Sexual Abuse and Exploitation of an Adolescent Girl with Gender Dysphoria and Congenital Adrenal Hyperplasia

Gender dysphoria is a psychosexual disorder characterized by powerful cross-gender identification and a continuous dissatisfaction with one’s biological gender role. Congenital Adrenal Hyperplasia (CAH) is a sexual developmental disorder resulting from congenital deficiency and functional impairment of enzymes enabling cortisol synthesis. Gender dysphoria may be developed in 5.2% of CAH patients. In our case, sexual abuse and exploitation of an adolescent girl with gender dysphoria and CAH will be discussed. The 17-year-old girl was admitted to our clinic with complaints of increasing sexual desire for girls, dissatisfaction with being a girl, desire to be male, self-harming, and overstepping personal borders. She sexually touched girls against their will, tried to kiss them, desired to have sex with them, and when they rejected sexual intercourse, she threatened them with a knife when her demands were not met; she attacked the officials at the institution and cut her own arm. In her medical history, a diagnosis of 46XX simple virilizing CAH had been made on the basis of labioscrotal fusion and the presence of a single urogenital opening at 1 month. At the age of 1.5 years, the patient was operated to be raised as a girl and surgical reconstruction was completed. As a result of inadequate parental care, she had been taken into institutional care at the age of 4. We learned that the patient who was in the institution until the age of 17 was frequently running away from the institution and once had been exposed to sexual abuse. We also learned that she had threatened a girl in her last institution and sexually abused her for 3 months. Gender dysphoria and personality disorder traits were detected in the patient. Genetic and environmental causes may lead to gender dysphoria. As in our case, interest in same-sex partners and forced sexual contact are problems that may occur in gender dysphoria. It should be emphasized that in individuals with genetic or environmental risk factors of gender dysphoria, the risk of developing gender dysphoria and the risk of sexual abuse need to be considered.

Cinsiyet disforisi ve konjenital adrenal hiperplazisi olan bir kız ergenin cinsel istismara uğraması ve cinsel istismarda bulunması

Cinsiyet disforisi, şiddetli olarak kendini karşı cinsten olarak tanımlama ve kendi biyolojik cinsiyetinden sürekli bir memnuniyetsizlikle karakterize psikoseksüel bir hastalıktır. Konjenital Adrenal Hiperplazi (KAH), kortizol sentezini sağlayan enzimlerin konjenital eksikliğinden ve işlevinin bozulmasından kaynaklanan bir cinsel gelişimsel bozukluktur. KAH’lı hastaların %5.2’sinde cinsiyet disforisi gelişebilir. Bu olguda, cinsiyet disforisi ve KAH’ı olan bir kız ergenin cinsel istismara uğraması ve cinsel istismarda bulunması tartışılacaktır. On yedi yaşında kız hasta kliniğimize kızlara yönelik cinsel istek artışı, kız olma konusunda memnuniyetsizlik, erkek olma arzusu, kendine zarar verme ve kişisel sınırları aşma şikayetleri ile başvurdu. Kızlarla cinsel ilişkiye girme, öpmeye çalışma, cinsel ilişki isteği geri çevrildiğinde bıçakla tehdit etme, talepleri karşılanmadığında kurum yetkililerine saldırma ve kolunu kesme semptomları mevcuttu. Tıbbi öyküsünde, doğumundan sonraki 1. ayında labio-skrotal füzyon ve tek ürogenital açıklık temelinde 46 XX basit virilizan tip KAH tanısı konulmuş, 1.5 yaşında kız olarak yetiştirilmek üzere cerrahi rekonstrüksiyon geçirmiş. Ebeveynlerin yetersiz bakımının bir sonucu olarak, dört yaşındayken kurum bakımına alınmış. Onyedi yaşına kadar kurumda kalan hastanın, kurumdan sık sık kaçtığı ve bir kez cinsel istismara maruz kaldığı öğrenildi. Ayrıca, son kurumunda bir kızı tehdit ettiği ve kıza 3 ay boyunca cinsel istismar uyguladığı öğrenildi. Hastada cinsiyet disforisi ve kişilik bozukluğu özellikleri tespit edildi. KAH’a veya yetersiz bakım ve cinsel sınırların olmamasına bağlı olarak cinsiyet disforisi ortaya çıkabilir. Olgumuzda olduğu gibi, hemcinsine olan ilgi ve zorla cinsel ilişkiye girme cinsiyet disforisinin zorluklarındandır. Cinsiyet disforisinin genetik veya çevresel risk faktörlerine sahip olan bireylerin cinsiyet disforisi geliştirme riskinin göz önüne alınması gerektiği ve bu bireylerin cinsel istismar riskinin artmış olduğu vurgulanmaktadır.

Kaynakça

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Kaynak Göster

  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984

4.8b 2.9b

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