Gender Issues


Issues 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.

Many 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.

In 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.

The 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 others. 

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



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