1. 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

2. INTRODUCTION

3. 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

4. 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

5. 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

6. 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

7. 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

8. WPATH Standards of care, Version 7 - September 2011

9. OUR STUDY

10. 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)

11. MATERIALS AND METHOD

12. 45,5% (N=25) N tot =55 54,5% (N=30) The Sample

13. 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

14. 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

15. 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

16. 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

17. - 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

18. RESULTS

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

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

21. BODY IMAGE @T0 (i.e., before hormonal treatment) compared to BODY IMAGE @T1 (i.e., after one year of hormonal treatment) Body Image – Hormonal Treatment

22. Two Sample Paired t-Test Sample N Mean SD ------------------------------------------------------------------------- 1. Data1_BimageT0 55 32.7 21.1 2. Data1_BimageT1 55 70.0 15.4 --------------------------------------------------------------------- Difference of Means: -37.33473 Null Hypothesis: Mean1 - Mean2 = 0 Alternative Hypothesis: Mean1 - Mean2 <> 0 t DoF P Value ------------------------------------------------ -14.73076 54 0.00000 ------------------------------------------------ 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

23. BODY IMAGE for subjects under 30 aa compared to subjects over 30 aa @T0 and T1 Body Image – Age

24. N Mean SD --------------------------------------------------------------- Under 30aa T0 30 35.1 20.8 Over 30aa T0 25 29.7 21.4 --------------------------------------------------------------- Difference of Means: 5.38 Body Image - Age N Mean SD --------------------------------------------------------------- Under 30aa T1 30 70.5 17.6 Over 30aa T1 25 69.4 12.5 --------------------------------------------------------------- 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).

25. 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 obese) @T0 and T1

26. N Mean SD ------------------------------------------------------------------ BMI not Regular T0 24 30.9 22.8 BMI Regular T0 31 34.1 19.8 ------------------------------------------------------------------ Difference of Means: -3.17 Body Image – Body Mass Index N Mean SD ------------------------------------------------------------------ BMI not Regular T1 19 66.3 17.3 BMI Regular T1 36 71.9 14.2 ------------------------------------------------------------------ Difference of Means: -5.65 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).

27. Body Image – Surgery Hystero-annessiectomy mastoplasty/mastectomy laser vocal cords surgery N Mean SD ------------------------------------------------------------------ Only Hormonal treatment T1 30 66.5 16.9 Hormonal treatment + Surgery T1 25 74.1 12.5 ------------------------------------------------------------------ Difference of Means: -7.5944 At the 0.05 level, the difference of the population means is not significantly different than the test difference (0). t DoF P Value ------------------------------------------------ -1.85866 53 0.06863 ------------------------------------------------

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

29. Sexual Orientation

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

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

32. 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

33. * 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

34. 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

35. 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

36. 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