

Cisgender refers to when an individual identify with their sex at birth. "Cis" as a prefix has the meaning of "on the same side."

Cisgender

Though progress is being made, many people still faces hardship, backlash, discrimination, and violence when they vary their gender identity or expression from the traditional gender norms. 

Challenges in Gender Identity Expression

The case of David Reimer began with the 1965 birth of twin boys, Bruce and Brian Reimer, in Winnipeg, Canada. When Bruce was a few months old, his penis was irreparably damaged during a routine circumcision due to faulty medical equipment. This tragic accident led his parents, Janet and Ronald Reimer, to consult with experts, ultimately connecting them with Dr. John Money at Johns Hopkins University. The family's story has since been widely covered in news reports and documentaries, providing further insight into their experiences.

The Case of David Reimer

Sexual orientation and gender identity are frequently confused, but they represent different facets of a person's identity. Gender identity is one's internal sense of their own gender, whereas sexual orientation is a separate, though related, concept concerning one's attractions to others. Recognizing them as two distinct concepts is crucial to avoid common misconceptions.

Distinction Between Sexual Orientation and Gender Identity

The term 'transgender' describes individuals whose personal gender identity does not align with the sex they were assigned at birth. People who are transgender may use a variety of terms to describe themselves, including the abbreviation 'trans' or identifying as 'non-binary'.

Transgender

For some transgender individuals, transitioning is a process of aligning their life with their gender identity, moving away from living in a manner associated with the sex they were assigned at birth. This process is highly individual and can encompass social, legal, or medical changes. However, it is not a required step, and not all transgender people will pursue any or all of these transition types.

Transitioning for Transgender Individuals

Contemporary understanding of gender identity is in a state of continuous evolution, providing more freedom for exploration and expression than in the past. This shift is particularly evident among younger generations like millennials and Gen Z. For instance, research shows a majority of millennials view gender as a spectrum rather than a binary, with 12% identifying as transgender or gender non-conforming. This evolving perspective is reflected in societal changes, such as the increased use of gender-neutral pronouns like 'they/them' and shifts in commercial practices, where retailers are moving away from gender-segregated marketing for items like toys and clothing.

Evolving Understanding and Expression of Gender Identity

While some cultures, such as the United States, have historically been cisnormative and based on a two-gender system classifying individuals as male or female based on their sex at birth, this is not a universal model. Many other cultures recognize more than two gender categories, with some of these identities being integral parts of their societies for centuries. These non-binary identities often predate modern Western definitions of gender and hold deep cultural significance.

Cultural Variations in Gender Systems

An individual named Kai was designated male on their original birth certificate. Kai enjoys wearing tailored suits, is romantically attracted to women, and has a deeply held, internal conviction that they are a woman. Which of these elements best describes Kai's gender identity?

The term sex assigned at birth is used to describe the legal and medical designation of male or female that is ascribed by doctors to infants at birth based on the presentation of their external genitalia. Assigned Male at Birth (AMAB) and Assigned Female at Birth (AFAB) are used to demark the identification one was give while also being used rhetorically to note the difference between both the sex someone was assigned and what their biological sex is - for instance in the case of intersex individual, and to differentiate between sex and gender identity.

Sex Assigned At Birth

Gender identity is an individual's internal, personal sense of being a man, woman, both, or neither. It is a distinct concept from sexual orientation, which relates to attraction, although the two are often mistakenly conflated. While a person's gender identity often corresponds to their sex assigned at birth (based on chromosomes and phenotype), this is not always the case. Gender identity should also not be confused with gender expression, which is the outward presentation of one's gender. It is crucial for clinicians to understand these distinctions and be knowledgeable about gender-affirming care.

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This can include education on sexual orientation and related terminology, gender identity and terminology, and specific disparities that the LGBTQ+ community faces.

Relevant LGBTQ+ healthcare education 

- Human Sexuality 
- Puberty
- Sexual Orientation 
- Gender Identity 
- Sexual Relationships/ Activities
- Paraphilias  
- Sexuality across the human lifespan 
- Sexuality and Disability 
- Sexual Dysfunction 


Topics of Sexology

Similar to eating, sexual activity is a fundamental motivated behavior essential to many people's lives. While its primary evolutionary purpose is the perpetuation of the species, human sexual behavior is complex and extends far beyond simple reproduction. The psychological study of this domain provides an overview of research on human sexual behavior and motivation, including key topics like sexual orientation and gender identity.

Sexual Behavior, Sexuality, and Gender Identity

Keuroghlian, A. S., Ard, K. L., & Makadon, H. J. (2017). Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments. Sexual Health (Online), 14(1), 119-122. http://dx.doi.org/10.1071/SH16145

Advancing health equity for lesbian, gay, bisexual, and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

These can include (but are not limited to) increased risk of STIs (83% of new HIV diagnoses among 13-24 year olds were gay men), increased risk of negative mental health outcomes like depression (39% of LGBTQ youth have seriously considered attempting suicide), increased substance abuse issues (39.1% of sexual minority adults have used an illicit drug, compared to 17.1% of sexual majority adults), and increased risk of homelessness (20-40% of homeless youth identify as LGBTQ). It's important for clinicians to understand how these are related to stigma surrounding the LGBTQ+ community, and to be aware of these disparities in order to provide proper resources.

Health disparities faced by the LGBTQ+
community

Gender Identity

Theory that believes that individuals who are a part of non-dominant groups in society continue to experience and suffer from health disparities, even after adjusting for confounding variables, due to constant stress caused by interactions with dominant groups. LGBTQIA-POC individuals may be at a higher risk to health disparities due to this stress.

Minority Stress Theory

Sexual orientation (or sexuality) has multiple dimensions and is a person's identity in relation to the gender(s) they are physically and/or emotionally attracted to. It concerns an individuals romantic, emotional, and/or erotic attraction towards others (or the absence of).

Sexual Orientation

A relationship that involves physical and/or emotional intimacy. 

Intimate Relationships

Wiederman, M. W. (2003). Paraphilia and fetishism. The Family Journal, 11(3), 315–321. https://doi.org/10.1177/1066480703252663 

Paraphilia and fetishism

Paraphilia

Sexual Dysfunctions are characterized by clinically significant disturbances related to an individual’s ability to respond sexually or experience sexual pleasure. This requires a multidimensional approach to diagnoses by considering the biological, sociological, and psychological factors that influence the ways in which individuals experience sex. However, these disorders, do not include sexual dysfunctions that are a result of inadequate or a lack of stimulation or knowledge which may still be treated, but are not diagnosed.

Sexual Dysfunctions

Puberty is the transitional process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. While the sequence of these physical changes is predictable, the timing of onset and the pace of development can vary significantly among individuals.

Puberty

Much of our understanding of the physiological underpinnings of sexual behavior and motivation stems from research on animals. The hypothalamus is a key brain region for motivated behaviors, including sex. Animal studies have been instrumental in revealing that different neural systems might govern the motivation for sex versus the physical ability to engage in it, a concept demonstrated clearly in research on rats.

Physiological Mechanisms of Sexual Behavior: Lessons from Animals

The scientific study of human sex and sexuality has undergone significant development over the past century, expanding its scope and refining its methods for understanding sexual behavior and identity.

Evolution of Research in Human Sexuality

Based on their physiological observations, Masters and Johnson proposed a model of the sexual response cycle consisting of four distinct phases: excitement, plateau, orgasm, and resolution. This model describes the sequence of physiological changes that are generally similar for most individuals during sexual activity.

Sexual Response Cycle

Read the following scenario. Based on the information provided, distinguish between the individual's gender identity, sexual orientation, and sexual behavior. Explain how each of these three distinct concepts is represented in the scenario.

Analyzing Components of Human Sexuality

An individual was assigned male at birth, internally identifies as a woman, is romantically attracted to men, and is currently in a long-term relationship with a woman. Based on this information, which statement provides the most accurate analysis?

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