QUALITY OF SEXUAL LIFE AND BODY IMAGE DURING SEX REASSIGNMENT PROGRAM: A PILOT STUDY C.I.D.I.Ge.M. Centro Interdipartimentale Disturbi dell’Identità di Genere Molinette Università degli Studi di Torino Chiara CRESPI, Valentina MINECCIA, Mariateresa MOLO

INTRODUCTION

It is the image that everyone has of her/him-self, that is the mental representation of the body in our minds. The body image is influenced by: sociocultural factors (parents, peers, media) interpersonal experiences physical characteristics personality characteristics sex age THE BODY IMAGE

The body image reflects: 1.How the subject is considered within the social environment; 2.How the group relates to GID subjects; 3.The attitudes derived from the observation of the others; 4.The comparison between the own body and that of the others THE BODY IMAGE AND GENDER IDENTITY DISORDER

Impact on transitioning – physical, emotional and social; MtF and FtM body are both not “really” female and male and not “natural”; Connecting gender identity, self esteem, public and private acceptance; Body image changes and the impact on quality of sexual life THE BODY IMAGE and TRANSFORMATION PROGRAM

The body change is the first major step in the transition program It takes a change of "physical identity“: strong investment in the new body It takes a change in the way of relating to the social environment (in the relationships) Anxiety or stress related to the outcomes of the change THE BODY IMAGE and TRANSFORMATION PROGRAM

Redefinition of the “new” gender role (female or male) for the presence of secondary sexual characteristics; More “strong” exhibition of the gender role; Acquisition of a “new” sexual identity New approach for relationships: meeting people becomes an opportunity to show their “new” identity THE BODY IMAGE and TRANSFORMATION PROGRAM

WPATH Standards of care, Version 7 - September 2011

OUR STUDY

AIMS 1 To evaluate the body image changes during the sex reassignment program 2 To relate the body image changes with quality of sexual life 3 To investigate the differences between Male to Female (MtF) and Female to Male (FtM)

MATERIALS AND METHOD

45,5% (N=25) N tot =55 54,5% (N=30) The Sample

TOT SAMPLE (N=55) SEX, N :  MtF  FtM 30(54,5%) 25(45,5%) AGE, YEARS (  SD) 30,51 (  9,89) EDUCATIONAL LEVEL, YEARS (  SD) 11,55 (  3,28) MARITAL STATUS, N (%):  Single  Married  Separate/Divorced  Cohabitant 45 (81,8%) 1 (1,8%) 2 (3,6%) 7(12,7%) JOB:  Unemployed  Employed  Self-employed  Undeclared work  Student 19(34,5%) 18(32,7%) 8(14,5%) 1(1,8%) 9(16,4%) SOCIAL AND DEMOGRAPHIC CARACTERISTICS

Study project The study is based on: CLINICAL DATA World Health Organization Quality of Life Questionnaire WHOQOL-100 Coccinelle Paris, 1968 T0 At the beginning of the transformation program T1 One year after the hormonal treatment

CLINICAL DATA  Sexual orientation;  Presence of a stable partner;  Surgery (hystero-annessiectomy, mastoplasty, mastectomy, laser, vocal cords surgery)  Body Mass Index (BMI);  Presence of sexual activity (masturbation or petting)  Presence of sexual intercourses (anal for MtF ; penis or sex toys use for FtM)  Presence of orgasm  Sexual satisfaction Robert Mapplethorpe Self-portrait, 1980

6 MAIN DOMAINS: - Physical; - Psychological; - Freedom, physical safety and security; - Social relationship; - Environment; - Spirituality, religion and personal beliefs. GENERAL Quality of Life SCORE WHOQOL-100 QUESTIONNAIRE

- Pain - Energy - Sleep - Positive emotions - Reasoning skills - Self-Esteem -Body Image -Negative emotions -Mobility -Daily living activities - Drug addiction - Work ability -Interpersonal relationships - Social support -Sexual activity -Safety -Home environment -Financial resources -Health care - Opportunities for new knowledge -Recreation - Physical environment - Transports - Spirituality WHOQOL-100 QUESTIONNAIRE 24 subscales

RESULTS

To evaluate the body image changes during the sex reassignment program: RESULTS

Age Body Mass Index Surgery The body image changes during the sex reassignment program Hormonal Treatment

BODY (i.e., before hormonal treatment) compared to BODY (i.e., after one year of hormonal treatment) Body Image – Hormonal Treatment

Two Sample Paired t-Test Sample N Mean SD Data1_BimageT Data1_BimageT Difference of Means: Null Hypothesis: Mean1 - Mean2 = 0 Alternative Hypothesis: Mean1 - Mean2 <> 0 t DoF P Value At the 0.05 level, the difference of the population means is significantly different than the test difference (0). T0 before hormonal treatment T1 one year after hormonal treatment

BODY IMAGE for subjects under 30 aa compared to subjects over 30 and T1 Body Image – Age

N Mean SD Under 30aa T Over 30aa T Difference of Means: 5.38 Body Image - Age N Mean SD Under 30aa T Over 30aa T Difference of Means: 1.13 Two Sample Independent t-Test At the 0.05 level, the difference of the population means is not significantly different than the test difference (0).

18.5 or lessUnderweight 18.5 to 24.99Regular weight 25 to 29.99Overweight >30Obesity Body Image – Body Mass Index Definition BODY IMAGE for subjects with regular weight compared to subjects with a no regular weight (i.e., under/overweight or and T1

N Mean SD BMI not Regular T BMI Regular T Difference of Means: Body Image – Body Mass Index N Mean SD BMI not Regular T BMI Regular T Difference of Means: Two Sample Independent t-Test At the 0.05 level, the difference of the population means is not significantly different than the test difference (0).

Body Image – Surgery Hystero-annessiectomy mastoplasty/mastectomy laser vocal cords surgery N Mean SD Only Hormonal treatment T Hormonal treatment + Surgery T Difference of Means: At the 0.05 level, the difference of the population means is not significantly different than the test difference (0). t DoF P Value

To relate the body image changes with quality of sexual life: RESULTS

Sexual Orientation

WHOQOL - Quality of sexual life scale: before and after hormonal treatment Paired T Test* Significant difference p< 0.05 * score

To investigate the differences between Male to Female (MtF) and Female to Male (FtM): RESULTS

Male to Female versus Female to Male: The Body Image, before hormonal treatment (T0) Paired T Test* At 0.05 the difference is not significantly different, (p=0.16) * score

* Male to Female versus Female to Male: The Body Image, after hormonal treatment (T1) Paired T Test* At 0.05 the difference is significantly different, (p<0.05) score

The number of subjects with regular weight has increased both in MtF and FtM group After hormonal treatment, 44% of FtM group is overweight (28%) or obese (16%) while only 20% of MtF group is overweight and no one is obese

CONCLUSIONSCONCLUSIONS 1. Hormonal treatment has a positive effect on G.I.D. patients 1. Hormonal treatment has a positive effect on G.I.D. patients 2. For GID people the quality of body image is influenced by the hormonal treatment and partially by the surgery 2. For GID people the quality of body image is influenced by the hormonal treatment and partially by the surgery 3. After hormonal treatment the quality of sexual life improves 3. After hormonal treatment the quality of sexual life improves

CONCLUSIONSCONCLUSIONS 5. FtM subjects seem to have a little worst body image maybe because of the overweight 5. FtM subjects seem to have a little worst body image maybe because of the overweight 6. A body image reflecting the gender identity has a positive impact on the quality of sexual life 6. A body image reflecting the gender identity has a positive impact on the quality of sexual life 4. During the transformation program there are some differences between MtF and FtM sample in terms of body image 4. During the transformation program there are some differences between MtF and FtM sample in terms of body image