Sexual abuse and exploitation of an adolescent girl with gender dysphoria and congenital adrenal hyperplasia

Sexual abuse and exploitation of an adolescent girl with gender dysphoria and congenital adrenal hyperplasia Gender dysphoria is a psychosexual disorder characterized by powerful cross-gender identification and a continuous dissatisfaction with one’s biological gender role. Congenital Adrenal Hyperplasia (CAH) is a sexual developmental disorder resulting from congenital deficiency and functional impairment of enzymes enabling cortisol synthesis. Gender dysphoria may be developed in 5.2% of CAH patients. In our case, sexual abuse and exploitation of an adolescent girl with gender dysphoria and CAH will be discussed. The 17-year-old girl was admitted to our clinic with complaints of increasing sexual desire for girls, dissatisfaction with being a girl, desire to be male, self-harming, and overstepping personal borders. She sexually touched girls against their will, tried to kiss them, desired to have sex with them, and when they rejected sexual intercourse, she threatened them with a knife when her demands were not met; she attacked the officials at the institution and cut her own arm. In her medical history, a diagnosis of 46XX simple virilizing CAH had been made on the basis of labioscrotal fusion and the presence of a single urogenital opening at 1 month. At the age of 1.5 years, the patient was operated to be raised as a girl and surgical reconstruction was completed. As a result of inadequate parental care, she had been taken into institutional care at the age of 4. We learned that the patient who was in the institution until the age of 17 was frequently running away from the institution and once had been exposed to sexual abuse. We also learned that she had threatened a girl in her last institution and sexually abused her for 3 months. Gender dysphoria and personality disorder traits were detected in the patient. Genetic and environmental causes may lead to gender dysphoria. As in our case, interest in same-sex partners and forced sexual contact are problems that may occur in gender dysphoria. It should be emphasized that in individuals with genetic or environmental risk factors of gender dysphoria, the risk of developing gender dysphoria and the risk of sexual abuse need to be considered.