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   Sexual Orientation
What is the meaning of sexual orientation?
 

Sexual orientation is not easy to define. However, according to many references, sexual orientation may be explained as the direction of an individual's sexuality, usually conceived according to the sex (sexual identity) or gender of the persons whom the individual finds sexually attractive and can interact with socially and psychologically (gender identity). The most commonly used categories of sexual orientation are heterosexuality (being sexually attracted to members of the opposite sex), homosexuality (being sexually attracted to members of the same sex) and bisexuality (being sexually attracted to members of either sex). In addition to these categories, we do have a fourth one: intersexuality. This latter describes those who possess anatomical, psychological, and/or genetic characteristics that correspond to both male and female with variable degrees of maleness and femaleness.

With the evolution of Sexology and the deeper understanding of human sexuality, a person's sexual orientation refers today to its social, political, and religious significance. A sexual orientation may determine whether a person is acceptable to his family, friends, coworkers, community, government, and religion. Sexual interests and experiences have come to represent the type of person, and whether he/she is ultimately acceptable to others. Even if harmless through sexual activities and thoughts, a person could be deemed harmful, and qualified to have a bad influence on others.
Can sexual orientation be quantified (measured)?

For some people, sexual orientation is continuous and fixed throughout their lives. For others, sexual orientation may be fluid and change over time. This is why sexual orientation is generally difficult to quantify due to its diversity that starts from self-labeling, to sexual behavior, sexual fantasy and patterns of erotic arousal.
However, starting the 19th century many attempts tried to establish scales that measure sexual orientation. The first one referred to the German physician and sexologist Magnus Hirschfield who measured the strength of an individual's sexual desire on two independent 10-point scales.
Fifty years later, the American sexologist Alfred Kinsey established his own mono-dimensional scale in order to estimate sexual orientation in humans: from 0 (exclusively heterosexual) to 6 (exclusively homosexual), with an additional category, X, for those with no sexual attraction to either women or men.  
In 1985, Frits Klein developed a scale to test his theory about the dynamic and multi-variable process of sexual orientation. In his book The Bisexual Option, Fritz Klein suggests that sexual orientation is dynamic and may change over time and is multi-variable indeed, i.e. it is composed of various elements, both sexual and non-sexual. He took into consideration sexual attraction, sexual behavior, sexual fantasies, emotional and social partners, lifestyle, and self-identification. Each of these variables was measured for the person's past, present, and ideal.

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How is sexual orientation determined? Is HOMOSEXUALITY inherited? Is somebody born homosexual?  
 

Sexual orientation probably is not determined by any one factor but by a combination of genetic, hormonal, and environmental influences. In other words, it is a complex interaction of environmental, cognitive and biological factors. However, many studies pointed out that certain genes and/or hormonal exposure increase the tendency to homosexuality with all its derivatives.

-GENETICS:
In 1993, Dean Hamer found the genetic marker Xq28 on the X chromosome. Hamer claimed in his study to have found a link between the Xq28 marker and male homosexuality, however the study was disputed by that time because the matter goes beyond what is called “unique gay gene”. Basically, it is much more complex than that. The figure below shows the genetic marker on Xq28 in green color.
 
 

Twins study indicate that male homosexuality may have a genetic component while at the same time indicating that genes are unlikely to be the only determining factor. One common type of twin study compares the monozygotic (or identical) twins of homosexual people to the dizygotic (non-identical or fraternal) twins of other homosexual people.
Bailey and Pillard (1991) in a study of gay twins found that 52% of monozygotic brothers and 22% of the dizygotic twins were concordant for homosexuality. If this study reflects really the genetic aspect of homosexuality - that male homosexuality derives solely from a genetic basis, then the results need to be nearly 100% - actually it was not the case.
Bailey, Dunne and Martin (2000) used the Australian twin registry to obtain a sample of 4,901 twins. The results of their multivariate analyses tend to suggest "significant and moderate genetic and nonshared environmental contributions for sexual orientation and its covariates".

The X chromosome theory is “turned ON” again. A recent study supports X-linkage from a different perspective. Women have two X chromosomes, one of which is "switched off". The inactivation of the X chromosome occurs randomly throughout the embryo, resulting in cells that are mosaic with respect to which chromosome is active. In some cases though, it appears that this switching off can occur in a non-random fashion. Bocklandt et al (2006) reported that the number of women with extreme skewing of X chromosome inactivation is significantly higher in mothers of homosexual men than in age-matched controls without gay sons. 4% of controls showed extreme skewing compared to 13% of the mothers with gays sons and 23% of mothers with two or more gay sons.
An Italian study was carried out in 2004 for the same purpose and indicated that female relatives of the homosexual men tended to have more offspring than those of the heterosexual men. Female relatives of the homosexual men on their mother's side tended to have more offspring than those on the father's side. The researchers concluded that there was genetic material being passed down on the X chromosome which both promotes fertility in the mother and homosexuality in her male offspring. The connections discovered, however, would explain only 20% of the cases studied, indicating that this might not be the sole genetic factor determining sexual orientation.

More recently, Mustanski (2005) failed to find the Xq28 marker in a complete genome scan of gay men’s DNA. Mustanski did however find autosomal markers at 7q36, 8p12 and 10q26.

It is obvious then that male homosexuality is influenced by a complex set of genetic factors that cause male brains to acquire some typical feminine characteristics. As for lesbianism, genetic studies are still in progress.

- BIRTH ORDER:
In 1997, Blanchard and Klassen reported that each older brother increases the odds of being gay by 33%. A recent study found that the chance of having a homosexual son increases in mothers who previously carried to term many male right-handed children as this effect is nullified if the man is left-handed. No similar effect was found in humans females, and the number of older sisters is meaningless with respect to lesbianism.
To explain this finding regarding male homosexuality, it has been proposed that male fetuses provoke a maternal immune reaction that becomes stronger with each successive male fetus. Male fetuses (not female ones) produce HY antigens which are "almost certainly involved in the sexual differentiation of vertebrates." It is this antigen which maternal anti-HY antibodies are proposed to both react to and 'remember'. Successive male fetuses are then attacked by anti-HY antibodies which somehow decrease the ability of HY antigens to perform their usual function in brain masculinisation resulting in a feminine-like brain, which implies later a homosexual man.
Then in this case, male homosexuality is not explained by socio-cultural and psychological means, but it is rather correlated to biological changes induced in the uterus when gestating a boy. The fraternal birth order effect appears to have the opposite effect in right-handed individuals than left-handed individuals, however the incidence of homosexuality correlated with an increase in older brothers is seen only in right-handed males.
 
- HORMONES:
During fetal development, hormones called prenatal hormones monitor the determination of sex differentiation. Hormones are the primary determiner of adult sexual orientation, or a co-factor with genes and/or environmental and social conditions.
Williams et al. (2000) found that finger length ratio, a characteristic controlled by prenatal hormones, is different in people of distinct sexual orientations.

The digit ratio refers to the lengths of different digits, fingers or toes. It has been suggested by some scientists that the ratio of two digits in particular, the 2nd (index finger) and 4th (ring finger) is affected by exposure to androgens such as testosterone while in the uterus and that this 2D:4D ratio can be used as a crude measure for prenatal androgen exposure.
2D:4D is sexually dimorphic: in straight men, the second digit tends to be shorter than the fourth, and in straight females the second tends to be the same size or slightly longer than the fourth. Women with congenital adrenal hyperplasia (CAH) have lower, more masculinized 2D:4D. All these differences might be due to different levels of exposure to androgens during fetal development. I am saying “might be” because there is evidence of other similar traits e.g. OtoAcoustic Emissions (OAEs is a medical test that check the degree of the inner ear health), arm to trunk length ratio, which show similar effects. Hox genes responsible for both digit and gonad growth have been implicated in this pleiotropy (the single influence of a gene on many phenotypic traits simultaneously).
           
Prenatal hormones also influence some brain structures supposed to be related to homosexual behaviors. A number of sections of the brain have been reported to be sexually dimorphic; that is, they vary between men and women. There have also been reports of variations in brain structure corresponding to sexual orientation. In 1990, it was reported that the suprachiasmatic nucleus (SCN) located in the hypothalamus showed a difference in size between homosexual and heterosexual men was reported. In 1992, a difference related to sexual orientation in the size of the anterior commissure was also reported. Recent studies showed there’s no evidence for a difference in the size of the anterior hypothalamic neurons INAH1, INAH2 or INAH4. However, the INAH3 anterior hypothalamic neurons appeared to be twice as big in the heterosexual male group as in the gay male group; the difference was highly significant. The size of the INAH3 in the homosexual male brains was similar to that in the heterosexual female brains. However, some minor contrary results were found. This is why Simon LeVay who conducted this research commented as follows: It's important to stress what I didn't find. I did not prove that homosexuality is genetic, or find a genetic cause for being gay. I didn't show that gay men are born that way, the most common mistake people make in interpreting my work. Nor did I locate a gay center in the brain. ... Since I look at adult brains, we don't know if the differences I found were there at birth or if they appeared later."
 
 
- INNATE BISEXUALITY:
Innate bisexuality (or predisposition to bisexuality) is a term introduced by Sigmund Freud that expounds all humans are born bisexual but through psychological development (which includes both external and internal factors) become monosexual while the bisexuality remains in a latent state. If this psychological development is misbalanced, then homosexuality turns on.
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Why a woman is (becomes) a LESBIAN?
 

Lesbianism is known since old times: in the Old Testament, books, literature, etc… The first known lesbian was a poet named Sapho de Lesbos (600 B.C) who wrote many poems that reflect lesbian love, jealousy, and hate. Marguerite Yourcenar (1903-1987) was a lesbian who lived 42 years in love with Grace Frick (an American teacher). Yourcenar wrote many famous books like "Le Jardin des Chimères", "Alexis ou le Traité du vain combat”, etc.. and met in 1937 the famous American lesbian Virginia Woolf for whom she translated "The Waves". Lesbianism is not limited to literature and many lesbians are gifted in other fields such as Frida Kahlo (1907-1954) the famous lesbian painter, Catherine Lara, Tracy Chapman, Skunk Anansi, Samantha Fox famous lesbian singers, Marlène Dietrich, Greta Garbo, Jodie Foster, Cynthia Nixon famous actors, and Martina Navratilova, Amélie Mauresmo, Sheryl Swoopes famous sportswomen.
Many recent movies involved lesbian actors and messages that support and/or encourage lesbianism. This is the case of the movies De Bound (1996), Fucking Amal (1998), Mudholland (2000), L Word (2004), etc…

 
 
Lesbianism also called saphism or tribadism is defined as a sexual and romantic attraction between women. Lesbians are not limited to those with masculine characteristics since many of them are extremely feminists and express their feminism pretty well: too soft, too sexy and too lovely. The main reasons that lay behind lesbianism are:
 
    1. A unique daughter who has many brothers at home: this might “dissolve” her feminism.
    2. A couple gives birth to a “baby girl” while a “baby boy” was better. Parents who cannot overcome this problem by accepting their baby girl will raise her as if she was a boy.  
    3. A misbalance in the parents’ roles: A dominant or absent mother, a dominant or absent father will result in a misidentification of the true roles of the “male” as a father and the “woman” as a mother with respect to the child.  
    4. A parent with tendency to or lives homosexuality (homosexuality environment).
    5. Divorce.
    6. Absence of religious environment.
    7. Environment that tolerates lesbianism.
    8. Watch pornographic movies during childhood and/or adolescence.
    9. Early lesbian relationship with an adult (lesbian).
    10. Curiosity: Discussions about sex and pornographic movies push adolescents to explore lesbianism, and once they pop they can’t stop. This is especially the case of “closed societies” where having a boyfriends is not allowed. Then having a girlfriend will allow this adolescent girl to explore her sexuality with another girl as such relations pass discretely.
    11. Deep deception from a previous relation.
    12. Absence of a man.
    13. Hormonal disequilibrium.
    14. Penophobia (fear from penis).
    15. Personal choice: sexual fantasy.
    16. Sexual phantasm.
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What is PANSEXUALITY?
 

Pansexuality (sometimes referred to as omnisexuality) is a sexual orientation characterized by the potential for anesthetic attraction, romantic love and/or >sexual desire for people regardless of their gender identity or biological sex. This includes potential attraction people who do not fit into the gender binary of male/female implied by bisexual attraction. Pansexuality is sometimes described as the capacity to love a person romantically irrespective of gender. Some pansexuals also assert that gender and sex are meaningless to them. The word pansexual is derived from the Greek prefix pan-, meaning "all".
The term pansexual generally is used for a person who does not classify their sexuality with a person's sex, but their gender. They believe that there is a set difference between sex and gender - gender being the socially constructed condition of being male or female, and sex being the biological condition of male or female.
People who are pansexual may be attracted to various different forms of romance, and may be aroused by various different acts of sex on a carnal level. Some suggest that pansexuality is more accurately described by its adepts: human- or person-oriented. Despite a person who is pansexual's fluid sexuality, some may have a preference. A person who is pansexual may be attracted to all genders and sexes but have a preference, (for example) for pre-operative transsexual people, other people who are pansexuals, masculine lesbians, intersexed people, etc.
Many people who identify as pansexual may associate with people of all sexual orientations, but are not necessarily interested in sex with people of all sexes or genders.

People who are pansexual usually consider any sexual act acceptable as long as it is consensual. For some people who are pansexual, biological sex is a secondary factor, something that will be discovered if and when sexual interaction takes place.
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What is ASEXUALITY?
 

Asexuality is a general term or self-designation for people who do not exhibit sexual attraction, or who otherwise find sexual behavior unappealing.

There is debate as to whether this is a sexual dysfunction or a sexual orientation. Furthermore, there is disagreement over the exact definition of the word. The term is sometimes used as a gender identity by those who believe their lack of sexual attraction places them outside the traditional definitions of gender. There has been little research done on asexuality, but those studies that have been conducted suggest that, if it is a sexual orientation, it is among the least common. A commonly used description is that they feel one can get more pleasure from eating a bar of chocolate than having sexual contact of any kind with another human being or an animal.

There is continuing disagreement over whether asexuality is a legitimate sexual orientation. Some argue that it falls under the heading of hypoactive sexual disorder or sexual aversion disorder.
Among those who do not believe it to be an orientation, other suggested causes include:  

  • Past sexual abuse.  
  • Sexual repression (of homosexuality, heterosexuality, or bisexuality),
  • Hormonal problems.
  • Delayed development.
  • Sublimation of sexuality for personal, religious or cultural reasons.
  • Not having met the right person: some asexuals, however, argue that they do not believe in the "right person myth", because they could not get into romantic/sexual affection with anybody for long years back and do not create any image of an ideal lover for themselves.

Many self-identified asexuals, however, do not believe that such diagnoses apply to them. Others assert that because their asexuality does not cause them distress, it should not be viewed as a disorder. Those who believe that asexuality is not pathological sometimes point to the fact that similar things have been said about homosexuality and bisexuality, which are now viewed by most as legitimate orientations.
Alongside this is the debate as to whether the term 'asexual' is an accurate term. In biology, the term is used to describe a species that reproduces from a single member, whereas in this context it pertains to an organism not reproducing at all, and that 'anti-sexual' (in the clinical, rather than polemical sense) may be a more accurate description of the behavior.

There are differences among people who identify as asexual, chiefly among them the presence or absence of a sex drive or romantic attraction. Some experience only one of these, while others experience both, and still others neither. There is disagreement as to which of these configurations can genuinely be described as asexual. While a number of people believe all four variations qualify, many others believe that to be asexual, one must lack both a sex drive and romantic attraction.

The sex drive of those asexuals who have one is usually not directed at anything, and is only an urge for sexual stimulation or release; one exception is those asexuals who are also fetishists, whose sex drive is focused on the fetish object rather than a person (though many fetishists do not identify themselves as asexual). In either case, the level of sex drive can range from weak to strong, and from rare to frequent. As mentioned above, some identify as asexual yet feel sexual attraction, though some would argue that they are not asexual. Some asexuals may experience sexual feelings, but have an aversion to sex or no desire to act on them, while others seek sexual release through sexual contact.

For those asexuals who experience feelings of romantic attraction, it can be directed towards any sex or sexes. These asexuals generally desire romantic relationships (ranging from casual liaisons to marriage) but often do not want these relationships to include sexual activity. Because of their romantic orientation, some asexuals describe themselves asgay, bi, or straight asexuals; this is related to the concept of affectional orientation.

Those asexuals who do want romantic relationships are in a difficult position, as the majority of people are not asexual. Asexuals able to tolerate sex can pair up with non-asexuals, but even then their lack of attraction or desire can be psychologically distressing to their partner, making a long-term romance difficult.

Asexuals who cannot tolerate sex must compromise with their partners and have a certain amount anyway, give their partners permission to seek sex elsewhere, have sexless relationships with those few who are willing, date only other asexuals, or stay single.

Aromantic is another term for asexuals who don't experience romantic attraction or "typical romantic attraction". While some do find a relationship with another asexual, they may not include things such as kissing or touching. Aromantic asexuals who are in relationships often are unsure of themselves, even if their partner is aromantic as well, because of the mass media showing "normal" relationships. They may feel they don't measure up to their partner's standards, usually due to a past failed relationship or lack of experience. This feeling usually goes away over time. Aromantic asexual couples often look like best friends to most people due to the nature of their relationships, even though something deeper is there. It's the same deep love romantics have, but it's shown in a different way from the norm.

Some asexuals use a classification system developed (and then retired) by the founder, David Jay, of the Asexual Visibility and Education Network, one of the major asexual communities (abbreviated as AVEN). In this system, asexuals are divided into types A through D:

  • Type A: has a sex drive but no romantic attraction.
  • Type B: has romantic attraction but no sex drive.
  • Type C; has both, but does not connect the two.
  • Type D: has neither.

The categories are not meant to be entirely discrete or set in stone; one's type can change, or one can be on the border between two types. Note that AVEN itself no longer uses this system, on the basis that it is too exclusive, but a number of asexuals still feel it is a useful tool for explaining their orientation.

As a conclusion, I can say that most asexuals are physically capable of sex. Some masturbate and some don't. The distinction between sexual and asexual people is that, if asexuals think about other people during masturbation (many asexuals don't think about anything specifically sexual) it is only as fantasy. If they actually were given the opportunity to be sexual with that person there would be no attraction, or the drive would be so low as to be completely ignorable.

Note that asexuality is not the same as celibacy, which is the deliberate abstention from sexual activity; many asexuals do have sex, and most celibates are not asexual. Also note that some asexuals are considered as autosexuals.
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Does AUTOSEXUALITY exist?
 

Autosexuality is sexual desire toward one's own body. As a paraphilia, autosexuality refers to people whose sexual interest is with themselves. It is rare for individuals to be sexually attracted only to themselves. It is also used to describe someone who desires masturbation over partnered sex.
An autosexual is also used as a term in evolutionary or genetic programming to describe a one parent population that does a crossover with itself and then mutation to produce children.
Most asexuals are physically capable of sex. Some masturbate and some don't. The distinction between sexual and asexual people is that, if asexuals think about other people during masturbation (many asexuals don't think about anything specifically sexual) it is only as fantasy. If they actually were given the opportunity to be sexual with that person there would be no attraction, or the drive would be so low as to be completely ignorable. Some asexuals may be considered autosexual; they have the drive to take pleasure from their own body. Other masturbating asexuals do not have a sexual drive motivating them; they just do it because it is pleasurable. The common factor is that all asexuals, masturbating or not, have little or no attraction to other people.

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What is BISEXUALITY?
 

The term bisexual was first used in the 19th century to refer to hermaphrodites. By 1914 it had begun to be used in the context of sexual orientation. Bisexuality is a sexual orientation which refers to the aesthetic, romantic, and/or sexual attraction of individuals to other individuals of both their own and the opposite gender or sex.
Most bisexuals are not equally attracted to men and women, and may even shift between states of finding either sex exclusively attractive over the course of time. However, some bisexuals are and remain fairly static in their level of attraction throughout their adult life.

Bisexual people are not necessarily attracted equally to both genders. Because bisexuality is often an ambiguous position between homosexuality and heterosexuality, those who identify, or are identified, as bisexuals form a heterogeneous group.

 
Some believe that bisexuality is a distinct sexual orientation on a par with heterosexuality or homosexuality, with a clear attraction to both men and women required.

Others view bisexuality as more ambiguous. Some people who might be classified by others as bisexual on the basis of their sexual behavior self-identify primarily as homosexual.
Equally, otherwise heterosexual people who engage in occasional homosexual behavior could be considered bisexual, but may not identify as such. For some who believe that sexuality is a distinctly defined aspect of the character, this ambiguity is problematic.

It is sometimes argued that the behavior of bisexuals may be explained by a subconscious homophobia or peer pressure. On the other hand, some believe that the majority of people contain aspects of homosexuality and heterosexuality, but that the intensities of these can vary from person to person.
 
Some people who engage in bisexual behavior may be supportive of lesbian and gay people, but still self-identify as straight; others may consider any labels irrelevant to their positions and situations.
Some bisexuals make a distinction between gender and sex. Gender is defined in these situations as social or psychological category, characterized by the common practices of men and women. For example, the fact that women wear dresses in Western Society whilst men traditionally do not is a gender issue. Sex in this case is defined as the biological difference between males and females, prior to any social conditioning. Bisexuals in this sense may be attracted to more than one gender but only to one sex. For example, a male bisexual may be attracted to aspects of men and masculinity, but not to the male body. Such a person's attractions may manifest themselves through sexual activities other than anal sex with other males.

Bisexuality is often misunderstood as a form of adultery or polyamory, and a popular misconception is that bisexuals must always be in relationships with men and women simultaneously.
Rather, individuals attracted to both males and females, like people of any other orientation, may live a variety of sexual lifestyles. These include: lifelong monogamy, serial monogamy, polyamory, polyfidelity, casual sexual activity with individual partners, casual group sex, and celibacy. For those with more than one sexual partner, these may or may not all be of the same gender.

The bisexual pride flag, overlapping triangles and bisexual moon symbols are the common symbols of bisexuality. The deep pink stripe at the top for homosexuality, the blue one on the bottom for heterosexuality, and the purple one (blended from the pink and blue) in the middle to represent bisexuality.
 
 

Historically, bisexuality has largely been free of the social stigma associated with homosexuality, prevalent even where bisexuality was the norm. In Ancient Greece pederasty was not problematic as long as the men involved eventually married and had children. In many world cultures, homosexual affairs have been quietly accepted among upper-class men of good social standing (particularly if married), and heterosexual marriage has often been used successfully as a defense against accusations of homosexuality.
On the other hand, there are bisexuals who marry or live with a heterosexual partner because they prefer the complementarity of different genders in cohabiting and co-parenting, but have felt greatly enriched by homosexual relationships alongside the marriage in both monogamous and "open" relationships.
Some in the gay and lesbian communities accuse those who self-identify as bisexual of duplicity, believing they are really homosexuals who engage in heterosexual activity merely to remain socially acceptable. They may be accused of "not doing their part" in gaining acceptance of "true" homosexuality. Some gay and lesbian people may also suspect that a self-described bisexual is merely a homosexual in the initial stage of questioning their presumed heterosexuality, and will eventually accept that they are lesbian or gay; this is expressed by a glib saying in gay culture: "Bi now, gay later."

These situations can and do take place, but do not appear to be true of the majority of self-described bisexuals. Nonetheless, bisexuals do sometimes experience lesser acceptance from gay and lesbian people, because of their declared orientation. Bisexual experimentation is also common in adolescents of every sexual orientation.

 
Bisexuals are often associated with men who engage in same-sex activity while closeted or heterosexually married. The majority of such men - said to be living on the down-low - do not self-identify as bisexual.

Because some bisexual people do not feel that they fit into either the gay and lesbian or the heterosexual world, and because they have a tendency to be "invisible" in public, some bisexual persons are committed to forming their own communities, culture, and political movements. However, since "Bisexual orientation can fall anywhere between the two extremes of homosexuality and heterosexuality," some who identify as bisexual may merge themselves into either homosexual or heterosexual society. Still other bisexual people see this merging as enforced rather than voluntary; bisexual people can face exclusion from both gay and straight society on coming out.
 
Bisexuals also tend to internalize social tensions related to their choice of partners. They may feel pressured to label themselves as either gays or lesbians instead of occupying a difficult middle ground in a culture that has it that if bisexuals are attracted to people of both sexes, they must have more than one partner, thus defying society's value on monogamy. These social tensions and pressure may and do affect bisexuals' mental health. Specific therapy methods have been developed for bisexuals to address this concern.

Relatively few supportive bisexual communities exist worldwide; therefore there is not as much support from people who have gone through similar experiences. This effectively can make it more difficult for bisexuals to "come out" as such.
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Who is a TRANSSEXUAL?
 

Transsexualism is a condition in which a person identifies as the gender opposite to the sex assigned to them at birth. In other words, a transsexual is a person who believes that his or her body does not reflect his or her true 'inner' gender. The transsexual has the desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment. In contrast, some transgender people often do not identify as being of, or desiring to be the opposite sex, but as being of or wanting to be another gender. Regardless of definition, transsexualism should not be confused with cross dressing or with the behavior of drag queens and drag kings, which can be described as transgender but not transsexual. Also, transvestic fetishism usually has little, if anything, to do with transsexualism.

Transsexualism often manifests itself as a dysphoria toward one's biological birth sex, as well as conflict living in one's social role.
If untreated, it can lead to mental and emotional problems, and sometimes suicide. It is estimated that 40% of untreated transsexual people are either institutionalized or die prematurely. However, with proper treatment, transsexual people often become fully functional members of society. The suicide statistics of treated transsexual people do not differ remarkably from non-transsexual populations.

Transsexual people almost universally prefer to be referred to by the gender pronouns and terms associated with their target gender. For example, a transsexual man is a person who was assigned the female gender at birth on the basis of his genitals, but despite that assignment identifies as a man and is transitioning or has transitioned to a male gender role and has or will have a masculine body. Transsexual people are sometimes referred to with "assigned-to-target" gender terms such as "female-to-male" for a transsexual man or "male-to-female" for a transsexual woman. These terms may be abbreviated as "M2F", "F2M", "MTF", "F to M", etc. These terms are particularly helpful in preventing confusion, because to some people the term "transsexual woman" is a female transitioning to become a male, and to others a male transitioning to become a female. When the terms transmen and transwomen are used though, it is typical for them to be used to refer to the gender that the person identifies with, regardless of their appearance or state of transition.

Transsexual people typically feel it important for people to understand that transsexualism neither depends upon, nor is related to, sexual orientation. Transsexual men and women exhibit a range of sexual orientations just as non-transsexual (some times referred to as Cis-gender) people do, and they will almost always use terms for their sexual orientation that relate to the gender with which they identify. For example, someone assigned to the male gender but who identifies as a woman, and who is attracted solely to men, will identify as heterosexual, not gay. Likewise, someone who was assigned to the female gender, identifies as a man, and prefers male partners will identify as gay, not heterosexual. Transsexual people, like other people, can be bisexual or asexual as well.

The transsexual community typically use the short form "trans", or simply "T" as a substitution for the full word "transsexual", e.g. TS, trans guy, trans dyke, T-folk, trans folk. Some may even use term that has become controversial to some, such as tranny and/or trans, despite others considering these terms to be offensive.

The most impressive hypotheses put forward to date, based upon careful clinical studies, indicate that several possible elements that cause transsexualism should be considered together: functioning of the brain and of the endocrine glands, neurological mechanisms, cultural and other environmental factors. Most, if not all, specialists in gender identity are agreed that the transsexual condition establishes itself very early, before the child is capable of elective choice in the matter, probably in the first two years of life. Others believe it is set even earlier, before birth during the fetal period. These findings indicate that the transsexual has not made a choice to be as he is, but rather that the "choice" has been made for him through many causes preceding birth and beyond his control. Advanced studies show, for instance, a difference in the human brain called the bed nucleus of the stria terminalis (BSTc), the limbic forebrain structure. In one study, male-to-female transsexuals and cis-gendered women were shown to have brains that were similar to each other in the BSTc area of the brain. On the other hand, both heterosexual and homosexual men showed male brain structuring in this area.

 
Representative photomicrographs depicting the BSTc in normal males (top row) and normal females (bottom row).
A, B, 14 years old male.
C, D, 39 years old male.
E, F, 16 years old female.
G, H, 32 years old female.
Note that the BSTc in males is larger than in females only in adulthood.
Scale bar, 1 mm. ac, Anterior commissure; ic, internal capsule; lv, lateral ventricle.
 
Most transsexual men and women desire to establish a permanent social role as a member of the gender with which they identify. Many transsexual people also desire various types of medical alterations to their bodies. These physical alterations are collectively referred to as sex reassignment therapy and often include hormones and sex reassignment surgery. The entire process of switching from one physical and social gender presentation to the other is often referred to as transition, and usually takes several years. The transition process can be highly traumatic and may involve the person being off work for a long period of time.

To obtain sex reassignment therapy, transsexual people are usually required to receive psychological therapy and a diagnosis of gender identity disorder. They are also required to live as members of their target sex for at least one year prior to surgery (so-called Real-Life Test or Real-Life Experience), although this time may be longer if the sexologist has concerns about the transsexual person's readiness. The intentions of the standard are to prevent people from transitioning when such a transition would be inappropriate (as a dramatic example, a person seeking to transition in order to veil their identity from police), or ill-advised (e.g., a strong cross-dresser, who still identifies themselves as their assigned gender). These standards are open to the criticism of being ineffective, or being too strict, discouraging genuinely transsexual people from seeking treatment. There is no conclusive evidence that sex change operations improve the lives of transsexuals, with many people remaining severely distressed and even suicidal after the operation.
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Copyright © 2007 Dr. Massoud Beaini
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