Mozhgan Afkhamizadeh

Sexual orientation and medical history among Iranian people with Complete Androgen Insensitivity Syndrome and Congenital Adrenal Hyperplasia

OBJECTIVE To report sexual orientation, relationship status and medical history of Iranian people with Differences of Sex Development (DSD) who were raised female. METHODS Our participants consisted of nineteen 46,XY individuals with Complete Androgen Insensitivity Syndrome (CAIS) and eighteen 46,XX individuals with Congenital Adrenal Hyperplasia (CAH) who were raised as females and older than 13years. As well as their relationship status and detailed medical history, an expert psychiatrist assessed their sexual orientation by a semi-structured psychiatric interview with them and, where applicable, their parents. RESULTS Five percent of CAH participants and 42% of CAIS participants were in a relationship, which was significantly different. All CAH individuals had been diagnosed at birth; 89% of CAIS had been diagnosed after puberty and due to primary amenorrhea and 11% were diagnosed in childhood due to inguinal hernia. Genital reconstructive surgery had been performed in 100% of CAH participants and 37% of CAIS. Regarding sexual contact experiences and sexual fantasies (androphilic, gynephilic or both), no significant differences were found. However, CAH females had significantly more gynephilic dreams (P=0.045). CONCLUSION This study, notable as one of the rare from a non-western culture, described sexual, medical and socioeconomic status of 46,XX CAH and 46,XY CAIS individuals living in Iran. Although broadly in line with previous findings from Western cultures, Iranian CAH individuals had fewer romantic relationships, but in contrast to previous studies their sexual orientation was only different from CAIS in the contents of sexual dreams.

Iranian Gender-Nonconforming Children Will Not Benefit from the Omission of Gender Incongruence in Children Diagnosis

The current proposal for the World Health Organization’s Eleventh Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) is to retain the Gender Incongruence in Childhood (GIC) diagnosis in the ICD11 though to remove it from ICD-11’s chapter on Mental and Behavioral Disorders. While proponents of removing the GIC diagnosis argue that a mental health diagnosis for transgenderidentified children is stigmatizing and clinically irrelevant, the current proposal is based on the perspective that omitting GIC from ICD-11 will lead to greater negligence of these children’s needs and lead to greater harm (Drescher, Cohen-Kettenis, & Reed,2016).Asmembersofaninterdisciplinaryprofessionalcommittee for transgender health in a non-Western culture, we believe that exclusion of the GIC diagnosis would seriously impair access of our juvenile clients to appropriate services. Firstofall, thepresenceofaGICdiagnosisintheICD-11,asthe most widely used health diagnostic manual, helps to shed light on a tabooin traditional societies suchasours. Inoursociety,abinary understanding of gender and sexuality is culturally hegemonic, and there is great intolerance toward gender-nonconforming behaviors. For instance, consider the ‘‘clinical’’ arguments provided by Winter, De Cuypere, Green, Kane, and Knudson (2016) against theGICpresence inICD-11:‘‘pre-pubertalchildrendonot need substantial medical support, but instead need the psychological space, support, and information to explore who they are, become comfortable with their gender identity and its expression, and learn how to handle hostility in others.’’The critical question, however, that remains unanswered in their argument is how we canpersuadeparents toacknowledge the real, substantialneedsof their children while at the same time inform them that their children are completely ‘‘normal’’? And this is not just about parents; teachers, relatives, school staff and, even more importantly, authorities who make decisions about supporting financially the organizations that help these children, need to know that the child’s wishes are not whims. Interestingly, almost all adults with gender incongruence who visit our clinic with their families for psychoeducation ask us to tell their families there is‘‘something definitelywrongwith them’’and that they are‘‘patients’’whoneed to be cured with hormonal and/or surgical treatments. For these people, this is theonlywaytoobtain their family’sacceptanceand support. Otherwise, in our culture, their condition would be consideredaperversionordebaucherytobeeradicated; if itwouldnot be eradicated, they would be ostracized by their families. This wouldcertainlyalsooccurwithchildren,whoare, less thanadults, unable to takecareof themselves.Therefore,webelieve that ICD11,byrecognizingGICasadiagnosis,providesgreaterprotection for these children from the risk they face of abuse and neglect. In addition to parents and authorities, keeping the GIC diagnosis in ICD-11 is also critical for augmenting the knowledge of mental health professionals whose clients are not only children & Behzad S. Khorashad sorourib2@mums.ac.ir

Topical propolis improves wound healing in patients with diabetic foot ulcer: a randomized controlled trial

Abstract In this randomized controlled trial, diabetic patients with foot ulcers (Wagner grades 1 and 2) were randomly assigned to conventional therapies for diabetic foot ulcer plus topical propolis ointment (5%; twice daily) or conventional therapies alone. The process of ulcer healing was observed during 4 weeks and compared between the two groups regarding the size, erythema, exudates, white blood cell (WBC) count and erythrocyte sedimentation rate (ESR). The process of ulcer size reduction during the four-week period of study was significantly different between the groups. However, this difference was not significant between the third and fourth weeks. There was no significant difference between two groups regarding erythema and exudate reduction as well as WBC count and ESR. Administration of topical propolis ointment in addition to the conventional treatments of diabetic foot ulcer could reduce the size of ulcers with Wagner grades 1 and 2.

Menstrual disorders and premenstrual symptoms in adolescents: prevalence and relationship to serum calcium and vitamin D concentrations

Abstract There have been several studies evaluating the association between vitamin and mineral status and menstrual disturbance. In the present study, we aimed to assess the relationship between the menstrual bleeding pattern and premenstrual syndrome (PMS) symptoms with serum 25-hydroxyvitamin D, and calcium levels in adolescent girls. A cross-sectional study was carried out in 897 high school girls from northeastern Iran. The prevalence of hypocalcaemia, normal serum calcium and hypercalcaemia was 27.1, 59.8 and 13.1%, respectively. The menstrual flow of participants differed significantly between the calcium status groups (p = .005). There was no significant association between the symptoms of PMS, as assessed by the questionnaire and serum vitamin D status, or serum calcium concentrations, apart from the irritability. There appears to be an association between serum calcium, menstrual blood loss and irritability in adolescent girls. Impact statement What is already known on this subject? Several studies have evaluated the association of vitamin and mineral status with menstrual disturbance, although these relationships are not consistent, specifically among calcium and vitamin D levels with a menstrual bleeding pattern. What do the results of this study add? In the present study, we investigated the correlation of menstrual bleeding patterns and PMS with calcium and vitamin D levels in a large population in adolescent girls. We found that the level of calcium was associated with the level of menstrual blood loss and irritability. However, no significant association was observed between the menstrual bleeding pattern or the PMS symptoms with a vitamin D status. What are the implications of these findings for future clinical practise/research? Further studies are required to assess the value of a calcium adequate intake or a calcium supplementation for the amelioration of PMS and a better understanding the role of calcium in PMS.

Childhood Sex-Typed Behavior and Gender Change in Individuals with 46,XY and 46,XX Disorders of Sex Development: An Iranian Multicenter Study

AbstractDisorders of sex development (DSD) are congenital conditions in which the typical genetic and hormonal profiles are affected and thereby the usual process of sexual differentiation. Most of these studies, however, have been conducted in Western countries. In the present study, preschool sex-typed activities of Iranian individuals with DSD and their age-matched non-affected male and female relatives were assessed using the Pre-School Activities Inventory (PSAI) modified for retrospective self-report. A total of 192 individuals participated in our study, including 33 46,XX individuals with congenital adrenal hyperplasia (CAH; M age = 10.36, SD = 5.52), 15 46,XY individuals with complete androgen insensitivity syndrome (CAIS; M age = 19.8, SD = 7.14), and 16 46,XY individuals with 5-alpha reductase deficiency type-2 (5α-RD-2; M age = 17.31, SD = 7.28), as well as one age-matched non-affected male and female relative for each patient. With regard to PSAI scores, male-identifying participants with 5α-RD-2 and male controls reported similar levels of male-typical childhood play. Female-identifying participants with 5α-RD-2 and CAH showed comparable scores: significantly less masculine and more feminine than male controls, but significantly more masculine and less feminine than females with CAIS and female controls. These findings support the role of androgens in the development of sex-typical childhood play behavior, with those being exposed to higher levels of fetal functional androgens expressing more masculine behavior at preschool ages.