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STUDY QUESTION: What are the levels of breast development and satisfaction in women with a Disorder/Difference of Sex Development (DSD)? SUMMARY ANSWER: Compared with normative data, women with DSD reached lower Tanner stages and reported less breast satisfaction. WHAT IS KNOWN ALREADY: Women with DSD may have chromosomal and hormonal variations that can impact typical breast development. While much emphasis is placed on genital development in this group, little is known about breast development, satisfaction and their association. STUDY DESIGN, SIZE, DURATION: Data collection was part of the cross-sectional European multicenter dsd-LIFE study. Fourteen recruiting sites included 1040 participants between February 2014 and September 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 695 female-identifying participants were included (Turner n = 332, 46,XY DSD n = 141 and congenital adrenal hyperplasia n = 222), with a median age of 28 years. Clinical (i.e. history of hormone and surgical treatments, Tanner breast examination) and patient-reported (i.e. breast satisfaction, relationship status, sexual satisfaction and experienced femininity) data was collected by independent trained research staff. The relationship between breast development, satisfaction and femininity was assessed. Control data on breast development and satisfaction in women without DSD was retrieved from the literature. MAIN RESULTS AND THE ROLE OF CHANCE: Of the 695 participants, 61% had received estrogen replacement and 51% puberty induction therapy, whereas 2% had received breast augmentation surgery. Approximately 65% of participants had reached Tanner breast stage 5, which is substantially less than the general population (90%). Breast satisfaction was lower than normative data as well (P < 0.001, Cohen's d = 0.45). Breast size and breast satisfaction were associated with feelings of femininity. LIMITATIONS, REASONS FOR CAUTION: Limitations include the sample representativeness (e.g. regarding the clinical heterogeneity) and the limited in-depth knowledge on (prior) hormonal regimens. Furthermore, no (matched) control data was collected as part of this study. WIDER IMPLICATIONS OF THE FINDINGS: In order to support the psychosexual well-being of women with DSD, enhancing breast development by sufficient hormone replacement and possible augmentation surgery is advocated. The scope of DSD management should be beyond genital development only and consider breasts as well. STUDY FUNDING/COMPETING INTEREST(S): The study was funded by the European Union Seventh Framework Program (FP7/2007-2013) under grant agreement no. 305 373. There are no competing interests. TRIAL REGISTRATION NUMBER: German Clinical Trials Register: Registration identification number: DRKS00006072.

Mit der Geschlechtszugehörigkeit ist eine spezifische Vorstellung von körperlicher Leistung verbunden. Im Sport zeigt sich diese etwa darin, dass eine Trennung in zwei Geschlechter als notwendige Praxis erachtet wird, um fairen Wettbewerb zu ermöglichen. Doch was bedeutet eine solche Trennung für intersexuelle Menschen, die sich schon körperlich der Zweigeschlechterordnung entziehen? Aus soziologischer, sexualwissenschaftlicher und medizinischer Perspektive arbeitet Dennis Krämer die existierenden Vorstellungen von Intersexualität als zeitgenössische Körperpolitiken heraus und reflektiert ihre diskursiven Konsolidierungen unter Berücksichtigung der gesellschaftlichen Verhältnisse.

From a medical point of view, "sexual ambiguity" in new born babies has been categorized as a psychosocial emergency, which sets in motion a diagnostic and interventional protocol –both surgical and hormonal- in order to "determine" the sex and "correct" the body. From social and critical perspectives, it's preferred to speak about sexual variability , that is, about sexed bodies that don't fit into the dualistic expectations of what is considered a suitable for a man's or a woman's body, or in which the different sex components – chromosomal, hormonal, gonadal, or anatomic- are not consistent. In the last decades a strong controversy around intersexuality and the need to change not only the medical management, but also the social models, and the representation of the dualistic collective imagination, has arisen. Nevertheless there seems to be a wide gap between the medical management contexts and languages, and those typical of the political and human rights movements. Bioethical considerations, the role of support groups, and the possible social interventions may open channels of intervention and bridges for dialogue and translation among these isolated spaces. In this sense, this paper intends to analyze the meanings, uses, and practices of the psychosocial in the treatment and research of the intersexualities/DSD in order to explore up until what point there is a "psychosocial turn" taking place, or are we still in a predominantly biomedical management paradigm. ; Desde el punto de vista médico, la 'ambigüedad sexual' en bebés recién nacidos ha sido catalogada como una urgencia psicosocial, que dispara un protocolo de diagnóstico e intervención —quirúrgica y hormonal— para "fijar" el sexo y "corregir" el cuerpo. Desde perspectivas sociales y críticas, se prefiere hablar de variabilidad sexual, es decir, de cuerpos sexuados que no encajan con las expectativas dualistas de lo que es considerado propio de un cuerpo de hombre o de un cuerpo de mujer, o en los que diferentes componentes del sexo —cromosómico, hormonal, gonadal o anatómico— no son coherentes. En las últimas décadas, ha surgido una fuerte controversia en torno a la intersexualidad y a la necesidad de cambiar no solo la gestión médica, sino también los modelos sociales y la representación de imaginarios dualistas. No obstante, parece existir una amplia brecha entre los contextos y lenguajes de la gestión médica y los propios de las movilizaciones políticas y de derechos humanos. Las reflexiones bioéticas, el papel de los grupos de apoyo y las posibles intervenciones psicosociales pueden abrir vías de actuación y puentes de diálogo y traducción entre estos espacios incomunicados. En ese sentido, este artículo pretende realizar un análisis de los significados, usos y prácticas de lo psicosocial en la investigación y tratamiento de las intersexualidades/DSD, para explorar hasta qué punto se está produciendo el llamado "giro psicosocial", o si seguimos en un paradigma de gestión predominantemente biomédico.

Desde el punto de vista médico, la 'ambigüedad sexual' en bebés recién nacidos ha sido catalogada como una urgencia psicosocial, que dispara un protocolo de diagnóstico e intervención —quirúrgica y hormonal— para "fijar" el sexo y "corregir" el cuerpo. Desde perspectivas sociales y críticas, se prefiere hablar de variabilidad sexual, es decir, de cuerpos sexuados que no encajan con las expectativas dualistas de lo que es considerado propio de un cuerpo de hombre o de un cuerpo de mujer, o en los que diferentes componentes del sexo —cromosómico, hormonal, gonadal o anatómico— no son coherentes. En las últimas décadas, ha surgido una fuerte controversia en torno a la intersexualidad y a la necesidad de cambiar no solo la gestión médica, sino también los modelos sociales y la representación de imaginarios dualistas. No obstante, parece existir una amplia brecha entre los contextos y lenguajes de la gestión médica y los propios de las movilizaciones políticas y de derechos humanos. Las reflexiones bioéticas, el papel de los grupos de apoyo y las posibles intervenciones psicosociales pueden abrir vías de actuación y puentes de diálogo y traducción entre estos espacios incomunicados. En ese sentido, este artículo pretende realizar un análisis de los significados, usos y prácticas de lo psicosocial en la investigación y tratamiento de las intersexualidades/DSD, para explorar hasta qué punto se está produciendo el llamado "giro psicosocial", o si seguimos en un paradigma de gestión predominantemente biomédico. ; From a medical point of view, "sexual ambiguity" in new born babies has been categorized as a psychosocial emergency, which sets in motion a diagnostic and interventional protocol –both surgical and hormonal- in order to "determine" the sex and "correct" the body. From social and critical perspectives, it's preferred to speak about sexual variability , that is, about sexed bodies that don't fit into the dualistic expectations of what is considered a suitable for a man's or a woman's body, or in which the different sex components – chromosomal, hormonal, gonadal, or anatomic- are not consistent. In the last decades a strong controversy around intersexuality and the need to change not only the medical management, but also the social models, and the representation of the dualistic collective imagination, has arisen. Nevertheless there seems to be a wide gap between the medical management contexts and languages, and those typical of the political and human rights movements. Bioethical considerations, the role of support groups, and the possible social interventions may open channels of intervention and bridges for dialogue and translation among these isolated spaces. In this sense, this paper intends to analyze the meanings, uses, and practices of the psychosocial in the treatment and research of the intersexualities/DSD in order to explore up until what point there is a "psychosocial turn" taking place, or are we still in a predominantly biomedical management paradigm.

The Urban Regeneration and Community Development Policy Framework for Northern Ireland sets out for DSD and its partners, clear priorities for urban regeneration and community development programmes, both before and after the operational responsibility for these is transferred to councils under the reform of local government. Four policy objectives have been developed, which will focus on the underlying structural problems in urban areas and also help strengthen community development throughout Northern Ireland. The policy objectives are as follows: Policy Objective 1 – To tackle area-based deprivation: Policy Objective 2 – To strengthen the competitiveness of our towns and cities: Policy Objective 3 – To improve linkages between areas of need and areas of opportunity: and Policy Objective 4 –To develop more cohesive and engaged communities. Key points from IPH response Urban regeneration and community development provide a basis for addressing the social determinants of health and reducing inequalities in health. This policy framework presents an opportunity for coherence and complementarity with 'Fit and Well - Changing Lives' as part of government's overall approach to tackling health inequalities. It is now well established that a focus on early years' interventions and family support services yields significant returns, so prioritising action in these areas is essential. Defined action plans on child poverty are essential if this policy framework is to make a real and lasting difference in deprived urban areas. Development of the environmental infrastructure to improve health in deprived areas should be supported by well-planned monitoring and evaluation. Linking the policy framework to economic development and local community plans will enhance effectiveness in the areas of education, job creation, commercial investment and access to services, which in turn are critical for the economic growth and stability of urban communities. Community profile data and health intelligence (as available through IPH Health Well) could usefully inform central and local government in terms of resource allocation and targeted service delivery.

When sex characteristics develop in ways that do not conform to binary models, dilemmas arise regarding how to understand the situation and what terminology to use to describe it. While current medical nomenclature suggests that it should be understood as a disorder of sex development (DSD) prompting medical responses, many describe intersex as a human variation in sexed embodiment that should be protected under discrimination laws. These opposing perspectives suggest different principles to employ in responding to dilemmas about gender assignment, early genital surgery and full disclosure of medical information. In this discursive psychological study, we explore how lay people, without prior knowledge or experience of intersex/DSD, make sense of these dilemmas and the underpinning discourses giving rise to how they talk about these situations. By using the discursive framework of ideological dilemmas, we analyse how people make sense of sex and gender (as binary or non-binary), how they deal with difference (as problematic or not), and how they understand who is in a position to make decisions in such situations. We conclude that engaging with dilemmas in-depth is more constructive than favouring one principle over others in moving social science research, reflexive clinical practice, and wider political debates on intersex/DSD forward.

When sex characteristics develop in ways that do not conform to binary models, dilemmas arise regarding how to understand the situation and what terminology to use to describe it. While current medical nomenclature suggests that it should be understood as a disorder of sex development (DSD) prompting medical responses, many describe intersex as a human variation in sexed embodiment that should be protected under discrimination laws. These opposing perspectives suggest different principles to employ in responding to dilemmas about gender assignment, early genital surgery and full disclosure of medical information. In this discursive psychological study, we explore how lay people, without prior knowledge or experience of intersex/DSD, make sense of these dilemmas and the underpinning discourses giving rise to how they talk about these situations. By using the discursive framework of ideological dilemmas, we analyse how people make sense of sex and gender (as binary or non-binary), how they deal with difference (as problematic or not), and how they understand who is in a position to make decisions in such situations. We conclude that engaging with dilemmas in-depth is more constructive than favouring one principle over others in moving social science research, reflexive clinical practice, and wider political debates on intersex/DSD forward. ; peerReviewed ; publishedVersion

Intersex/differences of sex development (DSD) conditions are divergences among genitalia, gonads, and chromosome patterns. These variances have been present for millennia and socially defined according to the cultural system established. The aim of this study is to describe the perspectives of adult intersex/DSD people, their relatives, and intersex/DSD expert professionals in Spain. A descriptive qualitative study design was adopted. The study was carried out in several locations in Spain. Individual in-depth interviews were conducted and addressed to 12 participants (4 intersex/DSD people, 3 relatives, and 5 professional experts). A total of 4 spheres, 10 categories, and 26 subcategories were obtained. The number of verbatims obtained in each of the spheres described were intersex/DSD as a community (n = 54), health sphere approach (n = 77), law sphere approach (n = 12), and psychosocial approach (n = 73). Regarding intersex/DSD as a community sphere, there is a clear need of promoting education on sex and body diversity. With respect to the health sphere, it is mentioned the inadequacy of services and how this has a negative impact on the health of intersex/DSD people. Regarding the law sphere, it is highlighted the need of designing legislations at a national level which protect and defend the rights of intersex/DSD people. Regarding the psychosocial sphere, these people suffer from social isolation, secrecy, shame, self-identity questioning, and mental disorders that negatively impact their quality of life.

Over the past years, the topic of "disorder/differences in sex development (DSD)" or "intersex" people has become subject of the international political agenda. In 2017, a resolution of the Parliamentary Assembly of the Council of Europe argued that the practice of surgically modifying intersex children's genitals without medical necessity and without consent of the person concerned is a human rights violation. This resolution and related statements might impact heavily on pediatric urologists and their practice. While this resolution concerns a form of soft law and is not directly enforceable in member states, it might impact the national debates concerning legislation and medical guidelines on DSD. Consequently, this article reflects on this discussion by elaborating on the importance of human rights in our evolving understanding and legislation on DSD and other gender and sexuality issues in general. It constitutes a plea for a dialogue between medical professionals, lawmakers and human rights scholars which would lead to legislation and medical guidelines that take a holistic and rights-based approach.

Mit der Geschlechtszugehörigkeit ist eine spezifische Vorstellung von körperlicher Leistungsfähigkeit verbunden. Im Sport zeigt sich diese darin, dass eine Trennung in Männer und Frauen als grundlegende Voraussetzung erachtet wird, um fairen Wettbewerb zu ermöglichen. Doch was bedeutet eine solche Trennung für intersexuelle Sportler*innen, die sich schon körperlich der Zweigeschlechterordnung entziehen? Dennis Krämer arbeitet aus soziologischer, medizinischer und sexualwissenschaftlicher Perspektive die existierenden Vorstellungen über Intersexualität als zeitgenössische Körperpolitiken heraus und reflektiert ihre Entstehung unter Berücksichtigung der gesellschaftlichen Verhältnisse.

Mit der Geschlechtszugehörigkeit ist eine spezifische Vorstellung von körperlicher Leistung verbunden. Im Sport zeigt sich diese etwa darin, dass eine Trennung in zwei Geschlechter als notwendige Praxis erachtet wird, um fairen Wettbewerb zu ermöglichen. Doch was bedeutet eine solche Trennung für intersexuelle Menschen, die sich schon körperlich der Zweigeschlechterordnung entziehen? Aus soziologischer, sexualwissenschaftlicher und medizinischer Perspektive arbeitet Dennis Krämer die existierenden Vorstellungen von Intersexualität als zeitgenössische Körperpolitiken heraus und reflektiert ihre diskursiven Konsolidierungen unter Berücksichtigung der gesellschaftlichen Verhältnisse.

Introduction: intrafamilial sexual abuse of children is a social and public health problem. The investigation of crimes of this nature shows widespread and often irreversible psychological harm to the victims. The harmful effects arise from the act itself as well as the absence of special care for children, whose development is gradual and whose condition of being subjects with rights is often ignored. Interdisciplinary coordination among the fields of Law, Psychology, and Social Work is essential to reduce the extent of the damage. The coordination of these areas of expertise when put into practice leads to the non-victimization of the child. This interdisciplinary effort has gained prominence in the discussions of children's rights, and the possibility of its implementation in the project "Testimony without harmful effects" (DSD, acronym in Portuguese). Objective: to analyze the DSD (Depoimento Sem Dano) from the perspective of the full protection of the child. Methods: a qualitative approach, with a literature review, legislation review and semi-structured interviews. Results: there was a shortage of national literature on DSD. The interviews enabled the designation of four categories based on the analysis of the different points of view of DSD according to those interviewed: the actions of the legal professionals and the care for children; the need for change in the dynamic of listening to the child victim; positivity of the "DSD" project proposal; the effectiveness of the technique. Discussion: the most characteristic aspects of intrafamilial sexual abuse of children justify the use of the DSD technique and its integrative phases. Conclusion: there is an imminent need for an extensive discussion of the guarantee of and effectiveness of the human rights of the child victim of intrafamilial sexual abuse, of the child victim's treatment and of listening to the child in a judicial proceeding. Dialogue among the different areas of expertise involved in the protection of the child is essential for the effective success of new possibilities.