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M05.03.04 Sexuality
This section provides an overview of key concepts in childhood sexual development and gender identity, equipping medical students with the knowledge to better understand and care for their young patients.
Core Concepts:
- Gender Identity: A child’s internal sense of being male, female, or neither. It is established around age 3 and reflects a deep psychological identification.
- Sexual Identity: An individual’s attraction to others based on their gender. It develops during adolescence and young adulthood, influenced by hormones and social experiences.
- Gender Dysphoria: Distress caused by a mismatch between a person’s gender identity and their assigned sex at birth (sex based on physical anatomy). It is more frequent in biological males compared to females.
- Gender Role: The behaviors and attitudes expected of a particular gender within a society. It can be congruent (aligned) or incongruent (not aligned) with a child’s gender identity.
Sexual Orientation:
Sexual orientation refers to the gender(s) to whom an individual is romantically or sexually attracted. It is determined by a person’s gender identity, not their assigned sex at birth. Here’s a breakdown of common sexual orientations:
- Homosexuality: Romantic or sexual attraction to the same gender identity. Can be ego-syntonic (comfortable) or ego-dystonic (distressing). When ego-dystonic, it may require professional intervention.
- Heterosexuality: Romantic or sexual attraction to the opposite gender identity.
- Bisexuality: Romantic or sexual attraction to more than one gender identity.
- Asexuality: Little or no romantic or sexual attraction to others.
Healthy Childhood Sexuality:
- Masturbation: Self-stimulation of the genitals for sexual pleasure. It is a normal behavior at all ages and in both genders. However, if it becomes excessive or interferes with daily functioning, it might be a sign of an underlying problem. Exploring Sexuality: Exploration of human sexuality is a normal part of development, especially during adolescence. This exploration may involve same-sex partners and does not necessarily indicate a fixed sexual orientation.
Table 1. Summary of Key Concepts in Childhood Sexual Development and Gender Identity
| Term | Description | Example |
|---|---|---|
| Gender Identity | Internal sense of being male, female, or neither | A child who identifies as a boy despite being assigned female at birth. |
| Sexual Identity | Attraction to others based on gender | A young woman who is attracted to men. |
| Gender Dysphoria | Distress due to gender identity-sex mismatch | A person assigned male at birth who feels distress because they identify as female. |
| Gender Role | Behaviors expected of a particular gender | A boy who enjoys playing with dolls, which may not be traditionally considered a masculine behavior. |
| Sexual Orientation | Gender(s) to whom someone is attracted | A man who is attracted to other men (homosexual). |
Pubertal Development:
Understanding the stages of pubertal development (Tanner Stages) is crucial for assessing a child’s sexual maturation.
Table 2. Tanner Stages of Development
| Stage | Breast (Female) | Pubic Hair (Both) | Genitalia (Male) |
|---|---|---|---|
| I | Preadolescent | None | Childhood size |
| II | Breast bud | Sparse, long, straight | Enlargement of scrotum and testes |
| III | Areolar enlargement | Darker, curling, increased amount | Penis growth in length; testes continue to enlarge |
| IV | Secondary mound; separation of contours | Coarse, curly, adult type | Penis growth in length and breadth; scrotum darkens, testes enlarge |
| V | Mature female adult | Adult shape and size | Adult size and shape |
Remember: These are just general guidelines, and there can be variations in the timing and progression of puberty among children.
Bibliography:
- American Academy of Pediatrics Committee on Adoles