Entrecruzamento de desigualdades: gênero e maternidade na carreira de médicas de família e comunidade / Intercrossing inequalities: gender and maternity in the career of family and community physicians

O estudo da crescente feminização da área da Medicina de Família e Comunidade coloca na agenda de estudiosos a preocupação com os fatores e impactos dessa tendência nas trajetórias das carreiras das médicas, principalmente daquelas que estão exercendo suasatividades em áreas periféricas. O objetivo do estudo do qual resulta este artigo foi compreender como as médicas justificam suas escolhas e permanências no exercício da Medicina de Família e Comunidade, mesmo em contextos considerados potencialmente violentos. Realizamos uma investigação de caráter qualitativo, que dialogou com aspectos da cartografia, a partir de entrevistas realizadas com oito médicas de família que se fixaram em áreas de alta vulnerabilidade social em uma capital brasileira. A análise dos enunciados apontou para o gênero como o eixo marcador de diferença, destacando o empuxo exercido pela maternidade, o conceito gênero em sua dinâmica interseccional. Identificamos que a responsabilização pelo cuidado permanece impactando o processo decisório das mulheres, (re)definindo o equilíbrio entre vida pessoal/familiar e trabalho e (de)limitando as trajetórias de suas carreiras.

The growing trend of feminization of family practice raises scholars' concerns about the factors and effects of this trend on the trajectories of female medical careers, particularly those working in outlying areas. The aim of the study, from which this article results, was to understand how medical women justify their choices and permanence in the family practice career while working in contexts considered potentially violent. We carried out a qualitative study with cartographic aspects, based on interviews with eightfamily doctors who are settled in areas of high social vulnerability in a large city in Brazil. The analysis of the statements pointed to gender, in its intersectional dynamics, as the major axis of difference in the practice. Motherhood is highlighted ashaving a major impact on female professionals. Our study identified that the duty of care persists in impacting women's decision-making, (re) defining the balance between personal and family life and (de) limiting their career trajectories.

HIV/aids no Brasil: feminização da epidemia em análise / HIV/aids in Brazil: the feminization of the epidemic under analysis / VIH/sida en Brasil: la feminización de la epidemia en análisis

Resumo Este trabalho analisa a feminização da epidemia de HIV/aids no Brasil e a importância de considerar esse processo no planejamento de ações em saúde pública. A pesquisa foi desenvolvida por meio de revisão de literatura e estudo de dados oficiais do Ministério da Saúde. Os resultados mostram que ações eficazes no combate à infecção por HIV/aids entre as mulheres devem contemplar diferenças de gênero e condições socioculturais de cada região. O artigo ainda propõe que é imprescindível um processo amplo de educação em saúde, que abranja simultaneamente homens e mulheres e tenha foco no empoderamento e no cuidado de si e do outro.

Abstract This article analyzes the feminization of the HIV/aids epidemic in Brazil and the importance of considering this process when planning public health actions. This study is a literature review and also includes the analysis of official data from the Ministry of Health. The results show that effective actions to combat HIV/aids infection among women must take gender differences and the sociocultural conditions of each region into consideration. The need for a broad health education process for both men and women focusing on empowerment, self-care and caring for others can also be highlighted.

Resumen Este artículo analiza el proceso de feminización de la epidemia de HIV/sida en Brasil y su importancia en las acciones de planificación en la salud pública. La investigación parte de una revisión de la literatura y de datos oficiales del Ministerio de Salud de Brasil. Las acciones efectivas para combatir la infección por VIH/sida entre las mujeres deben abordar las diferencias de género y las condiciones socioculturales en cada región. Es esencial un amplio proceso de educación sanitaria, que abarque a las poblaciones masculinas y femeninas, centrándose en el empoderamiento, el autocuidado y el cuidado de los demás dentro de las relaciones establecidas.

Functional limitation on elderly people in the northeast and the feminization of eld in urban and rural areas of Brazil

Population aging in Brazil increases on a large scale due to declining fertility and mortality. This phenomenon can be influenced by several factors (demographic, biological and social), making them determinants for the health conditions of the elderly populations residing in different geographic areas. The present study aims to identify the functional limitation in elderlyresidents of urban and rural areas of Brazil. This is a descriptive epidemiological study with a quantitative approach. It was evidenced that the functional limitation for activities of daily living and instrumental activities of daily living are concentrated in the northeast region, mainly in the urban area. The following states presented the highest proportions of daily life activity limitation in urban areas: Alagoas (11.60%), Rio Grande do Norte (10.95%), Pernambuco (10.36%) and Paraíba (9.62%). For activities of daily living in the rural area were found in the states of Paraíba (12.19%), Maranhão (8.93%), Piauí (8.85%) and then Pernambuco (7.24%). Data from the functional limitation for instrumental activities of daily living again highlighted the Northeast region, with the states of Rio Grande do Norte (26.01%), Paraíba (25.96%), Maranhão (25.72%) and Alagoas (24.57%). Lastly, it was verified that the elderly woman exhibits greater proportions of functional limitation in relation to the elderly of the masculine sex, standing out again the northeastern region of the country.

Efectividad de la terapia vocal versus tiroplastía en la voz de mujeres transgénero: una revisión integrativa / Effectiveness of vocal therapy versus thyroplasty in the voice of transgender women: an integrative review

Introducción. Las mujeres transgénero encuentran frecuentemente problemas en ajus-tar su voz a la frecuencia femenina. Para favorecer el cambio vocal deseado por estos in-dividuos, se ofrecen dos técnicas: una quirúrgica (tiroplastía) y otra clínica (terapia vocal). Objetivo. Esta revisión integrativa pretende verificar las publicaciones científicas relacionadas con las dos técnicas, observando cuál reporta mayor efectividad. Método. Se realizó una búsqueda en bases de datos, considerando las palabras clave: Transsexual Persons AND Voice Feminization AND Thyroplasty OR Voice Training. Resultados. Nueve artículos corresponden a estudios observacionales y tres utiliza-ron una metodología cuasi experimental. Los grupos estudiados incluyen un amplio espectro etario. Ninguno de los estudios informa aspectos económicos de las inter-venciones. No existe evidencia de seguimiento a largo plazo. Conclusiones. La vía de tratamiento vocal con adición hormonal puede ser una primera línea, y en caso de no reportar mejoras, la cirugía aparece como otra opción.Recomendación. La recomendación es que se realice terapia vocal, que no im-plica riesgos significativos de complicaciones, siendo además un abordaje relativa-mente económico.

Introduction. Transsexual women frequently encounter problems in adjusting their voices to the characteristics of their new gender. In order to help in the change to the desired voice, two techniques are often used: the surgical (Thyroplasty) and clinical (Speech Therapy). Objective. The aim of this integrative study is to verify through scientific publications the relationship between the two techniques and observe which is the most effective.Method. A systematic database search was conducted considering the keywords: Transsexual Persons AND Voice Feminization AND Thyroplasty OR Voice Training.Results. Nine articles corresponded to observational studies and three used a qua-si-experimental methodology. The groups studied include a broad age spectrum and the quality of the evidence is low. No study reports economic aspects of the interven-tions. There is no evidence of long-term follow-up. Conclusions. The vocal treatment route with hormonal addition can be a first line, and, in case of not reporting improvements, surgery appears as another option.Recommendation. The recommendation is for Speech Therapy, which has no significant risks of complications and is relatively cheap.

Cirurgia de feminização facial em transexuais: reflexões éticas e forenses / Facial feminization surgery in transsexuals: ethical and forensic reflections / Cirugía de feminización facial en transexuales: reflexiones éticas y forenses

Resumo Cirurgias de feminização facial, que visam tornar o rosto de mulheres transexuais mais feminino, alteram tecidos moles e duros. Tais procedimentos envolvem inúmeros aspectos éticos, desde a cobertura por planos de saúde e serviço público até o direito à mudança de nome. Há também consequências forenses, no que diz respeito à eventual necessidade de identificar pessoas submetidas a esse tipo de cirurgia. Essas consequências, embora importantes, são pouco consideradas em estudos científicos. Com isso, neste trabalho são analisados alguns aspectos éticos e forenses decorrentes de cirurgias de feminização facial.

Abstract Facial feminization surgeries, which aim to render transsexuals' facial features more feminine, alter soft and hard tissues. These procedures involve ethical issues such as health insurance and public service coverage, and the right to legal name change. Forensic consequences, concerning eventual need to identify individuals who underwent this surgery, are important and require scientific studies. In this article, we analyze some ethical and forensic aspects resulting from facial feminization surgeries.

Resumen Las cirugías de feminización facial que pretenden volver más femeninos los rostros de mujeres transexuales producen cambios en los tecidos blandos y duros. Tales procedimientos involucran muchos aspectos éticos, desde la cobertura del seguro de salud y del servicio público hasta las discusiones sobre el derecho al cambio de nombre. Hay también consecuencias forenses en lo que se refiere a las posibles necesidades de identificación de las personas que se someten a esta cirugía. A pesar de su importancia, estas consecuencias son poco abordadas en estudios científicos. Así, en este artículo se analizan algunos aspectos éticos y forenses derivados de las cirugías de feminización facial.

Intervención fonoaudiológica para la feminización de la voz en una persona transgénero MTF: estudio de caso / Phoniatric intervention for voice feminization in a transgender person MTF: a case study

El término transgénero hace referencia a aquellas personas cuya identidad de género (masculino -femenino) difiere del sexo (hombre ­mujer). La persona transgénero presenta un conflicto entre la identidad sexual y su condición biológica, debido a que esta última, ya está ajustada a unas características que están dadas desde el nacimiento. Una de las mayores dificultades que presentan es en la feminización de voz, debido a que esta es percibida como la del género opuesto. Por ello, usualmente realizan cambios vocales sin una técnica adecuada, recurriendo principalmente a tratamientos quirúrgicos u hormonales, desconociendo la terapia fonoaudiológica como una alternativa para mejorar su calidad vocal e interacción social. Dado lo anterior, el objetivo de este trabajo fue determinar la efectividad de la intervención fonoaudiológica para la feminización de la voz en una persona Transgénero MTF (Male to Female). Se utilizó un diseño descriptivo, cuantitativo, usando un diseño longitudinal de serie de estudio de caso de reversión ABA. La intervención se estructuró, principalmente, en tres apartados: evaluación inicial, intervención y reevaluación final. Los resultados mostraron una variación significativa en las cualidades acústico-perceptuales de la voz, la que presentó mayores características de una voz femenina, con modificaciones en el patrón fonorespiratorio y en la postura. En conclusión, la intervención fonoaudiológica fue efectiva debido a que se lograron cambios que permitieron lograr una voz más femenina en la persona tratada.

The term transgender denotes a person whose gender identity (male-female) is different from their sex (men-women). A transgender person presents a contradiction between sexual identity and biological condition, because the latter is determined by certain given characteristics since birth. One of the most difficult issues is the feminization of the person's voice (in the case if male to female), since it is perceived as being in the opposite end of gender. For this reason, usually male to female transgenders engage in vocal changes without appropriate techniques, resorting mostly to surgical procedures or hormonal treatments and ignoring speech and language therapy as an alternative to improve their vocal quality and social interaction. Therefore, the main goal of this work was to determine the effectiveness of the phoniatric intervention in order to produce the feminization of the voice in a transgender individual MTF. The methodology used is a quantitative, descriptive, using a longitudinal design of ABA reversion case study series. The intervention was structured in three main sections: initial evaluation, intervention and final re-evaluation. The results showed a significant variation in the acoustic perceptual qualities of the voice, with a more feminine voice involving modifications in the phonorespiratory pattern and in the posture. In conclusion, the phoniatric intervention was effective because achieved changes led to a more feminine voice.

Sob o risco de estresse: as consequências da emancipação feminina na revista Veja (2000 - 2018) / Under the risk of stress: consequences of the women emancipation in the Brazilian Veja magazine (2000 - 2018) / En riesgo de estrés: consecuencias de la emancipación femenina en la revista brasileña Veja (2000 - 2018)

Considerado uma 'epidemia global' pela Organização Mundial de Saúde (OMS), o estresse figura como um dos principais transtornos contemporâneos. Neste artigo, examinamos as construções discursivas do estresse feminino, ou seja, aquele especificamente relacionado às mulheres. Para isso, realizamos uma análise discursiva da revista Veja de 2000 a 2018. Nosso intuito é observar como o semanário trata as consequências da chamada 'emancipação feminina' em termos de estresse, a partir de duas principais vertentes: (1) a relação entre estresse, hormônios e TPM; (2) o estresse como consequência da 'tripla jornada' (o acúmulo dos papéis de profissional, esposa e mãe). Concluímos que tais discursos sobre o estresse feminino colaboram para reassegurar que certas fontes de tensão, bem como a forma de lidar com elas, sejam moralmente e fisiologicamente concernentes às mulheres.

Considered as a 'global epidemic' by the World Health Organization (WHO), stress figures as one of the major contemporary disorders. In this article, we examine the discursive constructions on female stress, that is, when the term is specifically related to women. In order to do so, we conduct a discursive analysis of the brazilian Veja magazine from 2000 to 2018. Our intention is to observe the ways in which the magazine reviews the consequences of the so-called 'feminine emancipation' in terms of stress from two main sources:(1) the relationship between stress, hormones and PMS; (2) stress as a consequence of the 'triple working time' (the accumulation of the roles played by women: worker, wife and mother). We conclude that such discourses on female stress collaborate to confirm that certain sources of tension, as well as how to deal with them, are regard as been morally and physiologically concerned to women.

Considerado una 'epidemia global' por la Organización Mundial de la Salud (OMS), el estrés figura como uno de los principales trastornos contemporáneos. En este artículo, examinamos las construcciones discursivas sobre el estrés femenino, o sea, cuando el término está específicamente relacionado con las mujeres. Para cumplir nuestro objetivo, se realizó un análisis del discurso de la revista brasileña Veja de 2000 a 2018. Nuestra intención es observar las formas como esta revista estima las consecuencias de la 'emancipación de la mujer' concerniente al estrés a partir de dos aspectos principales: (1) la relación entre estrés, hormonas y TPM; (2) el estrés como consecuencia de la 'triple jornada de trabajo' (la acumulación de sus papeles de profesional, esposa y madre). Concluimos que tales discursos sobre el estrés femenino colaboran para asegurar que algunas fuentes de tensión, así como el modo de hacer frente a ellas, sean moralmente y fisiológicamente relacionadas con las mujeres.

Gender Inequalities in the Health Setting: The Case of Medicine / Inequidades de género en el ámbito de la salud: el caso de medicina / Inequidades de gênero no ámbito da saúde: o caso da medicina

ABSTRACT Objective: To understand relationships of power according to gender experienced in scenarios of professional performance by Colombian female physicians. Materials and Methods: Qualitative study with phenomenological approach, from in-depth interviews to 33 female physicians, ranging in age between 29 and 60 years, and with over five years of professional exercise. Between October 2017 and March 2018, with prior informed consent, the interviews were conducted with questions about the relationships of power and the inequalities experienced with their male colleagues in scenarios of professional performance. Results: In the reports by the female physicians interviewed, it is possible to perceive gender inequalities in wages, forms of hiring, responsibilities assigned, recognition by the patients, and access to positions of power in comparison with their male colleagues. Conclusions: Medicine maintains a power structure centered on men, with differential opportunities by gender, and characterized by a lower wage, more responsibilities, lesser recognition, and limited access to positions of prestige for women. This phenomenon needs to be explored in other professionals from the health area.

RESUMEN Objetivo: comprender las relaciones de poder según el género, vividas en los escenarios de desempeño profesional por médicas colombianas. Materiales y métodos: estudio cualitativo con enfoque fenomenológico, a partir de entrevistas en profundidad a 33 médicas, con edades entre 29 y 60 años, y más de cinco años de ejercicio profesional. Entre octubre de 2017 y marzo de 2018, previo consentimiento informado, se realizaron las entrevistas con preguntas sobre las relaciones de poder y las desigualdades experimentadas con sus colegas hombres, en los escenarios de desempeño profesional. Resultados: en los relatos de las médicas entrevistadas, se perciben inequidades de género en los salarios, las formas de contratación, las responsabilidades asignadas, el reconocimiento por parte de los pacientes y el acceso a cargos de poder, en comparación con sus colegas hombres. Conclusiones: la medicina mantiene una estructura de poder centrada en los hombres, con oportunidades diferenciales por género, y caracterizada por un menor salario, más responsabilidades, menor reconocimiento y un acceso limitado a cargos de prestigio para las mujeres. Se requiere explorar ese fenómeno en otros profesionales del área de la salud.

RESUMO Objetivo: compreender as relações de poder segundo o gênero, vividas nos cenários de desempenho profissional por médicas colombianas. Materiais e métodos: estudo qualitativo com abordagem fenomenológica, a partir de entrevistas em profundidade a 33 médicas, entre 29 e 60 anos de idade, e mais de cinco anos de exercício profissional. Entre outubro de 2017 e março de 2018, com prévio consentimento informado, foram realizadas as entrevistas com perguntas sobre as relações de poder e as desigualdades experimentadas com seus colegas homens, nos cenários de desempenho profissional. Resultados: nos relatos das médicas entrevistadas, são percebidas inequidades de gênero nos salários, nas formas de contratação, nas responsabilidades designadas, no reconhecimento por parte dos pacientes e no acesso a cargos de poder, em comparação com seus colegas homens. Conclusões: a medicina mantém uma estrutura de poder centralizada nos homens, com oportunidades diferenciais por gênero, e caracterizada por um menor salário, mais responsabilidades, menor reconhecimento e um acesso limitado a cargos de prestígio para as mulheres. Faz-se necessário explorar esse fenômeno em outros profissionais da área da saúde.

Thorax masculinization in a transsexual patient: Inferior pedicle mastectomy without an inverted T scar

Transsexual individuals with gender dysphoria or gender identity disorder are rare, with a prevalence reported to range from 0.002% to 0.014%. Studies have shown that mastectomy yields significant improvements in body image and self-esteem in female-to-male transsexual patients. In patients with grade III breast ptosis, mastectomy with a nipple-areolar complex (NAC) graft is the most commonly used technique, although it has several disadvantages. In the case described herein, a bilateral mastectomy preserving the NAC in an inferior pedicle was performed. Additionally, a thin superior thoracic dermal-fat flap was preserved and eventually sutured at the previous inframammary fold, preventing an inverted T scar. This case shows the advantage of this technique for preserving the blood supply and innervation of the NAC, with a low hypopigmentation risk. Furthermore, in this technique, the patch effect does not impair the results of the NAC graft, and there is no need to use an inverted T scar that may result in thoracic feminization.

Feminização, estigma e o gênero facializado: a construção moral do gênero feminino por meio de cirurgias de feminização facial para travestis e mulheres transexuais / Feminization, stigma and the facial gender: the moral construction of the female gender through facial feminization surgeries for transgender women

Resumo Este artigo objetiva analisar os discursos de gênero construídos em torno das chamadas "cirurgias de feminização facial" tanto pelo discurso científico biomédico como por clínicas que oferecem tais procedimentos, os quais têm se tornado bastante populares entre travestis e mulheres transexuais. A partir de levantamento bibliográfico feito no website Google Acadêmico, inicialmente analiso artigos científicos do campo biomédico que buscam construir uma noção de gênero - ou uma identificação de gênero - por meio do conjunto dos traços faciais. Essa literatura biomédica fornece as bases a partir das quais profissionais e clínicas médicas construirão discursos e práticas acerca da "necessidade" e, por conseguinte, de um desejo desse tipo de intervenção para travestis e mulheres transexuais. Na sequência, analiso como tal discurso é encarnado (embodied) na descrição e na técnica dos procedimentos cirúrgicos da dita feminização facial a partir de material etnográfico de tese de doutorado sobre o Miss T Brasil, concurso de beleza voltado para travestis e mulheres transexuais. Os resultados demonstram que tanto o saber biomédico como as práticas em torno de tais cirurgias se pautam em ideais de constituição de uma "naturalidade" nos traços faciais e preservação de uma identidade reconhecida como pessoal. Constrói-se e visibiliza-se, assim, determinada feminilidade para travestis e mulheres transexuais que tanto parece corresponder a desejos pessoais de se alcançar um ideal normativo e socialmente validado de feminino, ao mesmo tempo que se promoveria o encobrimento de um estigma ao se permitir que elas "passem por" mulher em uma relação social ordinária.

Abstract The objective of this article is to analyze gender discourses constructed around the so-called facial feminization surgeries, both by the scientific biomedical discourse and by clinics offering such procedures, which became very popular among transgender women. From a bibliographical survey made on the Google Scholar website, I present an initial analysis of scientific biomedical articles that seek to construct an idea of gender - or a gender identification - through the set of facial features. This biomedical literature provides the bases from which professionals and medical clinics will construct discourses and practices on the "need" and, consequently, the desire of this type of intervention for transgender women. Then, I analyze how this discourse is embodied in the description and technique of the surgical procedures of the so-called facial feminization from the ethnographic material of a doctoral thesis on "Miss T Brasil", a beauty pageant for transgender women. The results shows that both the biomedical knowledge and the practices surrounding such surgeries are based on the ideals that constitute a "naturalness" in facial features and the preservation of a recognized personal identity. A certain femininity for transgender women is thus constructed and made visible, which seems to correspond to personal desires to achieve a normatively and socially accepted feminine ideal, as it promotes the concealment of a stigma by allowing them to "pass" as a woman in an ordinary social relation.

Therapeutic Effects of Leuprorelin (Leuprolide Acetate) in Sexual Offenders with Paraphilia

BACKGROUND: This study examined the clinical effects of leuprolide acetate in sexual offenders with paraphilic disorders evaluated by means of objective psychiatric assessment. METHODS: The subjects of this study were seven sexual offenders who were being treated by means of an injection for sexual impulse control by a court order. They had been diagnosed with paraphilia by a psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and had been put on probation by the Ministry of Justice between January 2016 and December 2016. RESULTS: After twelve months, we observed significant improvement in symptoms, as decrease of abnormal sexual interest and activity, sexual fantasy, Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Impulsivity (GCI-I). There were a mild feminization of the body shape, feelings of fatigue, and mild hot flushes. No other adverse effect was reported. CONCLUSION: These results suggested that the clinical effects of leuprolide acetate in sexual offenders might be an effective treatment and safety strategy.

Cirugía de feminización de voz con técnica glotoplastia de Wendler en Barranquilla Colombia / Voice feminization surgery with Wendler glottoplasty technique in Barranquilla Colombia

Introducción: La glotoplastia de Wendler es la técnica que en la actualidad ofrece mejores resultados entre los diferentes tipos de cirugías para la feminización de la voz. Objetivo: Describir nuestra experiencia con la Glotoplastia de Wendler durante el proceso de feminización de la voz de mujeres transgénero. Diseño: Pseudoexperimental (antes-después) Materiales y Métodos: 36 pacientes transexuales en proceso de transformación de hombre a mujer se sometieron a cirugía y rehabilitación con terapias de voz con el equipo de VOICEFEM - Voice Feminization Colombia. La técnica utilizada consiste en la creación de una sinequia de las cuerdas vocales (CCVV) previa desepitelización de la cara interna del tercio anterior de las mismas, 2 puntos de sutura con Vicryl 4/0 y vaporización con electrocauterio en la región lateral de la cara superior de las CCVV y utilización de goma biológica en la sinequia creada. La medición de la frecuencia fundamental, el tiempo máximo de fonación, y la realización del cuestionario TSEQ, se llevaron a cabo antes y después de la cirugía. Resultados: Se obtuvo un aumento de la Frecuencia fundamental promedio de 112Hz(P<0.05) a los 6 meses posteriores al procedimiento quirúrgico y una disminución de cerca de 30 puntos en los resultados del cuestionario TSEQ. Conclusión: La glotoplastia de Wendler, llevada a cabo por cirujanos con experiencia en este campo, ofrece resultados favorables con aumentos significativos de la frecuencia fundamental a mediano plazo y debe estar necesariamente asociada al manejo postquirúrgico con terapias de voz, para obtener el desenlace óptimo esperado.

"Introduction: Wendler's Glottoplasty is the technique that offers the best results among the different types of voice feminization surgeries. Male to Female Transgender patients have in this technique the last step for their successful transformation. Objective: To describe our experience in carrying out Wendler's glottoplasty during the process of feminization of the voice of transgender women. Design: Pseudoexperimental (before-after) study. Materials and methods: In 36 Male to Female Transgender patients, Wendler's glottoplasty was conducted by VOICEFEM - Voice Feminization Colombia's team, with further speech therapy rehabilitation. This technique consists of the creation of a synechia of the vocal cords which is carried out after the de-epithelization of the vocal cords on the inner face of its anterior third, 2 stitches with Vicryl 4/0 and vaporization with electrocautery in the lateral region of vocal cords upper face, and the use of biological glue in the created synechia. The measurement of the Fundamental Frequency, Maximum Phonation time, and the completion of the TSEQ questionnaire were carried out before and after the surgery. Results: There was an increase of 112 Hz in the average of Fundamental Frequency (P<0.05) 6 months after the surgery, and a decrease of approximately 30 points in the TSEQ questionnaire results. Conclusion: Wendler's Glottoplasty conducted by an expert surgeon, provides positive results with a significant increase for fundamental frequency in the medium term, and it is imperative to do also voice therapy rehabilitation posterior to the procedure in order to obtain the expected optimal outcome.

Feminizing adrenocortical carcinoma without gynecomastia

Malignant feminizing adrenocortical tumors are exceedingly rare. Their main presentation is gynecomastia. In these estrogen secreting tumors [with or without other adrenocortical hormones] lack of gynecomastia is exceptional as in our case

A 44-year-old man presented with abdominal pain. Radiological assessment revealed a tumor measuring 120 x 95 mm in the retroperitoneal area with numerous metastases. Pathological examination pleaded for an adrenal origin with a Weiss's score of 5. Six months later, the tumor relapsed, and he had a second surgery and was sent for hormone assessment

Clinical examination showed a skinny man with severe fatigue. He had no Cushingoid features. Gynecomastia and galactorrhea were absent. Penile length, testicular volume, and body hair growth were normal. Several cutaneous nodules were present. Biological assessment showed high morning plasma cortisol, which failed to be suppressed by treatment with 2 mg dexamethasone

Plasma estradiol and 17OH progesterone levels were high, but his testosterone levels were low. Radiological exploration showed numerous metastases: pleural, pulmonary, retroperitoneal, and abdominal. He was treated with classical chemotherapy, but he died four months after diagnosis

Mixed germ cell tumor in Androgen insensitivity syndrome: A case report / Philippine Journal of Obstetrics and Gynecology

Androgen insensitivity syndrome (AIS) is a disorder of sexual development characterized by a female phenotype with a 46 XY karyotype. Most patients present with primary amenorrhea; however,1.1% of patients present with an inguinal mass. Most commonly, seminoma arising from the gonads are found.                                                                                This report represents the case of a 15 year-old female looking adolescent who initially presented with an abdominopelvic mass. A diagnosis of AIS was made based on the physical examination findings, endocrine profiling, imaging studies and karyotyping. She underwent cytoscopy, exploratory laparotomy,adhesiolysis, tumor debulking, frozen section, bowel run, repair of serosal tear, Jackson-Pratt drain insertion, bilateral percutaneous nephrostomy under combined spinal and epidural anesthesia. Histopathologic examination of the excised mass revealed a mixed germ cell tumor. This paper will discuss the diagnostic approach as well as the management and prognosis of patients with AIS associated with mixed germ cell tumor.

The XY female: A rare case of Swyer syndrome with dysgerminoma

Swyer Syndrome is a pure form of gonadal dysgenesis that although rare, should not be disregarded in the differential diagnosis of patients who present with primary amenorrhea and abdominopelvic mass. The dysgenetic gonads fail to produce antimullerian hormone in an individual with Swyer Syndrome who is genetically male, resulting in feminization and absence of virilization. Phenotypically female, they usually seek consult at a later time during their teenage years due to primary amenorrhea. Our index patient consulted due to a large abdominopelvic mass and primary amenorrhea. Hormonal assay showed a hypergonadotropic hypogonadism endocrinologic milieu, and on karyotyping, showed a genetically male individual. This paper shall discuss an in-depth pre-operative, surgical and post-operative management of patients diagnosed with Swyer Syndrome.

A feminização da velhice: em foco as características socioeconômicas, pessoais e familiares das idosas e o risco social / The meminization of old age: a focus on the socioeconomic, personal and family characteristics of the elderly and the social risk

Dentro do processo de envelhecimento populacional, destaca-se a feminização da velhice, ou seja, o predomínio de mulheres na população idosa. Porém, viver mais pode não ser sinônimo de viver melhor. O objetivo deste estudo foi caracterizar o perfil socioeconômico, pessoal e familiar das idosas do "Clube da Vovó", em Viçosa/MG, além de identificar os tipos de riscos sociais enfrentados por elas associados a esse perfil. O estudo de caso foi realizado no ano de 2014. Tratou-se de um estudo qualitativo e quantitativo em que foram entrevistadas 40 idosas. Utilizou-se para a análise dos dados o SPSS e a análise de conteúdo. Destacou-se o número significativo de octogenárias e viúvas. Aspectos como a baixa renda e a baixa escolaridade foram encontrados. O estado de saúde das idosas foi majoritariamente avaliado como bom. Esses fatores, associados à percepção da velhice pelas idosas, revelaram que o envelhecimento feminino acarreta consequências que permitem inferir que elas estão em potencial risco social.

An important aspect in the aging process of the population is the feminization of old age, that is, the predominance of women in the elder population. However, living longer not necessarily means to live better. The aim of this study was to characterize the socioeconomic, personal and family profiles of the elderly women from the "Clube da Vovó" in Viçosa/MG. Besides, we intended to identify the types of social risks faced by that population that are related to this subject. The study was conducted in 2014 and was qualitative and quantitative. 40 elderly women were interviewed. The analysis of the data was carried out through the usage of the SPSS software and content analysis. The major point was the significant number of octogenarians and widows. Aspects such as low income and low education were unveiled. The health status of the elderlies was mostly rated as good. These factors, associated with the perception of old age by the women, revealed that the aging of women brings consequences that allow us to infer that they are in a potential social risk.

Características y efectos del uso de hormonas femeninas en transexuales masculinos en Lima, Perú / Characteristics and effects of female hormones used by male transsexuals in Lima, Peru

Introducción: En el proceso de feminización, los transexuales masculinos usan hormonas sexuales femeninas, cuya seguridad en el sexo genéticamente masculino no ha sido definida. Objetivos: Evaluar el grado de conocimiento y prácticas de la administración de hormonas femeninas, la frecuencia de uso, reacciones adversas, fuentes de información y acceso a estos productos por parte de transexuales femeninos. Diseño: Investigación cualitativa y cuantitativa prospectiva comunitaria. Lugar: Lima. Participantes: Transexuales masculinos de 18 años o más. Intervenciones: Cuatro transexuales capacitados identificaron mediante la modalidad æbola de nieveÆ a transexuales femeninos. Luego, se les realizó una entrevista semi-estructurada validada, el examen clínico respectivo y la toma de una muestra de 10 mL de sangre venosa. Medidas de resultados: El nivel de conocimiento, redes y calidad de información recibida, lugares de adquisición y efectos de las hormonas femeninas. Resultados: Solo el 11,8 por ciento de los participantes conseguía las hormonas con receta médica y poseía conocimiento sobre su efecto. Los principales efectos secundarios presentados fueron sensibilidad mamaria y aumento del peso corporal (88,2 por ciento), y disminución de la libido y erección (58,8 por ciento). La hormona más usada fue una combinación de dihidroxiprogesterona y estradiol vía intramuscular (47,1 por ciento). Conclusiones: Es necesario implementar servicios multidisciplinarios que cubran las necesidades de salud, incluyendo la de feminización que tiene esta población, y así evitar o disminuir el riesgo inherente a este proceso...

Introduction: In the feminization process, some male transsexuals use synthetic female hormones whose safety has not been defined in genetically male persons. Objectives: To evaluate the degree of knowledge, frequency of use, type of administration, adverse effects and source of information on female hormones in male transsexual persons. Design: Qualitative and quantitative community prospective study. Place: Lima. Participants: Male transsexuals 18 years old or older who had been using female hormones for 6 months or more. Interventions: Four trained male transsexuals identified new male transsexuals by the æsnow ballÆ method. Then, subjects were interviewed, underwent physical examination, and a 10 mL blood sample was obtained. Main outcome measures: Level of knowledge, quality of information received, acquisition source, and side effects of female hormones. Results: Only 11.8 per cent of the participants obtained the hormones by medical prescription and had some knowledge about their effects. Most common side effects were breast tenderness and weight gain (88.2 per cent), and decline of libido and erection (58.8 per cent). A combination of dihydroxyprogesterone plus estriol IM was the most common female hormone used (47.1 per cent). Conclusions: Implementation of multidisciplinary services that meet this population health needs is necessary to decrease risks...