Adolescents with Disorders of Sex Development: A 3-Year Psychosocial Follow-Up Before and After Gender Reassignment

Objectives: Psychosocial interventions have been increasingly proven to play a key role in a holistic team-oriented approach to disorders of sex development (DSD) care. This article examined the influence of cultural and religious factors on the acceptance of the decision for gender-reassignment surgery. Next, how this patient accepted herself and her body image, and invested in her femininity, was analyzed.

Methods: The study is based on a 3-year follow-up (from 2013 to 2015) of an adolescent with 46,XX DSD, in the mental health department of FANN National University Hospital in Dakar, Senegal. The patient and his/her parents and other family members underwent 12 sessions of counseling and supportive psychotherapy before and after surgical treatment. On average, each session lasted 55 min.

Results: Raised as a boy until the age of 15, the patient initially refused surgical intervention. The parents were also confused, owing to the societal preference for males and the fear of stigmatization. The role of the grandfather was instrumental in the counseling and supportive psychotherapy, as he attributed a masculine and religious given name to the child. The postsurgical anatomy reduced the patient’s distress. However, the psychic integration of her bisexuality was ambivalent and accompanied by depressive feelings and intense dream activity. Feminine socialization and environmental learning, conditioned by Wolof traditions and upbringing, were some constraints that affected postgender reassignment outcomes.

Conclusion: While gender reassignment affects the patient, but it can even more profoundly affect the parent of that is the same sex to whom as the child’s sex has been as identified at birth. Counseling and supportive therapy should take into account cultural constraints and transformations within and across the psychological developmental stages.