about gender often cause great concern but are not always addressed. It is
important to understand that male and female gender identities are established
before birth and not affected by hormone changes later in life.
women with CAH have successful heterosexual relationships, though for some
finding a partner is difficult. There
are some women with CAH who are more comfortable with bisexual and homosexual
relationships but this may in some cases, have more to do with their concerns
about the formation of their genitalia, with feelings of vulnerability and
apprehension of a sexual relationship with men. The main point to remember is that if a woman has
established heterosexual feelings, there is nothing about CAH that will change
this, even if the testosterone levels rise from time to time.
all women, testosterone levels can affect sex drive or
libido. The effect of
testosterone on libido however, is very unpredictable.
Some women with CAH find
that when testosterone levels are high, sex drive is increased. Reducing testosterone with higher dose of cortisol treatment
can reduce excessive sex drive. A
low libido is a more difficult problem as it is rarely improved by changing the
dose of treatment – counselling might be an answer here.
attitude of parents and doctors to gender and sex, and their own perceptions of
this area, can influence how girls and women cope with CAH.
Women appear to manage much better if, as children and young adults,
their parents and doctors were able to discuss openly and sensitively, not just
the medical side but also the emotional and sexual issues.
This affects how women perceive their genitalia/bodies as acceptable to
Those who have been brought up with no information about the condition and are unable to talk to their parents or doctors, find it difficult to over come common barriers when problems are brushed aside and sexual matters are not considered as a matter for discussion. A young adult, who will probably have had vaginal surgery will find it hard to ask for advice. She may find it very difficult to be comfortable with her body, be anxious about the prospect of sexual activity and unable to see it as something pleasurable.
©Dr G. S. Conway 1999
This Page was updated 30-Apr-2006
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