[After "transsexualism"]. / Après le "transsexualisme".

Sex reassignment protocols in France do not meet the demands of people in transition. Consequently, transsexual people draw up what are called "free" transitions, without any psychiatric follow-up, opening the way for discussion on the place of the law and the need for psychiatry in these cases.

Transgender identity and health care: implications for psychosocial and physical evaluation.

PURPOSE: The purpose of this article is to educate nurse practitioners (NPs) regarding: (a) the definition and range of transgenderism, (b) social influences on transgender persons, and (c) health care for transgender persons. DATA SOURCES: Data sources include review of the literature in the areas of gender, gender identity, marginalized populations, and gender transition. Personal communication was also utilized. CONCLUSIONS: Transgender persons remain marginalized and may remain closeted and at risk for negative psychosocial consequences. For those that do come out, other issues present, including the navigation of gender transition and psychosocial and physical changes that may be positive and/or negative. Examples of positive effects may include satisfaction of living authentically and decrease in depression. Negative effects may include social discrimination and loss of relationships. To provide holistic care, NPs need to be aware of transgender lives in social context and of their healthcare needs. IMPLICATIONS FOR PRACTICE: Suggestions for cultivating a supportive healthcare environment include the usage of sensitive language and an appropriate health history and physical examination. Further, to help rectify the knowledge deficit regarding transgender care among healthcare providers, NP educators and preceptors may utilize this article as a resource in their work with students.

Relationship challenges and relationship maintenance activities following disclosure of transsexualism.

ACCESSIBLE SUMMARY: • Transsexual persons are increasing their visibility in society, and health care providers and others (such as social workers) will be called upon to help with issues that transsexual persons face. Challenges that face transsexual persons often include issues involving relationships. Psychiatric and mental health nurses and other caregivers can increase their therapeutic skills in working with couples that include transsexual persons by becoming aware of these challenges and subsequent activities that can help with them. • This research study looks at couple relationships in which one partner reveals male-to-female transsexual identity. These are relationships that were established as man-woman and now will transition into relationships that include a male-to-female person and a female partner. • Common challenges for these couples include issues related to: (1) sexual identity and relationship uncertainty; (2) male-to-female transition decision making; and (3) presenting in public. • Relationship maintenance activities that helped the couples in the study maintain and strengthen their relationships through these challenges include: (1) communication; (2) self-talk (for example, putting the situation in perspective); (3) social networks; (4) positive interactions; (5) impression management (for example, managing displays of affection in public); and (6) social activism. ABSTRACT: This qualitative study describes the relational dynamics that help sustain relationships of couples that include male-to-female transsexual persons (MTF) and their natal female partners (NF) following disclosure of transsexualism. Relationship challenges and relationship maintenance activities are identified. Each partner in 17 MTF-NF couples participated in individual surveys and interviews. The data were coded for themes related to relationship challenges and activities. MTF-NF couples experience challenges within the contexts of their relationships and of society. These challenges include: (1) sexual identity and relationship uncertainty; (2) male-to-female transition decision making; and (3) public presentation. Relationship maintenance activities enabled the study couples to maintain and strengthen their relationships through these challenges. These activities include: (1) communication; (2) self-talk; (3) social networks; (4) positivity; (5) impression management; and (6) social activism. Via this report, psychiatric and mental health nurses can increase their therapeutic skills in working with MTF-NF couples.

Transsexual primary care.

PURPOSE: Transsexual presentations in primary care stress mainstream health care physical resources, institutional organization, and the cultural flexibility of providers and interdisciplinary staff. This article describes the ethical landscape, examines gender identity culture, and considers gender reassignment physiology. Nurse practitioners are challenged to advocate for this population. DATA SOURCES: Sources for the discussion derive from published institutional guidelines, institutional and civic policies, web-based information in the public domain, and professional journal articles. CONCLUSIONS: Advocacy for cultural sensitivity, institutional policy change,and professional integrity will determine healthcare quality for this population. Advocacy for cultural awareness and institutional change has begun in larger institutions and metropolitan areas, but is necessary across primary care settings. IMPLICATIONS FOR PRACTICE: Caring for transsexuals requires knowledge of anatomical reassignments, hormonal therapy effects, and cultural sensitivities particular to the gender identity community. Healthcare screening and physical exam modifications for these presentations require forethought and appropriate adjustments.

Care of the child with the desire to change genders--Part II: female-to-male transition.

In Part I of this 3-part article, the psychological and medical care of the child wishing to change gender was described. This second part presents surgical treatments and surgical nursing care for gender reassignment procedures for a genetic female wishing to reassign as a male. Part III will define the surgical needs of the genetic male who is reassigned as a female.

Creating environments of care with transgender communities.

Partnerships between transgender individuals and community health nurses have been a primary source of monitoring and responding to the impact of the HIV epidemic on transgender communities, specifically transgender women. This article provides two perspectives: first, from a transgender service provider, and second, from a public health nurse, on forming partnerships that brought consumers and providers together to create environments of care in which many transgender persons living with and at high risk of HIV were able to engage with medical providers who believed in their right to self-determination. The process led to an increased understanding of HIV prevention and treatment needs, better individual-level health outcomes, and institutional change, including the creation of a transgender medical clinic serving homeless transgender individuals in greater Boston.

Development, risk, and resilience of transgender youth.

Transgender youth face unique and complex issues as they confront cultural expectations of gender expression and how these fit with what is natural for them. Striving for balance, learning to cope, questioning, and eventually becoming comfortable with one's gender identity and sexual orientation are of paramount importance for healthy growth and development. Ineffective management of intense challenges over time without adequate social support places youth at risk for a number of unhealthy behaviors, including risk behaviors associated with acquiring HIV. This article explores early foundations of gender identity development, challenges in the development of transgender youth, and the limited data that exist on transgender youth and HIV risks. The concept of resilience is introduced as a counterbalancing area for assessment and intervention in practice and future research with transgender youth.

If transmen can have babies, how will perinatal nursing adapt?

Reproductive technology has made it possible for those born biologically female and who have partially transitioned to the male gender via hormones to become pregnant and give birth. This article explores the role of the perinatal nurse in providing care during the obstetric experience for a transgender male and his significant other. A carefully executed plan of care can assist the nurse in providing nonjudgmental, nondiscriminatory physical and emotional nursing care, and ensure that the family's healthcare needs are met and that their transition into parenthood is effective.

Caring for transgendered people: opportunities and challenges.

In contemporary society, there is a need to ensure that care provision is both of a high quality and that it is also based on equality. Nurses need to understand what their role is when caring for transgendered people. In attempting to provide high quality care to the transgendered population it is necessary to examine the complexities and challenges associated with gender identity. This article provides some insight into the complexities that are associated with gender identity, as well as some aspects of treatment available for the transgendered person.

Understanding key issues in gender-variant children and young people.

Children, parents and other family members are often concerned if the behaviour of the child is more like that of children of the opposite gender, or when they show signs that they are uncomfortable with their physical sex appearance. Gender identity disorders in children and young people (those up to the age of 17 years) are rare. According to the Department of Health, they are best understood as a natural, although unusual, variation in human development. Gender variance is complex and involves psychological, biological, family and social issues. A multidisciplinary approach to care and treatment is advocated. This article provides nurses with some understanding of gender variance in children and young people in order for them to begin to help children, young people and their families.

Nursing care of transgendered older adults. Implications from the literature.

Although there has been considerable medical and psychological research into the phenomenon of transgenderism, little attention has been paid to issues specific to the older transgendered adult. This article seeks to address this gap by exploring issues relevant to the nursing care of the older transgendered adult. The specific topics covered include social support, abuse and neglect, medical concerns, and access to medical care. Resources for the transgendered older adult also are included. Journal articles and texts from nursing, medicine, and psychology are used. This review highlights implications for nursing, offers suggestions for promoting a therapeutic relationship in both the inpatient and outpatient setting, and concludes with areas for future research.

Caring for sexual minority youths. A guide for nurses.

Nurses have the opportunity to assist sexual minority youths in making healthy transitions to adulthood. Being aware of the challenges that sexual minority youths experience, nurses can be attentive to their specific needs and risk factors, and provide sensitive care. Nurses can draw on their interpersonal, nursing assessment, and advocacy skills to promote a positive health care experience for sexual minority youths.