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La réassignation sexuelle soulève des questions éthiques complexes. Elle interroge l'identité de genre et le droit à l'autodétermination. Certains mettent en avant le droit à l'accès aux soins médicaux nécessaires pour vivre selon son genre ressenti. D'autres s'inquiètent de la précipitation potentielle dans des décisions médicales majeures, surtout chez les mineurs. La nécessité d'un diagnostic médical de dysphorie de genre peut être vue comme pathologisante. L'exigence d'une chirurgie pour le changement d'état civil, bien que non obligatoire dans de nombreux endroits, reste controversée. L'équilibre entre le consentement éclairé et l'accessibilité aux traitements, ainsi que la stigmatisation et la discrimination, contribuent à la complexité des enjeux éthiques. Enfin, les enjeux entourant la compétence des professionnels de santé, la qualité des soins et l'intégration des besoins individuels rendent ces décisions particulièrement sensibles sur le plan éthique. Gender reassignment raises complex ethical issues. It questions gender identity and the right to self-determination. Some highlight the right to access the medical care necessary to live according to one's perceived gender. Others worry about the potential rush into major medical decisions, especially among minors. The need for a medical diagnosis of gender dysphoria can be seen as pathologizing. The requirement for surgery for marital status change, while not mandatory in many places, remains controversial. The balance between informed consent and access to treatment, as well as stigma and discrimination, contribute to the complexity of ethical issues. Finally, the issues surrounding the competence of health professionals, the quality of care and the integration of individual needs make these decisions particularly sensitive from an ethical point of view. [ABSTRACT FROM AUTHOR]

L'expérience de l'auteur date de 1990, période où il prenait en charge la féminisation du squelette faciale afin d'améliorer l'intégration sociale des patients transsexuelles masculins. Très rapidement, ces techniques ont été étendues aux femmes génétiques souhaitant un visage plus féminin. Cette chirurgie du squelette faciale a ensuite été complétée par une chirurgie des parties molles. Cette chirurgie squelettique et volumétrique est devenue un apport important dans la recherche du rajeunissement facial et de la beauté. The author's experience dates from 1990, during the period when he was in charge of the feminization of the facial skeleton in order to improve the social integration of male transsexual patients. Very quickly, these techniques were extended to genetic women who wanted a more feminine face. This facial skeletal surgery was then supplemented with soft tissue surgery. This skeletal and volumetric surgery has become an important contribution in the search of facial rejuvenation and beauty. [ABSTRACT FROM AUTHOR]

The article reports that the first prescription of feminizing HRT is possible by a general practitioner (GP). Topics include considered that the first prescription of masculinizing HRT is restricted to a specialist such as endocrinologist, urologist or gynecologist. Renewal is possible by the general practitioner.

Résumé: La population transgenre a recours au système de santé depuis les soins ordinaires ou courants jusqu'à ceux relatifs à leur possible parcours de transition. Elle s'avère cependant sujette à de nombreuses discriminations au sein même du système de santé, malgré l'exposition à de nombreux facteurs risques (précarité, IST, VIH, agressions, dépressions...) qui ont été décrits dans un premier article. Les particularités du suivi médical et des risques psychosociaux spécifiques de cette population sont méconnues des soignants et le manque de formation vis-à-vis de la santé trans durant les études de santé participe au maintien des stéréotypes et attitudes discriminatoires. Ces éléments seront décrits dans cette deuxième partie. Enfin, une fiche de synthèse soulignera les principaux axes du suivi en soins primaires ambulatoires. Transgender people use the health care system for ordinary or routine care, and also for their possible transition path. However, despite their exposure to numerous risk factors (precariousness, STIs, HIV, aggressions, depressions...), they face numerous discriminations within the health care system, which will be described in the first article. The particularities of medical follow-up and the specific psychosocial risks of this population are unknown by health care providers and the lack of training on trans health during medical studies contributes to the persistence of stereotypes and discriminations. These elements will be described in this second part. Finally, a summary will highlight the main lines of follow-up in primary ambulatory care. [ABSTRACT FROM AUTHOR]

Insofar as ‘sexuation’ is a process that begins before birth and is only completed, if ever, in adulthood, it is probably not abusive to speak of a ‘clinic of sexuation’ in children. Of course, without ignoring the conceptual difficulties that will arise, particularly with regard to the polymorphism of infantile sexuality and the so-called “latency phase”. The observation, proven for decades, that there are genuine situations of transsexualism in some children seems to be a good starting point for addressing these questions. [ABSTRACT FROM AUTHOR]

Comprendre la place et les évolutions des prises en charge médicales et psychologiques de la vie sexuelle des femmes trans, dans le cadre des parcours de transition/affirmation de genre. Une revue narrative de la littérature médicale, psychiatrique et psychologique. Après sélection, 19 articles ont été retenus et analysés de façon inductive à l'aide de la théorie ancrée et des méthodes classiques d'analyse de contenu thématique. La majorité des articles recensés et analysés font le constat d'une relative absence de recherches sur le thème de la vie sexuelle. Les traitements chirurgicaux de réassignation sexuelle augmentent significativement la qualité de la vie sexuelle des femmes trans sauf dans le cadre de la pose d'un « néovagin ». Les changements d'orientation sexuelle ne sont pas toujours liés aux éléments du traitement entrepris par les personnes mais apparaissent liés à d'autres facteurs psychosociaux. Les catégories d'orientation sexuelle sont fluides autant que les pratiques sexuelles et le genre. Elles évoluent selon le moment de vie des personnes interrogées dans une parole singulière. Après avoir longtemps été considérée comme un élément central du diagnostic de « transsexualisme », la question de la sexualité et notamment de l'orientation sexuelle des personnes apparaît actuellement peu prise en compte dans les parcours de soin. Cette absence est critiquée fortement par les auteurs des principales revues de la littérature déjà publiées. On suggère une meilleure prise en compte de la vie sexuelle comme élément clinique de l'histoire singulière des femmes trans. On observe par ailleurs que la pratique des opérations chirurgicales sur les organes génitaux n'occupe pas la place centrale qu'elle occupait encore récemment et que la question de la sexualité se pose indépendamment des modifications anatomiques génitales. To understand the place of, and the evolutions in, medical and psychological treatment for trans women's sexual health, within the framework of gender transition/affirmation processes. A narrative review of the medical, psychiatric, and psychological literature. After selection, 19 articles were analyzed inductively using grounded theory and classical methods of thematic content analysis. Most of the articles reviewed establish a relative lack of research on the topic of sexual health and well-being. Sex reassignment surgical treatments significantly increase the quality of sex life for trans women, except when a "neovagina" is constructed. Changes in sexual orientation are not always linked to elements of treatment, but appear to be linked to other psychosocial factors. Categories of sexual orientation are as fluid as sexual practices and gender and change over the course of a subject's lifetime. The discursive construction of gender and sexual orientation is located within the singular discourse of a particular individual at a given moment of her evolution. After having long been considered a central element in the diagnosis of "transsexualism", the issues of sexuality and, in particular, of sexual orientation currently appear to be little taken into account by those professionals who accompany trans people on their medical pathway. This absence is strongly criticized by the authors of the main literature reviews that have already been published. They suggest a more serious clinical consideration of trans women's singular sex lives. It is also observed that the practice of genital reassignment surgery no longer occupies the central place it did until recently, and that the question of sexuality is posed independently of anatomical modifications of the genitals. [ABSTRACT FROM AUTHOR]

Depuis quelques années, en France, des consultations dédiées aux transidentités de l'enfant et de l'adolescent s'organisent. Dans un contexte d'évolution récente du concept de genre, l'expérience des équipes étrangères des Gender Clinics et les standards de soins internationaux guide l'organisation de l'accès aux soins et de l'offre d'accompagnement de cette population. Nowadays, in France, specialized consultations for transgender youth are developed. In a context of societal, political and anthropological evolution of the concept of gender, the international experience of the Gender Clinics abroad and the Standards of Care produced by international professional associations are guiding the French experience for gender transition in children and adolescents. [ABSTRACT FROM AUTHOR]

Summary Objectives It is hypothesized that transpeople show sex-atypical differentiation of the brain. Various structural neuroimaging studies provide support for this notion, but little is known about the sexual differentiation of functional resting-state networks in transpeople. In this study we therefore aimed to determine whether brain functional connectivity (FC) patterns in transpeople are sex-typical or sex-atypical, before and after the start of cross-sex hormone therapy (CHT). Methods We acquired resting-state functional magnetic resonance data in 36 transpeople (22 with female sex assigned at birth), first during gonadal suppression, and again four months after start of CHT, and in 37 cisgender people (20 females), both sessions without any hormonal intervention. We used independent component analysis to identify the default mode network (DMN), salience network (SN), and left and right working memory network (WMN). These spatial maps were used for group comparisons. Results Within the DMN, SN, and left WMN similar FC patterns were found across groups. However, within the right WMN, cisgender males showed significantly greater FC in the right caudate nucleus than cisgender females. There was no such sex difference in FC among the transgender groups and they did not differ significantly from either of the cisgender groups. CHT (in transgender participants) and circulating sex steroids (in cisgender participants) did not affect FC. Conclusion Our findings may suggest that cisgender males and females experience a dissimilar (early) differentiation of the right WMN and that such differentiation is less pronounced in transpeople. [ABSTRACT FROM AUTHOR]

Résumé Nous avons cherché à comprendre le vécu parental après une réassignation sexuelle ( male to female ) d’un sujet. Après avoir exposé les différents travaux cliniques consacrés à la transidentité (ou transsexualisme) et défini la parentalité, nous avons analysé les données cliniques issues d’un entretien clinique de recherche et d’une passation d’une épreuve projective, le TAT, étayée par une méthodologie innovante développée par des projectivistes (Lintanff et Verdon, 2014). Nous avons rencontré une femme, Mme L., qui a été père par trois fois et qui a décidé de changer de sexe après des événements traumatiques et somatiques et une longue période de travestisme. Mme L. a peu évoqué son propre vécu de père, si ce n’est que la réassignation sexuelle a occasionné une rupture des liens avec ses enfants de leur plein gré. Elle a surtout évoqué son histoire de vie et son vécu d’enfant, d’adolescent et d’adulte confronté à la transidentité et les aménagements qu’elle a pu mettre en œuvre pour soulager une identité de genre non conforme à l’identité biologique. Le TAT a pu souligner la précarité identificatoire, rendant complexe le rapport aux polarités : masculine, féminine, paternelle, maternelle. La réassignation sexuelle vers le sexe féminin n’a pas occasionné une meilleure qualité des identifications féminines et maternelles. Nous soulignons la valeur heuristique des épreuves projectives dans la clinique de la transidentité. Objectives We tried to understand the parental real-life experience after a hormonal and surgical sex reassignment (male to female). Patients and methods After exposed research on transidentity and defined the parenthood, we analyzed the clinical data from interviewing and projective test: TAT. Our research is based on the French interpretation of this test, and on the show both the BM and the GF cards (Lintanff and Verdon, 2014). We met a woman, Mrs L., who was a father by three times and who decided to change sex after traumatic and somatic events and long period of transvestitism. Results The reassignment caused a loss of contacts with his children. Mrs L. (now) little evoked his life story, except his suffering when child, he repudiates his body's sex, which he oppose to his gender. We analyse (TAT) wavering of female and maternal identifications even after reassignment. Conclusion Projective tests provide a particularly heuristic solution for understanding the weaknesses and psychic resources of subjects having changed gender. [ABSTRACT FROM AUTHOR]

Résumé Introduction La mastectomie bilatérale de réassignation sexuelle vers l’homme est la première et souvent l’unique intervention chirurgicale permettant au patient transsexuel d’accéder physiquement au sexe masculin. C’est une chirurgie spécialisée nécessitant un accompagnement psychologique particulier. L’objectif de notre étude était d’évaluer la satisfaction des patients opérés de mastectomie bilatérale de réassignation vers le sexe masculin et l’impact sur leur vie sociale et personnelle. Matériel et méthode L’ensemble des 22 patients opérés entre janvier 2012 et mars 2013 pour mastectomie bilatérale de réassignation ont été contacté par courrier pour être inclus dans l’étude. La satisfaction après intervention était mesurée par auto-questionnaire adapté du questionnaire de reconstruction mammaire du Q-Breast modifié pour la chirurgie de réassignation sexuelle. Un score global supérieur à 320/378 était considéré comme « tout à fait satisfaisant ». Résultats Seize patients sur 22 (73 %) ont répondu au questionnaire. Le score moyen était de 332/378, correspondant à un résultat « tout à fait satisfaisant ». Le score d’évaluation du bien-être psychologique était de 54,5/60. Conclusion Notre étude a confirmé le bénéfice réel de la chirurgie de mastectomie bilatérale dans le processus de réassignation sexuelle vers l’homme, à la fois en termes de qualité de vie et de confiance en soi. Les patients ont rapporté une importante satisfaction quelle que soit la technique utilisée et une amélioration de l’intégration sociale après chirurgie. Cependant, cette chirurgie ne doit s’envisager que dans le cadre d’une prise en charge globale par une équipe multidisciplinaire expérimentée. Summary Background Mammaplasty in gender reassignment surgery is often poorly understood, due to a lack of information about this condition and its therapy. The aim of this work was to evaluate patient satisfaction following bilateral mastectomy for female-to-male gender reassignment. Methods We contacted 22 patients who underwent mammaplasty for female-to-male gender reassignment between January 2012 and March 2013 in our university hospital. Patients were sent postal questionnaires. A modified Q-breast questionnaire adapted for gender reassignment surgery enabled us to objectively evaluate patient aesthetic and psychological satisfaction. An overall score superior to 320 was considered as very satisfied for the patient. Results A total of 73% of the patients answered the questionnaire. The mean score was 332/378. This score corresponded to “very satisfied” on our questionnaire. The psychological score was 54.5/60. Conclusion This study showed that a real benefit was obtained in terms of patient quality of life and self-confidence. The high level of patient satisfaction confirmed that gender reassignment mastectomy is a useful and valid procedure, which enables these patients to reclaim their place in society. It can only be considered if it is within the framework of structures that ensure comprehensive and pluridisciplinary treatment for the patient. [ABSTRACT FROM AUTHOR]

Résumé Les auteurs présentent les techniques chirurgicales de féminisation du tiers moyen et du tiers inférieur du visage dans le cadre de la chirurgie de réassignation sexuelle. Ces techniques adaptées aux patientes transsexuelles homme vers femme sont proposées devant des caractéristiques masculines fortes du visage des patientes et reposent pour le tiers moyen sur le remodelage de la région malaire par transfert de tissu adipeux, rhinoseptoplastie de réduction et/ou de déprojection, chirurgie de la lèvre supérieure. Concernant le tiers inférieur, elles reposent sur la résection angulaire de la mandibule, la génioplastie ainsi que la chondrolaryngoplastie. Summary The authors present the surgical techniques of facial feminization of the middle third and the inferior third in the context of sexual reassignment surgery. These techniques adapted to patients ‘male to female’ are proposed to strong masculine facial features of patients and are based in the middle third of the remodeling of the malar region by fat grafting, reduction and/or deprojection techniques in rhinoseptoplasty and upper lip surgery. Concerning the inferior third, remodeling of the mandibular angles, genioplasty and chondrolaryngoplasty are adapted. [ABSTRACT FROM AUTHOR]

Résumé Le transsexualisme et les dysphories de genre, tout comme l’orientation sexuelle et l’identité de genre des adultes, ont été longtemps attribués, quant à leur développement, à des facteurs psychosociaux. Bien que toujours en discussion, ce sont les déterminismes biologiques précoces qui semblent devoir rendre compte désormais de la norme et de ses variantes. Grâce aux progrès technologiques récents des neurosciences (neuroradiologie en particulier), on identifie les particularités cérébrales et les différences entre hommes et femmes et plus spécialement dans les états de discordances psycho-génitale et pour l’identité de genre : l’hypothalamus en particulier, le connectome cérébral, le neuropile, l’organisation synaptique sont différents selon le sexe. Il y a d’autre part divers états pathologiques qui sont de véritables expérimentations naturelles qui confirment l’importance fondatrice du développement cérébral et des hormones au cours de la vie intra-utérine. Transsexualism and gender dysphoria, gender identity and orientation were used to be attributed to psychosocial factors. Although always in discussion, they are now attributed to hormonal abnormalities during intra-uterine period of cerebral development. Thanks to the recent technological progress, it is now possible to visualize the brains, especially the hypothamus, the cerebral connectome, the synaptic organization which is different according to the sex (male or female). On the other hand, diverse pathological states and syndromes, which represent natural experiments, confirm the founding importance of hormones in the cerebral development during the intra-uterine period of development. [ABSTRACT FROM AUTHOR]

Résumé À l’issue des évaluations françaises et internationales concernant la prise en charge des patients transsexuels (et transgenres), l’intérêt de proposer une psychothérapie en complément de la transformation hormonochirurgicale a été unanimement reconnu. Force est de constater que les travaux concernant ce sujet sont rares, que les modalités de cette proposition restent mal définies et que sur ce sujet des questions restent en suspens. Cet article propose donc de présenter la conception et l’évolution de cette psychothérapie dans les différentes versions des standards de soins, ainsi que les approches théoriques sur lesquelles le modèle actuel est fondé, puis d’exposer les questions qui persistent selon nous, concernant ce sujet, ainsi que nos remarques et propositions se rapportant à ces dernières. Objectives At the end of the French evaluations and the international revision concerning the standard of care (SOC) for transsexual and transgender patients, the interest to propose psychotherapy as a supplement to the sex reassignment therapy (SRT) was unanimously recognized. But, it is clear that the works concerning this subject are rare, and that the methods of this proposal remain ill-defined. So, many questions remain unsettled such its frame, modalities, methods, objectives and its place and relation with or in the SRT, as well as on the theoretical models on which these psychotherapies base themselves. The goal of this article is therefore to present the conception and the evolution of this psychotherapy in the various versions of the standards of care, as well as the theoretical approaches on which the current model is established, then to expose the questions which according to us, still persist concerning this subject, as well as our remarks and proposals relating to the latter. Materials At start, with the first SRT in the 1950s, this practice and his combination with psychotherapy suffered from a strong ethical but also partially ideological, controversy. An important number of medical practitioners met around the endocrinologist H. Benjamin to establish the first standards of care by SRT for transsexual, and defended that this treatment was the only one that could relieve the problem of gender identity of the transsexual patients. In the opposite, some psychiatrists and psychologists were in strict opposition to this treatment and postulated that transsexualism was a psychotic disorder which needed to be cured only by psychotherapy. In spite of this fist hard confrontation, it seems accepted today that the SRT can bring beneficial effects, and that an additional psychotherapy is maximizing the prognostic of this treatment. So, in the present, in the SOC, the goal of psychotherapy is “to help transsexual, transgender […] individuals achieve long-term comfort in their gender identity expression…” . However, the question of the modalities, forms and theoretical fundaments stay still not well defined. Results Today, the SOC recommend that psychotherapist actively collaborate and participate to the decision-making reunions of the SRT's professional team. In the same way, the role of the psychotherapist is described very near of a role of coaching and counseling, to optimize the SRT's final result. In complete consistency with these points, the theoretical models exposed are unconflict and unpathologized models which postulate that the true gender of patients could not be expressed because of social stigmatizations which can make them present a gender dysphoria. But, these points of view are more controversial that it's appearing. Conclusions The more controversial point concerns the narrow collaboration and the active participation of the psychotherapist with the SRT's professional team and its potential consequences. In that configuration, a collusion of the different therapeutic spaces can take place. The patients can feel unease with this particular therapeutic relation. In the same way, on the theoretical level, the conflict is a primary fundament in a psychodynamic perspective, but it also can be considered as a normal element of the therapy and the SRT's way. For all of those remarks, the question and works on the psychotherapy in complement with the SRT have to be continued. [ABSTRACT FROM AUTHOR]

Résumé La clinique des patients transsexuels nous fait considérer que ce qui fait l’homme ou la femme n’est pas qu’une histoire d’anatomie mais relèverait davantage d’une construction singulière pour chaque sujet. La transformation hormono-chirurgicale (THC), quand elle est bien indiquée, permet incontestablement de soulager une part importante de souffrance chez ces personnes en les ré-assignant dans le sexe désiré. Elle ne fait néanmoins pas taire la question du Sujet. Nous avons ainsi observé que c’est souvent une fois la marque corporelle du genre désiré inscrite par la chirurgie, qu’une autre forme de souffrance peut faire son apparition. Ce « babyblues » comme le nomme les patients, serait davantage lié à ce passage d’une représentation imaginaire à son inscription dans le réel du corps. Souvent présent depuis l’enfance, le questionnement identitaire sera remanié au fil de l’histoire et du développement psychique de ces sujets. L’acte chirurgical en tant qu’« entame » sur le corps provoque un ensemble de bouleversements et de remaniements psychiques qui viennent réactiver l’histoire infantile de ces adultes maintenant réassignés. La « renaissance » dont parlent nos patients, vient réveiller la part infantile du sujet en leur permettant de revisiter des scènes fantasmatiques de leur histoire d’enfant et d’adolescent. À partir du suivi postopératoire d’Hortense, une jeune patiente MtF (masculin vers féminin), nous tenterons d’illustrer ce passage qui, loin d’être linéaire et continu, nous fait considérer que la rencontre avec le féminin peut être problématique. Pour cette patiente, comme beaucoup d’autres, c’est une fois le parcours de THC terminé que le féminin vient les questionner car après tout : qu’est-ce qu’être une femme ? Dans l’espace de son travail de psychothérapie et de son suivi postopératoire avec le chirurgien, Hortense nous invite à penser la question féminine autrement. The clinical analysis of transsexuals patients leads us to consider that what constitutes a man or a woman is more a question of a singular and individual construction for each patient than a question of anatomy. The hormono-surgical reassignation when it is well indicated, undoubtedly relieves a significant share of suffering for these people by re-assigning them in the desired gender. It does not however silence the question of the individual construction. We observed that it is often when the desired gender is “marked” in the body through surgery that another form of suffering may appear. This “babyblues” as named by the patients, would be more related to the transition from an imaginary representation to its inclusion in the real of the body. Based on the postoperative follow-up of Hortense, a young patient MtF (male-to-female), we seek to illustrate this transition is far from being linear and continuous, leading us consider that the encounter with the feminine can be problematic. Often present in the childhood, the identity construction will be constantly revised during the psychical development of these subjects. The surgical procedure as an “imprint” in the body triggers psychical upheavals and overhauls which will reactivate the infantile story of these reassigned adults. The “rebirth” that the patients refer to, awakes the infantile part of the subject and allows them to revisit phantasmagoric scenes of their childhood and adolescence. For this patient, like many others, it was once the hormono-surgical reassignation course ended that she was truly confronted with the feminine question because after all: what is being a woman? In the space of her psychotherapy and her postoperative follow-up with the surgeon, Hortense invites us to think about the feminine question and gender identity from a new perspective. [ABSTRACT FROM AUTHOR]

Résumé L’approche chirurgicale des gynécomasties, le changement de sexe de la femme à l’homme et l’augmentation du nombre d’obèses souhaitant avoir recours à la chirurgie esthétique nous ont conduit à approfondir les connaissances anatomiques du CAM, peu détaillées chez l’homme. En nous inspirant de la méthodologie d’une étude japonaise, nous avons étudié 50 volontaires sains de sexe masculin, âgés de 18 à 55 ans, de juillet à août 2015. Nous avons mesuré différentes distances relatives au CAM pour définir au mieux sa position verticale et horizontale ainsi que l’écart inter-mamelonnaire en fonction de la taille, du poids et de l’indice de masse corporel (IMC). Au terme de l’analyse, nous avons pu souligner une position thoracique verticale plus basse du CAM chez la personne de grande taille, une position horizontale plus latérale chez le sujet présentant un IMC élevé et une relation linéaire entre l’IMC et l’écart inter-mamelonnaire (Em) définie par (Em) = 8,96 × IMC. Le jugement du chirurgien et les désirs du patient sont à la base de la thérapeutique, mais pourraient être appuyés par cette étude anatomique qui a permis d’établir une idée de la cartographie du CAM chez l’homme, qu’il faudra confronter à d’autres études de plus grande échelle. Summary The surgical approach of gynecomastia, sexual reassignment surgery in female-to-male transsexuals and the increase of number of obese wishing to turn to plastic surgery led us to deepen the anatomical knowledge of the nipple areola complex (NAC) in men, poorly retailed in the literature. By inspiring us of the methodology of a Japanese study, we studied 50 healthy volunteers male, from 18 to 55 years old, from July till August 2015. We measured various distances relative to the NAC to define its vertical and horizontal position, as well as the internipple distance according to the size, to the weight and to the body mass index (BMI). At the end of the analysis, we were able to underline a lower vertical thoracic position of the NAC in the tall category of person, a more side horizontal position to the subject presenting a high BMI and a linear relation between the BMI and the internipple (Em) defined by (Em) = 8.96 × BMI. The surgeon's judgment and the desires of the patient are essentials basis of therapeutics decisions that could be lean on this anatomical study, which allowed to establish an idea of the cartography of the NAC in man. It will be interesting and necessary to confront it with other studies with larger scale. [ABSTRACT FROM AUTHOR]

Everybody speaks about gender and gender theory. It is amazing that nobody is concerned by the origin of the modern meaning of gender. Gender appears in English in the 14th century, and comes from the French gendre. An ancient meaning of gender, almost forgotten, the state of being a male or a female, reappears modified in 1955. Nobody, neither dictionaries nor books entirely dedicated to gender, quotes the founding text of John Money. For various reasons, Money is now discredited. But the main reason is the conve nience to use gender as a joker; everybody can use it, giving it the meaning which serves one's ideology. It could be the relationship between sexes, or the feminine condition, or the critic of social norms; it will be the denial of biological reality: human procreation is sexed. Gender is simply the social status based on sex constructed by all societies, either they recognize two sexes or more. These statutes include always arbitrary clauses. Chiefly "a differential valence", a belittling of women. Nevertheless the existence of sex differences cannot be denied: inequality of rights only begins when differences are prioritized. Changing biological sex is impossible; but social statutes can be invented for difficult situations, created by biology or other cause, that hurt people: disorders of sex development, transsexualism, etc. But to claim that the choice of biological sex is a human right is an aberration. [ABSTRACT FROM AUTHOR]

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Résumé Gender est un mot importé en anglais du français gendre au xiv e siècle ; il a alors un sens principal grammatical : classe de noms qui régit des accords, masculin, féminin, neutre. Gender a aussi un sens mineur tombé dans l’oubli : l’état de mâle ou de femelle. En 1955, John Money donne une vie nouvelle à ce deuxième sens en parlant de gender comme du statut social en fonction du sexe, affiché dans le rôle, ressenti dans l’identité. Genre en français avait le même sens grammatical que gender , mais en outre une importante polysémie ; il va s’enrichir du sens identitaire/statutaire en accord ou non avec le sexe biologique natal. Ce terme est approprié pour rendre compte de la dissociation qui peut se produire chez les intersexes entre réalité biologique du sexe et statut social. Le terme genre connaît une inflation et perd le sens originel donné par Money pour en arriver à désigner une réalité psychédélique qui l’emporte sur la réalité biologique. Il est étrange que personne ne cite le texte originel de Money. Peut-être parce que Money sent le soufre… Les transsexuels, les transgenres, les néo-féministes qui se déclarent queer , lesbiennes et non pas femmes formulent des demandes diverses. On ne peut pas changer le sexe biologique d’une personne humaine, mais on peut inventer des statuts ad hoc pour diminuer les souffrances. Parler un langage clair peut aider à raison garder et à parvenir à un consensus grâce à un dialogue constructif plus tolérant de part et d’autre. Gender is a word borrowed by the English from the French gendre in the 14th century; it had then a main meaning: class of nouns, which requires agreements, in English masculine, feminine and neuter. Gender had also a minor meaning, largely forgotten: “state of being male or female”. In 1955, John Money gives a new life to this second meaning in speaking of gender as the social status according to the sex, disclosed by the role, intimately felt in the identity. Genre had in French the same grammatical meaning as in English, but also an important polysemy; it will be enriched by the new meaning gender as identity and status in harmony or not with the natal biological sex. This term allows to consider the possible dissociation between the biological reality of sex and the social status in case of intersexuation. There is an inflation of the use of term gender, which loses the original meaning given by Money and comes to designate a psychedelic reality superior to biological reality. It is strange that nobody quotes the original text of Money. Does Money feels sulphur now? Transsexuals, transgenders, neo-feminists who declare themselves queer, lesbian and not women have different demands. It is impossible to change the sex of a human being, but one can build status ad hoc to reduce sufferings. To speak clearly can help to keep one's senses and succeed in providing a consensus thanks to a constructive dialogue more tolerant from each side. [ABSTRACT FROM AUTHOR]

Résumé Introduction Depuis plus de 20 ans, l’unité de transsexualisme de l’hôpital Foch accueille des demandes de changement de sexe. Elles font l’objet d’une évaluation d’au moins deux années, au terme desquelles une commission pluridisciplinaire (composée de psychiatres, psychologues, endocrinologues et chirurgiens) confirmera ou non le diagnostic de transsexualisme et l’indication de transformation hormono-chirurgicale (THC). Objectif Le but de cette recherche est d’évaluer le bien-être des patients en postopératoire afin de confirmer la pertinence des décisions hormono-chirurgicales. Patients et méthode Nous avons interrogé, rétrospectivement, sur la base d’un autoquestionnaire élaboré par nos soins, tous les transsexuels opérés de 1991 à 2009 après évaluation psychiatrique à Foch, soit 266 transsexuels (un tiers masculin vers féminin [MF] et deux tiers féminin vers masculin [FM]). Le questionnaire interroge leur vie sociale, familiale, sexuelle et professionnelle, ainsi que leur état psychique et physique en postopératoire. Résultats Nous avons collecté des données sur 207 sujets (78 %), dont trois sont décédés. Il existe un fort taux d’activité professionnelle 85 % ; 90,5 % de FM contre 73 % de MF ; 9,5 % des FM sont inactifs contre 27 % des MF ; 72 % des FM ont un niveau d’étude supérieur (secondaire ou plus) contre 55 % des MF. Les FM (63,5 %) vivent plus souvent en famille que les MF (40 %). Les MF vivent majoritairement seules (55 %), mais l’ensemble des patients vivent plus souvent en union libre. Seuls 30 % des FM sont mariés, contre 10 % des MF. Les FM vivent majoritairement en couple (61,5 %) contre 41 % de MF. Les FM ont majoritairement des enfants par don de sperme. Peu de patients adoptent. Ils sont nombreux à élever les enfants de leur conjoint(e). La vie sociale des patients s’est globalement améliorée pour les deux groupes, sauf certains MF (10 %) qui souffrent de rupture familiale et amicale. La vie sexuelle s’est améliorée pour 73 % des MF et pour 56 % des FM car peu ont pratiqué une phallo-plastie (40 %) et la pose d’une prothèse érectile (24 %) ; 86 % s’estiment en bonne santé physique et psychique. Le taux de mortalité est faible : 1,5 %. Deux décès sont dus à un cancer et l’autre à un suicide (0,5 %). Les patients (92,5 %) observent un bon suivi médical postopératoire, soit par un endocrinologue (66,5 %), soit par un généraliste (26 %), et/ou par un psychiatre ou psychologue (8 %). Le taux de morbidité psychiatrique postopératoire est de 3 % et d’utilisation de toxique chez 2 %, tous des FM. Les délits en postopératoire ne sont le fait que de FM (7 %). Soixante pour cent des patients sont satisfaits de la chirurgie, 25 % sont insatisfaits et 15 % sont mitigés. Soixante et onze pour cent des patients imputent leur insatisfaction au manque d’esthétisme, et 46 % au manque de fonctionnalité ; 83,5 % des patients ont changé leur état civil, 14,5 % sont en cours. Deux patients (MF) n’ont jamais demandé de changement d’état civil, ils disent regretter. L’un d’eux a d’ailleurs demandé à revenir à son sexe de naissance. Quatre-vingt-quinze pour cent des patients n’expriment aucun regret ; 4,5 % ont ressenti parfois un regret, surtout au vu des résultats chirurgicaux. Conclusion Dans leur majorité, les patients expriment un bien-être psychologique et sexuel après opération. Cependant, on note une meilleure insertion sociale et familiale parmi les FM et une meilleure satisfaction chirurgicale et sexuelle chez les MF. Introduction For over 20 years, the unit of transsexualism of Foch Hospital receives requests for sex reassignment surgery (SRS). The requests are evaluated during a period of at least 2 years after which a multidisciplinary committee (composed of psychiatrists, psychologists, endocrinologists and surgeons) confirm or not the diagnosis of transsexualism and the indication of hormonal and surgical treatment. Objective Assessment of the well being of patients after surgery in order to confirm the adequacy of the hormonal and surgical decision. Patients and method We surveyed retrospectively, on the basis of a self-administered questionnaire developed by us, 266 transsexuels (one third of MtF and two thirds of FtM) who did the surgery from 1991 to 2009 after a psychiatric evaluation in Foch hospital. The questionnaire inquires the social, familial, sexual and professional life of each patient, as well as their mental and physical state after surgery. Results We collected data on 207 individuals (78%), but three are dead. In this population, there is a high rate of professional activity (85%), 90.5% of FtM against 73% of MtF. Only 9.5% of FtM are professionally inactive against 27% of MtF. Seventy-two percent of FtM have a high level of education (high school diploma or higher) against 55% of MtF. FtM (63.5%) live more often in families compared to MtF (40%). MtF live mainly alone (55%). Thirty percent of the FtM are married against 10% of MtF. The majority of FtM are sharing their lives with a partner, 61.5% against 41% of MtF. Most of FtM become fathers thanks to a sperm donation and few by adoption. Many of them are raising the children of their partners. The social life of the patients has generally improved for both groups except for some MtF (10%) who broke off the relationship with their families and friends. Sex life has improved for 73% of MtF and for 56% of FtM, this due to a small number of FtM who practiced a phalloplasty surgery (40%) or an insertion of an erectile prosthesis (24%). Eighty-six percent consider themselves in a good physical and mental health. The mortality rate is low: 1.5%. Two people died of cancer and one committed suicide (0.5%). In majority, patients (92.5%) profit from a medical follow-up by an endocrinologist (66.5%), or by a general practitioner (26%) and/or by a psychiatrist or a psychologist (8%). The rate of psychiatric morbidity after surgery is of 3% and the use of toxic is of 2%, both concerning only FtM. Seven percent of FtM were pursued by law. Sixty percent of the patients are satisfied with the surgery, 25% are dissatisfied and 15% have an ambivalent opinion. Seventy-one percent of the patients attribute their dissatisfaction to an insufficient result from an aesthetic point of view and 46% from a functional point of view. About 83.5% of the patients officially changed their sex in their civil status, 14.5% are still in process. Two patients (MtF) have never asked for a change of their civil status because of their deep regret of the SRS. One of them has also asked to return to his sex of birth. Ninety-five percent of patients do not express any regret. About 4.5% felt some regret given the results of the surgery. Conclusion The majority of patients express a sexual and psychological well being after surgery. However, a greater number of FtM are satisfied with their social and family life, whereas a greater number of MtF is satisfied with the result of the surgery and their sexual life. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Cet article vise à présenter et discuter l’évolution des catégorisations dont le transsexualisme a fait l’objet depuis son introduction dans les nomenclatures internationales (CIM et DSM) et présente les points de vue a-catégoriel et différentialiste de cette clinique singulière. Méthodologie Il a été procédé à une revue de littérature concernant les différentes définitions du transsexualisme, les remaniements de son diagnostic dans les nosographies internationales, ainsi qu’une mise en perspective des principaux travaux des auteurs ayant traité ce sujet. Résultats Il a été constaté que le transsexualisme a connu plusieurs modifications passant du syndrome transsexuel à part entière à l’actuelle dysphorie de genre avec ou sans trouble du développement des organes sexuels proposée par le DSM 5. Cette nouvelle version du diagnostic basée sur une approche a-catégorielle élargit le précédent trouble de l’identité sexuelle du DSM-IV jusqu’à en faire presque disparaître le transsexualisme. Discussion Ce rassemblement de tous les troubles de l’identité sexuelle en un seul et unique diagnostic est discutable. Confondu en une seule entité clinique, il est dès lors plus difficile de faire la distinction entre les différents types de troubles de l’identité sexuelle, entre les différents types de transsexualisme et de différencier le transsexualisme du proche mais distinct transgenderism . Conclusion La proposition du diagnostic de dysphorie de genre nous apparaît comme un risque d’amalgame empêchant une distinction clinique nécessaire pour la mise en place d’une prise en charge adaptée à chacun de ces troubles. Il est donc exposé l’intérêt d’une approche catégorielle du transsexualisme et des troubles de l’identité sexuelle. Purposes This article presents the various successive ways in which trans-sexualism has been conceptualized and categorized since its introduction in the international nomenclatures (ICD and DSM), and presents the a-categorical and differentialist viewpoints on this singular clinical subject. Methodology A review of the literature of the different definitions and the revisions of diagnoses in the international nosographies, and of the main works on trans-sexualism was performed. Results This review shows that trans-sexualism has been conceptualized and categorized in various ways since its introduction, ranging from the trans-sexual syndrome itself to the current gender dysphoria as proposed by the DSM 5. This new version based on an a-categorical approach broadens the earlier gender identity disorder in the DSM IV to the extent that trans-sexualism almost disappears. Discussion Gathering all gender identity disorders into a single diagnosis is controversial. If they are combined into one single clinical entity, it is more difficult to differentiate between the different types of gender identity disorder, the different subtypes of trans-sexualism and to distinguish trans-sexualism from the transgenderism, which is not the same phenomenon. Conclusion The proposal to use a single diagnosis of gender dysphoria diagnostic entails the risk that the assimilation will prevent the clinical precision needed to instate appropriate treatment for each individual gender identity disorder. We therefore conclude to the interest of a categorical approach of trans-sexualism and gender identity disorders. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Repenser la filiation psychiatrique de nombre de théorisations analytiques de la « transsexualité », en désigner les points de butée, pour voir si et comment il est possible de penser une psychanalyse de la post-transsexualité. Chercher à voir si la théorisation psychanalytique peut se départir de certains dogmatismes théoriques et recouvrer sa visée hétérotopique. Méthode Mise en exergue de l’hétérotopie comme motif commun aux transidentités et à la psychanalyse. Qu’elles présentent un mimétisme de la binarité de genre ou une conception transgenre bouleversant cette binarité, les transidentités produisent des hétérotopies des modèles du féminin et du masculin. L’approche psychanalytique vise, elle aussi, dans son fonctionnement, une dimension hétérotopique : elle articule un paradoxal « savoir de l’inconscient », où le savoir et ses catégories positives sont déconstruits, dans un questionnement de l’origine et de l’adresse de toute posture discursive, et suit, elle aussi, les six principes foucaldiens de l’hétérotopie. Mise en exergue de l’historicité de catégories de la métapsychologie, perpétrant une préoccupante maltraitance théorique, clinique et idéologique, et procédant de visions essentialisées des sexes et des genres. La fluidité de la théorisation analytique se rigidifie dans certaines théorisations des « transsexualités », les rapprochant de la psychose ou de la perversion et les inscrivant dans un refus de la différence des sexes. Résultats Déconstruction de certains outils analytiques ou psychiatriques pour repenser les transidentités. Les réaménagements sont théoriques : il s’agit de penser une psychanalyse hétérotopique, foucaldienne et ouverte aux apports féconds des Gender , Queer et Transgender Studies . Il s’agit également d’aborder par la multiplicité les apories de la binarité ou de l’identité. Les réaménagements sont également cliniques et articulent une tentative de repenser les protocoles, de pointer la maltraitance des visées « thérapeutiques » et de restituer l’expertise aux sujets trans. Discussion Comment concilier la pertinence d’instruments théoriques et leur véridiction (leur archéologie et leur généalogie), pour les resignifier ? Le propos est de concevoir des instruments métapsychologiques et cliniques susceptibles de rendre compte de la spécificité des identifications et des vécus transidentitaires, et construits par-delà la normativité sociale, culturelle et politique de la binarité des sexes. Conclusions Nécessité pour une approche psychanalytique d’écouter les savoirs locaux et minoritaires. Nécessité pour cette approche de se détacher des visées psychiatriques d’évaluation de la « transsexualité » et du « vrai sexe ». Nécessité de réaffirmer l’hypersingularité de chaque sujet trans par-delà la généralité de la nosographie ou des catégories étiologiques. Nécessité de repenser les contre-transferts théoriques et cliniques induits par ces questions et d’historiciser la catégorie de « différence des sexes ». Objectives The aim of this article is to explore the psychiatric origin of many psychoanalytical theories of “trans-sexuality” and pinpoint their limits, so as to envisage the possibility of post-trans-sexuality psychoanalysis. The article asks whether psychoanalytical theory can move away from theoretical dogmatism and recover its heterotopic viewpoint. Method The article starts by proposing heterotopia as a motive common to trans-identities and psychoanalysis. Trans-identities, whether they mimic the binarity of gender or overturn it, invariably generate heterotopias of femininity and masculinity. The psychoanalytical approach too, by way of its functioning, is also aiming for a heterotopic dimension: it sets out a paradoxical “knowledge of the unconscious” that deconstructs positive knowledge categories, and questions the origin and the recipient of any discursive position. In this respect, it follows the six Foucauldian types of heterotopia. Our paper goes on to consider the historical dimension of certain metapsychology categories that prove to be theoretically and clinically harmful, and proceed from essentialized conceptions of sex and gender. The generally flexible perspective of psychoanalysis can rigidify in the setting of certain theories of “trans-sexuality” assimilating it to psychosis or perversion, or to a denial of sexual differences. Results Certain psychoanalytical and psychiatric tools need to be deconstructed in order to reappraise trans-identity. The reorganisation is theoretical: the aim is conceive to a form of heterotopic psychoanalysis that is Foucauldian and open to the fertile perspective of what are known as “gender, queer and transgender studies”. This multiplicity of approach is intended to enable an apprehension of the aporiae of binarity and identity. The reorganisation also concerns the clinical sphere, endeavouring to question official protocols, pinpoint deleterious “therapeutic” perspectives, and restore the expertise to the “trans” subjects. Discussion How can we reconcile the relevance of theoretical tools and their veridiction (their archaeology and genealogy), in order to resignify them? The task is to try to design metapsychological and clinical tools liable to reflect the specific identifications and experiences of trans-identity, escaping from the social, cultural and political normativity of sexual binarity. Conclusions There is a need in psychoanalytical approaches to lend an ear to local and minority knowledge. There is likewise a need for these approaches to look beyond psychiatric assessments of “trans-sexuality” and determination of the “real sex” of an individual. The hyper-singularity of every “trans” subject should be reasserted, freed from the general nosographies and etiological categories. And there is a need to re-think the theoretical and clinical counter-transferences generated by these questions, and to historicize the category of “sexual difference”. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Le trouble de l’identité de genre (TIG), tel que défini par le DSM, est utilisé couramment par les psychiatres français pour la prise en charge des personnes trans dans les équipes hospitalières spécialisées. L’objectif de l’article est d’interroger cette procédure diagnostique dans un contexte où le Trouble de l’identité de genre est objet de débats et de controverses et où la caractérisation pathologique de l’expérience transgenre est questionnée. Méthode À partir d’une enquête ethnographique de terrain, effectuée entre 2005 et 2008 auprès d’une équipe hospitalière spécialisée, l’article se centre sur l’usage du Trouble de l’identité de genre dans la consultation psychiatrique en essayant de saisir ce qu’il impose et propose à toutes les personnes concernées, médecins et consultants, et ce qu’il laisse percevoir de notre conception de l’identité sexuée. Pour ce faire, il est proposé en premier lieu de ne pas retenir le terme d’autodiagnostic, mais de s’en tenir à ce qui est présenté par les consultants au plus près de ce qui est dit. Résultats Trois modalités de déclarations ont ainsi pu être dégagées : des déclarations d’identité , des déclarations de situation et des déclarations d’intention . L’article montre quelles mises à l’épreuve elles subissent au cours de l’investigation psychiatrique. Discussion Dans ce processus diagnostique de Trouble de l’identité de genre, l’identité sexuée est bien pensée comme subjective (le fait d’un sujet) mais dans une version de l’intériorité mentale, ce qui est assez bien en phase avec la version occidentale classique de l’identité sexuée où le genre est conçu comme une propriété des personnes. Conclusion Cette manière de prendre en charge les choses n’est pas toujours aussi productive que les psychiatres l’imaginent. Si la plupart tiennent fermement au diagnostic et à sa validité, c’est parce qu’ils le voient comme le seul moyen de ne pas se fourvoyer dans une transition inappropriée. Pourtant, il n’est pas sûr que ce soit le diagnostic qui protège les différents protagonistes de ce risque comme le suggère la conclusion de l’article. Objectives The gender identity disorder (GID), such as defined by the DSM, is usually used by French psychiatrists to take care of trans people in specialized hospital teams. The paper questions this diagnostic process in a context where the GID is object of debates and controversies and where the pathological characterization of the transgender experience is questioned. Methods From an ethnographic fieldwork conducted between 2005 and 2008 in a French hospital, the paper focuses on the use of GID in the psychiatric consultation, trying to show what it imposes and proposes both to doctors and consultants. First of all, it is suggested that the term autodiagnosis should not be used to define consultants’ discourse but to hold on to what they said precisely in the first consultation. Results Three modes of declaration have been found: declarations of identity, declarations of situation and declarations of intent. This paper shows how they are put to test in the psychiatric investigation. Discussion In this diagnosis process, the gender identity is seen as subjective but in a version of mental interiority in conformity with the classic western version of gender identity that sees gender as a property of the person. Conclusion This way of taking care is not as productive as psychiatrists imagine it is. If most of them are attached to the diagnosis of GID, it is because they see it as the only way to protect against an inappropriate transitioning. Nevertheless, it is not sure whether it is the diagnosis, which can do this as the conclusion of this paper suggests. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Cet article rappelle les conditions juridiques du changement de sexe à l’état civil en France pour les personnes transsexuelles et ses évolutions possibles, sous l’influence des normes juridiques internationales et notamment celles émanant du droit européen. L’intervention du législateur est ainsi vivement souhaitée, le système élaboré exceptionnellement par les juges de la Cour de cassation étant considéré comme source d’instabilité juridique. Méthode Cette influence des normes juridiques externes se vérifie à travers les conséquences juridiques du changement de sexe à l’état civil sur la famille et plus précisément sur la vie de couple (concubinage, Pacte civil de solidarité et mariage) et la filiation (la situation de la personne déjà père ou mère, l’adoption, l’assistance médicale à la procréation et la gestation pour autrui). Résultats À la faveur de cet article, l’on fait le constat d’un changement de paradigme avec la primauté de l’individu sur le collectif. Ainsi, il apparaît que l’individu devient la mesure de toute chose avec la primauté des droits individuels, au point que l’on peut s’interroger notamment et à terme sur la privatisation de l’état civil. Discussion Dans le même esprit, l’on voit se dessiner une véritable modification de l’appréhension du corps humain par l’effacement progressif de la théorie de l’indisponibilité du corps humain au profit sinon d’une théorie, à tout le moins d’un phénomène de réification du corps humain, de soi-même et même d’autrui. Conclusion Dès lors, il est patent que l’analyse de ces phénomènes (primauté de l’individu et réification du corps humain) dépasse largement le strict champ d’étude juridique, pour atteindre celui de l’éthique. L’analyse doit donc être en réalité transdisciplinaire, chaque discipline étant en mesure d’apporter sa contribution à ce travail d’analyse. Ce numéro de L’évolution psychiatrique en est d’ailleurs la meilleure preuve. Au demeurant, et c’est heureux, le champ de la réflexion ne peut être réduit à la présente étude. Ainsi, quel sort réserver aux mineurs et aux majeurs protégés ? Objectives This article recalls the legal requirements for a changing legal gender on official identity documents for transsexual persons in France and possible evolutions, under the influence of international legal norms and especially the influence of European legislations. Legislation is keenly awaited, as the system set up by the French Court of Cassation (last resort appeals) is considered to be a source of legal instability. Method This influence of the legal provisions in force outside France can also be seen in the consequences of sex change and a new legal identity on the family and especially on the life of marital couples (cohabitation, civil solidarity pact and marriage) and on filiation (the situation of a person who is already a father or a mother, adoption, medically assisted procreation and gestational surrogacy). Results This article explore a paradigm shift entailing the primacy of the individual over the group. Thus, the individual appears to be becoming the measure of all things, with the primacy of individual rights, so much so that one can wonder is there is not also a privatisation of civil status. Discussion In a similar vein, there is a tendency to changes in the way the human body is apprehended, by a gradual erosion of the theory of the inalienability of the human body in favour of a theory, or at least a phenomenon, of objectification of the human body, whether one's own of that of another. Conclusion Consequently, it is plain that the analysis of these phenomena (the primacy of the individual and the objectification of the human body) is beyond the scope of Law and belongs to the ethical dimension. The approach therefore needs to be trans-disciplinary, as each discipline is in position to contribute to the discussion. This issue of “ L’évolution psychiatrique ” provides evidence along these lines. Nevertheless, and this is to be welcomed, the scope of reflexion is not exhausted by the present paper. For instance, what are the appropriate outcomes for minor children and protected adults? [ABSTRACT FROM AUTHOR]

Copyright of Studia Universitatis Babes-Bolyai, Iurisprudentia is the property of Babes-Bolyai University, Cluj-Napoca, Romania and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: In France, female-to-male transsexuals who have obtained a change of civil status have the right to request donor sperm insemination (DSI) for the woman with whom they live. Because this was met with some reluctance, a trial program with a follow-up study was devised with the agreement of the ethical committee. The aim was to check the quality of parenthood and the development and quality of life of the children. Patients and methods: These couples were considered to be similar to any couple requesting medical assistance to procreate. There is always an interview with a specialist in psychology before gametes are given. In these cases, there was a second one with a professional who worked with transsexuals. Usually parents are left free to choose to disclose or not the gift of gametes; but in this situation, since everybody in the father's environment as a child was aware of his background history, these parents were advised to tell the truth about the DSI and the father's transsexual past. A follow-up was proposed every second year. Parents and children were not volunteers participating in a research program; they came for a consultation from which they expected some help in their particular situation. The parents had interviews with a psychiatrist and two psychologists, the children were observed in their playing and drawing, and one standard measure (the Brunet-Lézine Scale) was used. Results: Forty-two children born to 32 couples were followed up from 2000 to 2012 and the program is still on-going. Though without a penis, the transmen are considered by their wives as men; the wives are not homosexual; the couples are stable (there have been only three separations); the children are very well cared for and have good relationships with their fathers, they seem normal, happy, without any major difficulty, without any gender identity variant. Fathers (with one exception) spoke easily of the DSI, but had some difficulty with their transsexualism – although willing to talk about it, they found it hard to put into appropriate words. They were helped by one father, who wrote and illustrated a booklet, telling of his childhood experience in simple words. The children coped well with this disclosure. Conclusion: This trial program brought positive results. It may continue and others may be set up in spite of persistent prejudices. The “therapeutic alliance” with these couples is now good enough to allow for research beyond pure observation – with a protocol and standard measures to appreciate the mental health, gender identity and quality of life of these children as they become adolescents. [Copyright &y& Elsevier]

Résumé: La question de la transidentité divise la communauté des juristes. La Cour de cassation a été appelée à se prononcer à plusieurs reprises ces derniers mois. En dépit de l’influence du droit européen, elle maintient une position restrictive ancrée dans une approche pathologique du transsexualisme. Il semble que seule une loi puisse conduire désormais à une évolution du droit sur cette question. [ABSTRACT FROM AUTHOR]

When four-year-old Antoine walked into my consulting-room, I was far from imagining that he would plunge me, at my own risk, into the cauldron in which LGBTIQ (Lesbian, Gay, Bisexual, Transgender, Intersexed and Queer) culture is concocted. Queer in English has connotations of "bizarre" and was used to stigmatize homosexuals before being proudly taken up, first by homosexuals themselves, then in transgender circles as a characterization of an undifferentiated identity, with no specific sex/gender, or with one or the other, or with both simultaneously. It could be said that being queer means that one has got rid of gender, experienced as a straitjacket. Antoine wanted to be a girl ; he began to show me how one's sexed identity is constructed. Freud had explored sexuality and issues related to sex ; gender identity had not at that time been invented. It was invented in 1955 by John Money, who is so disparaged nowadays. The term became so widely used that it ended up denying biological reality. Two years earlier, in 1953, Harry Benjamin had coined another term that really caught on - "transsexualism" - to describe the irrepressible feeling of not belonging to the sex in which one was born and the wish to change one's sex via a hormono-surgical transformation of one's body. Then things moved away from the "transsexual phenomenon" to the polymorphous "transgender movement", leading to the claim that the choice of one's sex/gender is a human right. Every child has the right to choose whether to be a boy or a girl. The freedom to choose one's sex is put into the same category as that of choosing one's object of sexual love. What can psychoanalysts do in the face of such a tidal wave ? They have no power to stem it, but perhaps they can make it easier to understand [ABSTRACT FROM AUTHOR]

Résumé: Introduction: La chirurgie de réassignation sexuelle est réalisée en France après l’accord d’une équipe pluridisciplinaire composée de psychiatres, psychologues, endocrinologues et chirurgiens. Les professionnels reçoivent le patient durant au moins deux ans avant toute décision chirurgicale irréversible sur les organes sexuels. Objectif: Comprendre les raisons d’un regret postopératoire et revoir nos outils d’évaluation psychiatrique et psychologique. Patient et méthode: Nous présentons une demande exceptionnelle de retour au sexe de naissance quelques jours seulement après la chirurgie, chez un homme de naissance suivi pendant huit ans avant la décision chirurgicale. Nous avons étudié en détail son dossier composé des différentes consultations avec le psychiatre référent de l’unité de transsexualisme et les autres partenaires de soin. Nous avons également analysé les résultats aux tests psychologiques et le questionnaire de suivi postopératoire. Résultats: L’emploi des tests psychologiques n’a pu mettre en lumière les risques de regrets postopératoires chez cet homme. Les éléments de diagnostic différentiel ont été abordés mais le patient a menti. Conclusion: La littérature scientifique montre que les risques de regrets sont plus élevés chez les hommes ayant assumé une longue vie hétérosexuelle, exprimant une demande tardive et étant peu soutenus par leur famille ou des amis. Nous y ajoutons l’absence de vie sexuelle, l’interruption de traitement et l’absence de trouble du genre dans l’enfance comme autant de critères de risque de regret postopératoire. De plus, les tests psychologiques ne sont plus utilisés dans notre unité pour évaluer la demande d’un patient transsexuel. [Copyright &y& Elsevier]

Summary: Mastectomy in case of large breast should use a particular technique. The principle of mastectomy by periareolar flap or higher in MAP must be abandoned in favor of mastectomy by lower horizontal with the office of the WFP transformed by a tummy. Main technical note contains the plasty in MAP because the conventional mastectomy is well known. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: Les chirurgies de reconstruction de la verge offrent une gamme de techniques variant de lambeaux fasciocutanés, septocutanés, musculocutanés, ostéocutanés ou ostéomusculocutanés, prélevés sur des zones sus-pubienne, abdominale, inguinale, antébrachiale, brachiale, scapulaire, deltoïdienne, thoracodorsale, péronière et antérolatérale de cuisse. Au milieu de cette variété existe-t-il une norme, un gold standard, qui permette de choisir la meilleure et quels sont les critères qui définissent cette norme ? Le but de cet article est de faire un survol des principales techniques de phalloplastie et de mettre en évidence leurs avantages et limites pour répondre à la question ultime : existe-t-il un gold standard ? Méthode: Revue de la littérature réalisée sur PubMed et sélection d’articles sur les phalloplasties les plus courantes et leur évolution dans le temps. Sélection des articles d’évaluation sur les principales techniques. Résultats: Six techniques de phalloplastie (sus-pubienne, abdominale, inguinale, antébrachiale, péronière, antérolatérale de cuisse) sont décrites. Peu d’études les évaluent de façon formelle autre que le taux de complications, même si plusieurs suggèrent un maintien de la sensibilité érogène. Discussion: Les critères idéaux d’une phalloplastie comprennent : 1) une apparence esthétique satisfaisante ; 2) la création d’un néo-urètre permettant d’uriner debout ; 3) une rigidité suffisante pour les rapports sexuels ; 4) une sensibilité tactile et érogène ; 5) une chirurgie réalisée en une seule étape ; 6) une faible morbidité du site donneur et son camouflage aisé ; 7) une densité, texture et couleur conformes au périnée. Aucune technique à l’heure actuelle ne répond à tous ces critères et ne peut constituer un gold standard. La norme, s’il en est une, devrait plutôt mettre l’accent sur l’information et l’éducation des patients pour mieux répondre à leurs besoins et diminuer les attentes irréalistes et déceptions postopératoires. [Copyright &y& Elsevier]

In view of new techniques for dealing with the body, as offered by science and technology in contemporary society, this article contains a discussion of relationships between body, sexuality and symptoms, based on contributions by psychoanalysis. In particular the phenomenon of transsexualism as seen today is discussed, in view of the adoption of procedures by public health systems designed to meet demands for sex change through hormonal and surgical techniques. [ABSTRACT FROM AUTHOR]

Abstract: At birth, every citizen is given a sexual identification based up on the differences of primary anatomical-genital organs. One distinguishes sexual identity (male or female), gender identity (masculine or feminine), sexual orientation and preference with different erotic subtypes. The biological distinctions of these different aspects are very precocious, determined by prenatal intra-uterine biological process. The deepest cerebral structures are involved, precisely the hypothalamus. These differentiating processes are to be reinforced or opposed by future epigenetic, psychological and cultural factors. There are multiple stages, loci, mechanism, and factors involved in these complicated and evolutionary process. Disturbing factors can impair and deviate these progressive differentiations at several levels and periods. Diverse anomalies can be produced: these; they are to be found at the base (roots) of many clinical presentations: for example, gender dysphoria or inversion, transsexualism (MtF, FtM), sexual orientation and preferences, etc. [Copyright &y& Elsevier]

Copyright of Sexologies is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Sexologies is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Sexologies is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Gender identity is not given, but a construction, a belief. The child experiences his or her body, but he has to learn from his/her parents or environment, who he or she is: a boy or a girl; he or she is handled differently according to his/her sex. The biological components of the sex are sometimes incomplete or mixed; a decision should be taken about the sex of assignment in a very few cases. We used to speak in terms of intersexuation, hermaphroditism, and pseudo-hermaphroditism, but now a new designation has appeared “Disorders of Sex Development”. The follow-up study of those children has given rise to the notion of gender, which is psychosocial, as different from sex, which is biological. The notion of gender made a fortune, but is now under question. Other children without any sign of intersex condition refuse their biological sex. Some of them will become transsexuals and ask a hormonal and surgical transformation of their body. All those, who have a « variation » in their body, identity or sexual orientation fear to be stigmatized and want to overcome the secrecy and shame that weight heavily on their lives. They sometimes think that it needs the suppression of binary sexes/genders. [Copyright &y& Elsevier]

Copyright of Pratiques Psychologiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: L''auteur présente une réflexion philosophique et juridique sur le transsexualisme. Il s''interroge sur la justification de légiférer en cette matière sensible. [Copyright &y& Elsevier]

Abstract: From May 1995 to March 2005 sixty-three consecutive male-to-female gender transformation surgeries were performed at our university center by one author. Our retrospective study collected data from medical records, questionnaire and physical examination. Fifty-nine percent of patients had autologous blood transfusion. Histological examination of testicles found beginning cancer in 1 case. After a-8-year initial period where secondary bilateral Z-plasties were systematically performed, this procedure was abandoned because it left unnatural visible scars. Excluding haematomas (9 cases), we found 8 major complications (12,6%): 1 rectal lesion, 1 leg compression, 5 skin necrosis of the vaginoplasty (total necrosis in 2 cases, partial necrosis in 2 cases, necrosis of full-thickness skin graft in 1 case), and 1 secondary post-traumatic rectovaginal fistula. The questionnaire was completed by 22 patients with a-45-month mean follow-up. Results were graded on a 0 to 10 scale. Mean grades were global satisfaction: 7.6, life quality: 8.4, genitalia appearance: 8.0, clitoris sensitivity: 8.4, urinary function: 8.3, vaginal function: 7.2, sexual function: 7.0. Rate of general satisfaction was high. In a few cases however, patients expressed some disappointment both in being considered as women in their daily living and in having sexual intercourse. These poor results seem clearly related to unfavourable anatomical and morphological initial conditions. Our series demonstrates that surgical treatment of psychiatric disorders meets physical limitations. [Copyright &y& Elsevier]

The sample for this investigation consisted of 80 people: 37 were beginning their studies as superior technicians in policiology, 30 were finishing their studies in preventive policiology, and 13 were active elements of a police force who agreed to participate. All individuals were living in Aguascalientes, Mexico at the moment of the study, were 18 years old or older and were, mostly, men. The semantic networks method was used for the collection of data. Three words were give as stimuli: homosexual, transsexual, and transvestite. These future policemen refer to homosexual people using disrespectful words and associate immediately a transvestite or transsexual person with being gay. Participants associate homosexuality to an illness and transvestism to a job as well as to joy and fun. [ABSTRACT FROM AUTHOR]

Copyright of Sexologies is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The latest film of Pedro Almodóvar, Bad Education, treats the theme of pedophilia in the context of the Catholic boarding school in Franco''s Spain. In a larger sense, since the film posits the adoption of a perverse lifestyle (drug addiction, transvestism and prostitution) as a result of childhood sexual abuse, the film continues the director''s ongoing exploration of faulty perception of body image and deviant sexualities. This paper attempts to review and clarify the structural character of perversion, calling on the example of fetishism, to distinguish the originality of transvestism in relation to this structure and finally to differentiate perversion and transsexuality, a category often evoked in the context of Almodóvar''s cinema. This study reviews the appearance of body dysmorphophobia and the difficulty of diagnosing perversion or psychosis. [Copyright &y& Elsevier]

Abstract: The authors studied the outcome of Rorschach tests on 28 transsexuals who had applied for sex reassignment surgery. The results were analysed on a 63-item grid. The transsexuals and the control group were matched by biological sex, age and education level. For the interpretation of the results, the authors refer to: a)- psychodynamic theory (C. Chabert); b)- L. Cassier''s symbol elaboration index (SEI); c)- some aspects of the Exner method. The various indexes produce significant figures: - Subject''s very low SEI levels suggests a defect in symbolization capacity bringing their mental processes close to those of operatory thought: i)- a deficit in emotional control (CF+C>FC); ii)- the passive movements count (Kau+K) is higher than the active movements count (Snow White index confirmed), signifying a tendency to look to others to resolve problems in reality. What are the applications of this new approach to transsexualism? We find the elements of operatory thought dear to P. Marty to be characteristic of the mental functioning of transsexuals: difficulty in feeling and expressing emotional states, life of the imagination reduced to the factual, and concretely-oriented thought processes. Operatory thought can be constituent of the development of the ego and be rooted in the essentiel depression of the infant. It may also represent an “extreme” defence mechanism against an “extreme” threat endangering the ego. In this case it may be only transitory and open to evolution. This psychosomatic model directly influences the accompaniment of patients who would benefit, in psychotherapy, from help in gaining better access to symbolization. [Copyright &y& Elsevier]

Abstract: Considered for many years as a mistake of nature, transsexualism will later be the subject of medical and psychological specialties. It thus becomes part of the mental disorders nomenclature (DSM and CIM) during the eighties, classified among the sexual identity disorder for one (DSM) and among sexual deviations and disorders for the other (CIM). If presently such practices are more and more common, one must note how much admission of this syndrome in its own right, necessitating a specific and pluridisciplinary take-over, is recent. Newly, the French law ratified the change of sexual identity. Nevertheless, a demand of sex modification as been identified many times through history. If some cases descriptions can be found during the first half of the XIXth century, it is mainly during its second half that this behaviour has been studied systematically, associated with those of sexual perversions and in particular homosexuality. It is only in 1838 that Esquirol gave the first clinical description of a case that can be considered as relevant to transsexualism. In this first narration, the author highlights the absence of physical anomaly or psychological disorder: the person wants to be recognized as part of the sex opposite to his anatomical one. From 1864 on, a German theologian, Ulrichs, pleads for the depenalisation of these inversions. After him, Westphal considers that these are no vices nor insanity. Krafft-Ebbing, a German psychiatrist, publishes in 1869 the first scientific book on sexual abnormality. Hirschfeld will then clearly differentiate homosexuality and transvestism, his category of extreme tranvestites being very near to transsexualism. It is his assistant Abraham who will perform the first chirurgical transformation in 1921. But it is only in 1952 that Hamburger''s team in Denmark will do what can be considered as a complete change of sex including hormones administration as well as surgery. Thus science finally answers to the demand of the subject already described a century before by Krafft-Ebbing. We will attempt to present how, through history, this concept slowly emerged from perversions and psychosis. [Copyright &y& Elsevier]

The Rorschach test appears as the main projective method used to investigated the personality of sex reassignment candidates. We shall first look at studies testing, the hypothesis of troubled background. In a second time, we will analyze the hypothesis of independent issue. Finally, we will present the few follow up studies built up with the Rorschach test. [Copyright &y& Elsevier]

Copyright of Andrologie (11662654) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The French Agency (HAS), in the Ministry of Health, provides guidelines for the treatment of gender dysphoria and transsexualism (as defined by ICD-10, WHO, and APA DSM-IV-TR). Since it is a mental disorder, psychiatric assessment and treatment are a cardinal in the standard of care, before (minimum two years) and after SRS (sex reassignment surgery). [Copyright &y& Elsevier]