Sexual Activity and Temperament In Polish Transsexuals Stanislaw Dulko, M.D1
Two groups of 23 female-to-male and 14 male-to-female transsexuals were compared to a representative sample of Polish controls along following dimensions: (i) temperamental features including reactivity and mobility of nervous processes, as measured by Strelau's Temperament Inventory; and (ii) patterns of sexual activity, measured with Dulko's Questionnaire for Measurement of Transsexualism. Transsexuals were found to resemble respective controls on temperamental dimensions according to their sense of gender identity and not their somatic sex. Male-to-female transsexuals were more similar to control females than to control males and the reverse was true for female-to-male subjects. With respect to forms of sexual activity, transsexuals, particularly the female-to-male, were found to have a relatively versatile erotic life. Both groups experienced more dreams with erotic content than respective controls. However, they also manifested fewer successes at satisfying their erotic needs. KEY WORDS: sexual activity; temperament; transsexualism. 1Department of Sexology and Pathology of Human Relations in Medical Center of Postgraduate Education, Al. Bieruta 40, 04-158 Warsaw, Poland. INTRODUCTION Little evidence exists concerning the interrelationships between sexual activity in transsexuals and their personality traits, and no studies have investigated relationships between sexual activity and dimensions of temperament in transsexuals. It was predicted that transsexuals would resemble respective groups of normal males and females in their patterns of sexual activity and in temperamental traits (strength of excitation or reactivity, and mobility of nervous processes). It was uncertain, however, whether the resemblance would be along somatic sex or sexual identity groups. Strength of excitation of nervous processes is understood in line with Pavlovian tradition as the capacity of a nerve cell for work. It is supposed to manifest itself in the capacity of the nervous system to withstand prolonged or brief but strong excitation, without passing into a state of retroactive inhibition. The capacity is measured by resistance to strong, continuing, or recurrent stimuli. Strelau (1982) modified Pavlov's theory of temperament by substituting the notion of excitation process by a concept of reactivity, thus emphasizing that the physiological mechanism of temperament is not restricted to the level of cortex only. This modification stresses the psychological nature of temperament which may be investigated with behavioral as well as physiological measures. Strength of excitation and reactivity are inversely related, i.e., a high score on the excitation scale is an index of low reactivity. It is usually assumed that any organism is endowed with a typical optimum level of activation (Hebb, 1969) or stimulation (Leuba, 1965). In low reactive (excitation resistant) individuals the optimum is placed relatively high and hence they are bound to display more intense and more frequent activities in order to ensure a sufficient supply of stimulation and to match the optimum. The opposite, low general activity level, holds for highly reactive persons. Low reactive persons are thus hypothesized to actively seek sources of stimulation which may include their own activity (e.g., sports and physical exercises), frequent changes of environment (generally high physical mobility), choice of stimulating professions, or risk-seeking behavior, etc. In Strelau's Temperament Inventory (1982) reactivity is measured by (i) readiness to undertake activity in highly stimulating conditions, (ii) maintaining an activity despite a continuing high level of stimulation, (iii) lack of emotional disturbances in stressful situations, (iv) lack of visible changes in efficiency of action in conditions of prolonged or strong stimulation. In the majority of studies in which the Temperament Inventory was used, the hypotheses relating reactivity and stimulatory value of displayed behavior have been confirmed. Behaviorally, however, the trait of mobility is relatively easy to identity since it is manifested as an ability to produce fast and appropriate reactions to changing circumstances (Strelau, 1982). The respective items of the Temperament Inventory, diagnostic of mobility, pertain to this criterion. According to Strelau, persons with high mobility of nervous processes should manifest a high need for a specific kind of stimulation: one provided by changes or variations in situation. Temperament has been defined by Strelau (1982) as a set of formal properties of behavior, manifested mostly in an energetic level of activity and temporal characteristics of reactions. The Temperament Inventory has been used mainly to measure reactivity and mobility of nervous processes, since these two temperamental properties have been considered by Strelau to hold a dominant position in regulation of human relations with the environment. Strelau (1969; 1972; 1974; 1978; 1982) claims that underlying temperament is comprised of inborn physiological mechanisms which are responsible for the energetic level of the organism. Particularly important are certain properties of a hormonal system and nervous centers located in the brain stem. Boyar and Aiman (1982) investigated diverse functions of the hypothalamus and pituitary gland and suggested that transsexualism may result from neuroendocrine deficiencies of the hypothalamus and pituitary. According to Dorner (1978), a deficiency of androgens in genetic males during a critical period of brain development changes differentiation of the brain in the direction of a female brain. Moss et al. (1979), Unger (1979), and Lipton et al. (1976) suggested that hypothalamic hormones may influence diverse properties of behavior, including sexual behavior. According to Strelau (1982), some forms of behavior are manifestations of temperamental traits. Changes in properties of behavior may be due to a decreased frequency in transmission of electrical impulses in neurons responsible for secretion of LH-RH (Renaud et al., 1975). Investigation of factors influencing gender identity and gender roles in humans is difficult and becomes more complex if one considers the lack of appropriate empirical procedures, which could cover the diversity of the human repertoire of behaviors, modified by social factors. The list of factors that are decisive for gender identity and gender role is thus by no means closed and conclusive. So far relatively little attention has been paid to patterns of sexual activity in transsexuals. The existing data are scarce and usually relate to single cases. They show considerable discrepancies. McConahay and McConahay (1977) suggested that transsexual subjects have more heterosexual than homosexual experiences. Randell (1959) and Roth and Ball (1964) found that half of male-to-female transsexuals had sexual intercourses with females. On the other hand, Bentler (1976) found an almost equal distribution of 42 male- to-female studied transsexuals between three distinct categories: homosexual, asexual, and heterosexual. Hoenig and Kenna (1974) found that most transsexuals masturbate. Partial evidence concerning patterns of sexual activities in both types of transsexuals has been provided by Sorensen and Hertoft (1982). All female-to-male transsexuals included in this study were sexually attracted by women and engaged in sexual behavior three to four times a week. In contrast to the male-to-female transsexuals, they experienced genital satisfaction both during intercourse and while masturbating; masturbation involved the clitoris. None of the female-to-male subjects in this study felt sexually attracted by males although some had heterosexual intercourse. Genital sexual satisfaction was absent in male-to-female transsexuals and, in contrast to the former group, they were found to inhibit their sexual drive. Two specific hypotheses were formulated in the present study. Hypothesis 1: Transsexuals of the female-to-male type (F/M) should manifest temperamental features in line with their gender identity rather than with their somatic sex and thus should resemble males rather than females from a comparative group of normals. By the same token, male-to-female transsexuals would resemble normal females rather than normal males. Hypothesis 2: Transsexuals of the female-to-male type would display patterns of sexual activity that would resemble males from a comparative, nontranssexual group, whereas transsexuals of the male-to-female type should be similar to a respective group of normal females. METHODOLOGY Subjects Subjects were 37 transsexuals from different areas of Poland. The group included 23 female-to-male transsexuals and 14 male-to-female transsexuals, aged 18 to 46 (mean age 27.35; y = 8.311). The majority were single, came from urban areas, and had completed at least high school. Some worked, others were still in school. All transsexuals had permanent sexual partners for at least 6 months. The comparative group of normals was studied by Stawowska (1973) It included 2520 subjects, 1265 male and 1255 female, aged 17 to 60, mostly students and teachers. The comparison group for studying sexual activity was formed by Ponikiewska (1976) and consisted of 100 married couples, aged 19-49, in habitants of a large city. The majority of women had completed high school, whereas the majority of men had not. Method Hormonal tests were performed, including levels of testosterone, estradiol, prolactin, LH and FSH in serum, and dynamic tests using LH-RH. Temperament (reactivity and mobility of nervous processes) was measured with Strelau's Temperament Inventory. The questionnaire is based on the typology of temperament outlined by Pavlov and modified by Strelau (1982). The third experimental version was used. The questionnaire was designed by Strelau (1982) to measure three properties of nervous processes: strength of excitation and inhibition, balance, and mobility. Subjects were asked to complete the questionnaire, but their scores were computed for only two subscales: excitation (reactivity2) and mobility of nervous processes. Patterns of sexual activity were rated with the questionnaire for measurement of transsexualism, devised by the author. The questionnaire consists of 179 items that refer to sexual experiences and are listed according to the order in which the experiences are usually acquired. The items refer to facts rather than to the subject's opinions on these facts. Except for a few open questions, the remaining ones are categorized. Besides demographic and clinical data pertaining to transsexualism, the following aspects of sexual activity in adolescence were measured: sexual preferences, image of oneself as a sexual partner, expected and real sex-role, attitude toward sexuality, first sexual experiences, sexual intercourse, number of partners and partnerships, present partnership and type of emotional relationship with the partner, strength of sexual drive, frequency of satisfying sexual needs, degree of satisfaction during sexual behavior, and patterns of sexual activity. The latter included frequency of experiencing sexual needs, frequency of engaging in sexual activities and satisfaction derived (experience of orgasm or felt sexual pleasure), as well as "substitutive" compensatory patterns of sexual activity (daydreaming, fantasies, erotic dreams, night orgasms). Dimensions of sexual activity included strength of sexual drive (how frequently a subject experienced sexual drive) and frequency of erotic dreams. Frequency of satisfying sexual needs was rated, as was frequency of intercourse or other forms of sexual activity. Satisfaction derived from sexual activity was rated from the subject's reported experiences of orgasm, pleasant sensations, satisfaction, or disappointment. Patterns of sexual activity included "techniques" and "positions" taken during sexual intercourses and other forms of sexual activity. The studies were carried in the Department of Sexology and Pathology of Interpersonal Relationships in Warsaw. All subjects consented to participate and were assured secrecy of the data. The study was not anonymous because the data were used later for diagnostic and therapeutic purposes. All subjects were studied individually by the author. Data were collected during three consecutive sessions, between May 1982 and January 1983. RESULTS Means, standard deviations, and proportions of measured variables were computed. Chi-square, U test, and Fisher's exact test were used for nonparametric data, and t tests for parametric data. Table I. Comparison of Reactivity in Transsexuals with their Respective Control Group, Accounting for Sex of Subjects According to the Biological Criterion of Somatic Sex Groupa Age n x SD U p F/M 18-46 17 60.83 12.748 2.922 <.01 F 18-60 959 51.00 12.700 M/F 18-41 14 48.93 14.856 1.019 < .05 M 17-61 1265 56.00 13.100 Table II. Comparison of Reactivity in Transsexuals with their Respective Control Group, Accounting for Sex of Subjects According to the Psychological Criterion of Sex: Gender Identity Groupa Age n x SD U p M/F 18-41 9 53.80 13.094 .661 >.05 F 18-60 959 51.00 12.700 F/M 18-46 23 60.83 11.823 1.380 >.05 M 17-61 1265 56.00 13.100 aM/F = male-to-female transsexuals; F/M = female-to-male transsexuals. 2A score in reactivity is an inverse value of a questionnaire score; see Introduction. Results and their interpretations are presented in Tables I and II which compare scores in two temperamental features, reactivity and mobility of nervous processes, of both groups of transsexuals (female-to-male and male-to- female) with the respective groups of normals. Table I compares scores in reactivity with subjects' somatic sex, whereas Table II compares reactivity scores with subjects' gender identity. Female-to-male transsexuals scored significantly lower on reactivity. Behaviorally, people who have lower reactivity are more resistant to highly stimulating situations. A lower degree of the reactivity testifies to greater strength of the nervous system, readiness to undertake activity in highly stimulating conditions; maintaining an activity despite continuing high level of stimulation; a lack of emotional disturbance in stressful situations; and a lack of visible change in efficiency of action in conditions of prolonged or strong stimulation. Male-to-female transsexuals scored significantly higher in reactivity than the control normal group. Additionally, transsexuals of the female-to-male type scored significantly lower on reactivity than male-to- female transsexuals, with a respective mean difference of Æx = 11.90; t = 2.614; p < .02. When the comparison was made with subjects' gender identity, no significant differences were found for reactivity scores between transsexual and control groups. The next property studied was mobility of nervous processes. Since in previous studies (Stawowska, 1973) no significant sex differences were found with respect to this temperamental trait, the respective control group with which the group of transsexuals was compared has been differentiated not with respect to the sex but to age. No significant differences were found between the transsexuals and normals, Æx = 0.10; U = .045, ns, for subjects below 30 years of age; Æx = 3.10; u = .836, ns, for subjects between 31 and 60 years of age. Behaviorally, the trait of mobility is relatively easy to identify since it is manifested as an ability to produce fast and appropriate reactions to changing circumstances. This does not differentiate the transsexual groups either (with a respective mean difference Æx = 2.36; t = 0.624, p > .05). The second part of the study investigated patterns of sexual activity displayed by transsexuals in comparison to a group of normals. The following manifestations of sexuality were measured: (i) reported variety of techniques and positions employed during sexual activity, (ii) frequency of experienced sexual need, (iii) frequency of satisfying sexual needs, (iv) amount of sexual satisfaction, frequency of orgasm, (v) amount of pleasant sensations experienced during intercourse despite lack of orgasm, (vi) frequency of erotic dreams. Female-to-male transsexuals differed from male-to-female transsexuals in the reported variety of employed techniques and positions during sexual activity, x2(1) = 4.849, p < .05. Female-to-male transsexuals reported employing more variable positions during sexual behavior than male-to-female transsexuals. Additionally, it was found that female-to-male transsexuals preferred a typically male position, with subject above partner, whereas male- to-female transsexuals preferred a typically female position. Both types of transsexuals manifested similar frequencies of felt sexual need, x2(1) = 0.007, ns, whereas normals displayed considerable differentiation in this respect, with normal males scoring higher on experienced sexual desire than normal females, x2(1) = 15.125, p < .001. No differences in reported frequency of experienced sexual need were found between the pooled group of transsexuals and the respective pooled group of normals, x2(1) = .018, ns. Nor were any differences observed between the separate groups of transsexuals and the respective subgroups of controls. The frequency of satisfying sexual needs was similar in both groups of transsexuals, x2(1) = 0.294, ns, whereas control males scored significantly higher in this respect than control females, x2(1) = 4.568, p < .05. The pooled group of transsexuals was satisfying their sexual needs significantly less frequently than the pooled group of normals, x2(1) = 8.87, p < .001. Comparison of separate groups of transsexuals with their respective controls revealed the following pattern: (i) Female-to-male but not male-to-female transsexuals scored significantly lower than the comparison group of normal males in frequency of satisfying their sexual needs (respective data, F/M vs. M, x2(1) = 11.88, p < .001; M/F vs. M, x2(1) = 3.03, ns.). (ii) Female-to-male transsexuals scored slightly lower than control females (the result is of borderline significance), x2(1) = 3.77, p < .07), whereas no differences were found between male-to-female transsexuals and the respective control females, x2(1) = 0.370, ns. The pattern of data obtained for frequency of experienced orgasm repeats that for frequency in satisfying sexual needs, with one exception: not only female-to-male but also male-to-female transsexuals scored significantly lower in frequency of orgasm than a control group of males. Respective data: F/M vs. M, x2(1) = 58.28, p < .001; M/F vs. M, x2(1) = 61.55, p < .001. Similar to the former set of data, a pooled group of transsexuals was found to experience orgasm significantly less frequently than a pooled comparison group of normals, x2(1) = 24.676, p < .001. In situations where sexual behavior was not accompanied by an experience of orgasm, male-to-female transsexuals experienced pleasant sexual sensations somewhat less frequently than female-to-male transsexuals, x2(1) = 3.615, p < .07. Additionally, it was found that the control group of normal females scored significantly higher than any group of transsexuals in frequency of pleasant sexual sensations experienced despite lack of orgasm (F/M vs. F, x2(1) = 6.589, p < .02; M/F vs. F, x2(1) = 27.937, p < .001). Both types of transsexuals experienced a similar degree of erotic dreams, x2(1) = 1.92, ns. Among control subjects, males scored higher than control females, x2(1) = 19.168, p < .001. The pooled group of transsexuals and each subgroup separately experienced significantly more erotic dreams than their respective controls (F/M vs. F, x2(1) = 35.06, p < .001; F/M vs. M, x2(1) = 7.22, p < .01; M/F vs. M, x2(1) = 13.83, p < .01; M/F vs. F x2(1) = 37.31, p < .001). CONCLUSIONS 1. With regard to the temperamental trait of reactivity, transsexuals resembled the comparative control in line with the former's gender identity and not somatic sex. Thus, female-to-male transsexuals displayed a level of reactivity similar to a comparative group of males with whom they identified and not to the corresponding group of females. Male-to-female transsexuals had reactivity levels analogous to those of the comparable group of normal females. 2. Transsexual subjects tend to carry out a relatively versatile erotic life. This seems particularly true for female-to-male transsexuals. 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