ABSTRACT
La temática de la identidad de género y las nuevas presentaciones de la sexualidad, plantean la necesidad de una revisión acerca de los modos de constitución de la sexualidad desde una perspectiva psicoanalítica. Recurrir a la obra de Silvia Bleichmar nos brinda la oportunidad para una aproximación a la temática de la sexualidad, el género y la identidad sexual en la infancia. La sexualidad como eje de la constitución psíquica no se reduce al ordenamiento de la identidad sexual ni a la biología del cuerpo. Es de carácter premasculino y prefemenino. La asignación al género enunciada por los padres es asumida por el yo. Los trastornos de género en la infancia se vinculan con déficits severos de la identificación primaria. Las problemáticas actuales en relación a estos temas, invitan a revisar algunos conceptos de la teoría, como así también la posición que nos cabe como analistas. Se ejemplificará con algunos casos de niños con trastornos de género, que han llevado a Silvia Bleichmar a intervenir explícitamente con la familia, la justicia, la sociedad, y a abrir un debate con organismos vinculados acerca de la ética de las intervenciones en estos casos.
The subject of gender identity and updated presentations on sexuality give rise to the need of reviewing from a psychoanalytic perspective, the ways in which sexuality is built. Resorting to Silvia Bleichmar's work affords an opportunity to approach the subject of children's sexuality, gender and sexual identity. Sexuality as an axis of psychic constitution can neither be reduced to sexual identity nor to body anatomy. It is pre-male and pre-female. Parental adscription of gender enunciation is taken in by the child's ego. Gender disorders in childhood are linked to severe shortages of primary identification. Present day problems with these subjects invite a revision of some theoretical concepts, as well as of our position as psychoanalysts. Some cases of children with gender disorders that prompted Bleichmar's explicit intervention with the family, the legal system and society, as well as to open a discussion with institutions linked to the subject on the ethics of interventions in these cases will be provided by way of examples.
Subject(s)
Humans , Sexuality , Gender Identity , Psychoanalysis , ChildABSTRACT
Gender identity disorders (GID) or transsexuality have been a latent issue in Chile 20 years after the first sex reassignment treatment in 1973. Sexual minority groups have posed the problem and even present a bill for civil sexual change. Since the nineties, the number of consultants due to gender identity problems has increased steadily, including children and adolescents. The lack of medical expertise in the area, requires urgent training programs. The first part of this manuscript will deal with the definition, epidemiology, etiology and role of the endocrinologist in the process of sexual reassignment among patients with gender identity disorders. We review sexual differentiation, brain sexual dimorphism and Sexual Development Disorders (SDD) aiming to understand the neurobiological causes of GID and to perform a better differential diagnosis with Sexual Development Disorders. GID are not a psychiatric disease. However the suffering caused by stigmatization, exclusion andabuse generate emotional problems (gender dysphoria). SDD has a genetic and hormonal basis in most cases. Its clinical expression at birth can cause an erroneous civil sex assignation or a discordant civil sex with the sexual identity of the person when there is a surgical correction. GIS without gender dysphoria was excluded as a mental disease from DSM-V and it will also be excluded from the eleventh version of the international classification of diseases. It will maintained as a condition that should be differentiated from SDD and whose treatment should be financed by health systems.
Subject(s)
Humans , Male , Female , Sexual and Gender Disorders/etiology , Sexual and Gender Disorders/therapy , Sexual and Gender Disorders/diagnosis , Sexual and Gender Disorders/epidemiologyABSTRACT
Una importante proporción de personas con esquizofrenia experimenta delusiones de contenido sexual en algún momento del curso de su enfermedad; incluso, algunos pacientes pueden llegar a la convicción de que pertenecen a un sexo distinto del que poseen. Esto puede llevar a un diagnóstico inapropiado de transexualismo y eventualmente a procedimientos hormonales o quirúrgicos innecesarios. A partir del caso de una paciente con esquizofrenia y delusión de cambio de sexo revisamos la literatura pertinente en donde se evidencia la rareza de una real comorbilidad entre transexualismo y esquizofrenia aunque permanece pendiente profundizar en la compleja situación de la sexualidad de nuestros pacientes con esquizofrenia.
A significant number of people with schizophrenia experiences delusions of sexual content at some point in the course of their disease; moreover, some patients may be convinced that they belong to a different sex from their own. This can lead to inappropriate diagnosis of transsexualism and eventually unnecessary hormonal or surgical procedures. Taking the case of a patient with schizophrenia and delusion sex change as a starting point, we review and discuss relevant literature, where we find a real rarity of comorbidity between transsexualism and schizophrenia. However, the complex situation of the sexuality of our patients with schizophrenia remains pending of further study.