Dr Ayodhya S. Malalagama, Consultant Psychiatrist, Base Hospital Warakapola

1. Dr Ayodhya S. Malalagama
Consultant Psychiatrist
Base Hospital Warakapola
Sri Lanka College of Sexual
Health and HIV Medicine
22nd Annual Scientific
Sessions – 2017
7th October

3. Boys Don't Cry
1999 American biographical film
Brandon Teena

4. Violence Against the Transgender Community in
2017
Human Rights Campaign Foundation Overview

5. National Center for Transgender Equity
and the National Gay and Lesbian Task
Force 2011

10. Sexual
identity
Gender
identity
Biological Cultural
Intercultural Communication: The Indian Context
Rao RN, Thombre A 2015

11. Sexual
development
Gender
development
Sexual
diamorphism
Gender bias

12. Intrinsic
Biological
epigenetic
Extrinsic
Enviornmental
cultural
Gender Identity

13. Gender Plasticity

14. Nascent
Gender
Identity
Sexuality
Personality
DisordersAnxieties
Peer
interactions
Sexuality
Puberty
Physical
dev

15. Cisgender
Gender identity
consistent with the
sex they were
assigned at birth
Transgender
Gender identity that
does not match the
sex they were
assigned at birth.

16. Gender Spectrum
Gender Spectrum Theory
Angela N. Tharp

17. Terminology
Gender binary Gender Non binary (GNB)

19. Fluctuation of gender identity
some days / rather times
awareness of a certain gender
has suddenly grown strong in a
person in that very moment,
without question
Gender fluid

20. Agender/genderless/Gender neutral/Neutrois

21. Androgyne Gender which is
simultaneously feminine
and masculine
although not necessarily
in equal amounts
Western society currently
recognizes no set gender
roles for androgynes

22. Pangender

23. Non
binary
gender
terms
gender ambiguous
gender bender
gender blender
gender smoothie
gender expansive
masculine of center
feminine of center
Ehrensaft D. 2011 Gender Born, Gender Made: Raising Healthy Gender-
Nonconforming Children. New York, NY: The Experiment. 290 p. 2

26. Transsexual
Dual role
transvestism
Fetishistic
transvestism
Buhrich N 1977

27. Transgender / Transsexual
Prevalence: 1 in 30 000 natal males / 1 in 100 000 natal females
(Hoenig 1974)
Prevalence of self-reported transgender identity in children, adolescents and
adults : 0.5 to 1.3%.
(Zucker 2017)
Refers to the broad spectrum of individuals who transiently or
persistently identify with a gender different from their gender at birth.

28. Gender Identity Disorder
A. Marked incongruence between
one’s experienced/ expressed
gender and assigned gender, of
at least 6 months duration, as
manifested by 2 or more of the
following indicators:
2. Strong desire to be rid of one’s
primary and/or secondary sex
characteristics because of a marked
incongruence with one’s
experienced/expressed gender
3. Strong desire for the primary
and/or secondary sex
characteristics of the other gender
4. Strong desire to be of the other
gender (or some alternative gender
different from one’s assigned
gender)
5. Strong desire to be treated as the
other gender (or some alternative
gender different from one’s
assigned gender)
6. Strong conviction that one has
the typical feelings and reactions of
the other gender (or some
alternative gender different from
one’s assigned gender)
B. The condition is associated with
clinically significant distress or
impairment in social, occupational,
or other important areas of
functioning, or with a significantly
increased risk of suffering, such as
distress or disability

29. Is gender dysphoria a mental illness?

36. Sexual health and HIV

38. (Reisner 2010)

39. (Keuroghlian AS. Sexual Health among
Transgender People. National LGBT health
education centre)

41. • Most research on risk for
transgender women also
assumes heterosexuality
• Being the receptive
partner involving
penetration (Bauer 2015).
• Due to lack of funding,
research is focused mainly
on HIV risk and prevention
• Not on other STIs
• or sexual health concerns,
such as fertility or
pregnancy
(Reisner 2016).

43. All transgender persons
should be screened at
least once for HIV.
Repeat screening is
based on HIV risk
assessment.National guidelines from the U.S.
Centres for Disease Control (CDC)
U.S. Preventive Services Task Force
(USPSTF)

44. Effective risk assessment

50. References
1. Tharp AN. Gender Spectrum Theory.
2. Madeline B. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People,
Centre of Excellence for Transgender Health. June 17 (2), 2016.
3. https://www.genderspectrum.org/quick-links/understanding-gender
4. Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender
nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232.
5. Eden K, Wylie K, Watson E. Gender dysphoria: recognition and assessment. Advances in Psychiatric Treatment. 18:2
-11.2012.
6. Gates GJ. How many people are lesbian, gay, bisexual and transgender. The Williams Institute :4; 2011.
7. http://pulitzercenter.org/reporting/Thailand-empower-don’t-pity-trans-sex-worker
8. Reisner SL, Perkovich B, Mimiaga M J. A mixed methods study of the sexual health needs of New England transmen
who have sex with nontransgender men. AIDS patient care and STDs, 24(8), 501-513. 2010.
9. Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N. HIV/AIDS Prevention Research Synthesis
Team. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic
review. AIDS and Behavior, 12(1), 1-17.2008.
10.Buhrich N, McConaghy N. Can Fetishism Occur in Transsexuals?. Archives of Sexual Behavior. 6;3.1977.