Patients with disorders/differences of sex differentiation/development (DSD) are exposed to mental and physical suffering. The aim of the study was to assess the mental state and the risk of psychological disorders in adult DSD patients in the Polish population, dependence of psychological disorders on therapeutic procedures and to identify groups of disorders which require particular psychological support.
The study involved 59 patients with DSD (gonadal dysgenesis, androgen insensitivity syndrome, 5 alpha-reductase deficiency, ovotestis), and with the Y chromosome in the karyotype, aged 16-65 (mean 26), with registered female or male sex. The subjects completed the General Health Questionnaire (GHQ-28), which is used to assess the mental state of adults. Raw results were converted into sten scores using the norms for the Polish adult population.
A high risk of psychological problems was identified in 24% of the studied DSD patients. It was found that 26% of men and 21% of women had a high risk of mental problems. Women presented significantly more somatic symptoms, more symptoms of anxiety and insomnia, and worse general mental health than men. The most disturbing symptoms were observed among patients with the complete androgen insensitivity syndrome (CAIS), partial androgen insensitivity syndrome (PAIS) and total gonadal dysgenesis (TGD). A particularly poor mental state was presented by women without a vagina and without an enlarged clitoris, and by DSD patients without corrective surgery of the genital organs. A slight nonsignificant prevalence of worse mental state has been observed in patients using sex hormones substitution.
DSD patients are prone to a higher risk of mental illness compared to the general Polish population. Women with DSD have a significantly worse overall mental state than men, but men more frequently show a high risk of mental illness. A particularly poor mental state is presented by DSD women without a vagina and without an enlarged clitoris, as well as DSD patients without earlier corrective surgery of genital organs. DSD patients receiving sex hormone replacement therapy because of hypogonadism may be also at risk of mental problems. These patients require psychological support and an individual approach to their particular needs.