Gender Incongruence of Childhood Diagnosis and Its Impact on Brazilian Healthcare Access

Gender Incongruence of Childhood Diagnosis and Its Impact on Brazilian Healthcare Access Arch Sex Behav (2017) 46:2511 COMMENTARY ON WINTER ET AL. (2016) Gender Incongruence of Childhood Diagnosis and Its Impact on Brazilian Healthcare Access 1,2 3 3 • • • Maria Ineˆs Rodrigues Lobato Alexandre Saadeh Desiree Monteiro Cordeiro 3 2,4 1,2 • • • Daniel Augusto Mori Gagliotti Angelo Costa Brandelli Anna Martha V. Fontanari 2 1,2 1,2 • • • Ce´sar Bridi Filho Cla´udia Correˆa Garcia de Garcia Dhiordan Cardoso da Silva 1,2 1,2 1,2 • • • Jaqueline Salvador Karine Schwarz Maiko Abel Schneider 1,2 1,2 1,2 ´ • • • Marcia Ivani Brambila Aline Giardin Lisia Maya Monteiro 1,2 2 Bianca Machado Borba Soll Andre´ Gonzales Real Received: 1 September 2016 / Accepted: 8 September 2016 / Published online: 22 September 2016 Springer Science+Business Media New York 2016 We have read the article by Winter, De Cuypere, Green, Kane, (PROTIG-Porto Alegre and AMTIGOS-Sa˜o Paulo) organized and Knudson (2016) regarding the WPATH statement on the to assist children and adolescents with gender dysphoria/gender GenderIncongruenceofChildhoodDiagnosis.Here,wewantto incongruence. Both are situated at university hospitals, with mul- express our concern about the opinion of about half of the par- tidisciplinaryteams.Genderdysphoricchildrenurgentlyneedser- ticipating European and North American WPATH members. vices to prevent and to reduce the risks associated with the horri- We feelthatthe situation ofpeople in other partsofthe world has fyingexperiencesthatimpactedsomanyadultswhoneverhadany hardly been taken into account. support from mental health providers. However, a diagnosis of Onlyin1997,Brazilianshadthefirstofficialregulationbythe gender dysphoria/gender incongruence in children and adoles- Federal Medicine Council for the adult population with gender cents is a formal requirement for their access to the Brazilian pub- dysphoria (or gender incongruence) and only in 2008 did the lic healthcare system that is based on ICD parameters. There- Brazilian public healthcare system begin to cover trans-related fore, what can be expected with the removal of the Gender Incon- procedures such as hormone therapy and surgeries. Our clinic gruence of Childhood Diagnosis in children? Brazilian children startedin1998, andmostadults with gender dysphoria/gender will againbe increasinglyexposedtoneglect or abuse, possiblyby incongruence who came to our services were neglected and theirownfamilies,whereasparentswhowanttohelptheirchildren sometimes abandoned by their families since childhood. They will be without any support from health providers. Furthermore, were emotionally and physically abused and had poor or no mental health and medical professionals will no longer be social support. When they finally arrived at our transgender appropriatelytrained.Finally,usingthediagnosiswillnolongerbe services, they carried the suffering and health disabilities related helpfulinschools,whowouldotherwisebeopentospecialarrange- to these experiences with them. ments. Considering these facts, we recognize how much we still Counseling these children and their families is of utmost need to do for this vulnerable population. This is especially true importance for the preservation of their self-worth and self- when we consider the children. There are two services in Brazil esteemandtoovercomeexperiencesofteasingandbullying.For theprotectionandsupportoftransgenderchildreninourcontext, that is still marked by severe prejudice and discrimination toward & Karine Schwarz gender and sexuality diversity. It is crucial that the GIC condition remain in the ICD. Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, Reference 2400, Porto Alegre, RS 90035-003, Brazil Gender Identity Disorder Program, Hospital de Clinicas de Winter, S., De Cuypere, G., Green, J., Kane, R., & Knudson, G. (2016). The Porto Alegre, Universidade Federal do Rio Grande do Sul, proposed ICD-11 gender incongruence of childhood diagnosis: A Porto Alegre, RS, Brazil World Professional Association for Transgender Health Membership Hospital de Clınicas da Faculdade de Medicina da Universidade Survey. Archives of Sexual Behavior, 45, 1605–1614. de Sa˜o Paulo, Sa˜o Paulo, Brazil ´ ´ Pontifıcia Universidade Catolica, Porto Alegre, RS, Brazil Archives of Sexual Behavior Springer Journals

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Psychology; Sexual Behavior; Public Health; Social Sciences, general
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