HUMAN SEXUAL DEVELOPMENT AND PARAPHILIAS Prof MUDr Ji

HUMAN SEXUAL DEVELOPMENT AND PARAPHILIAS Prof. MUDr. Jiří Raboch, Dr. Sc. Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague

sexual deviations sexual delinquents deviant sexual delinquents

SEXUAL DEVELOPMENT

GONADAL DIFERENTIATION mesoderm WT 1 NR 5 A 1 Bipotential gonad DMRT 1, 2, SRY, SOX 9 testis DAXI ovary AMH testosterone Estrogens gestagens Kucinskas and Just, 2005

SEXUAL DEVELOPMENT

RAT´S BRAIN

RAT´S SEXUAL ACTIVITY

SEXUAL CENTERS IN THE HYPOTHALAMUS sex center Female area praeoptica Hypothalamus ventralis Male mediobasalis hypothalamus mating center nc. ventromedialis area praeoptica

DIFERENTIATION OF HYPOTALAMIC NUCLEI AND EPITHELIAN OF THE 3 rd. BRAIN VENTRICLE

FETAL TESTOSTERONE LEVELS

HOHLWEG´S EFFEKT Kiss 1/kisspeptin system Kiss 1 gene expression and kisspeptin protein levels in anteroventral periventricular nucleus – higher levels in females Kauffman 2009

RESULTS OF HYPOTHALAMOTHOMY

SEXUAL DEVELOPMENT

SIGMUND FREUD 1856 - 1939 n n THEORY OF UNCONSCIOUNESS PSYCHOSEXUAL DEVELOPMENT CHILDHOOD SEXUALITY CONFLICTS, COMPLEXES

Consequences of early stress and childhood maltreatment (child sexual abuse) …The major structural consequences of early stress include reduced size of the mid-portions of the corpus callosum and attenuated development of the left neocortex, hippocampus, and amygdala… …Early stress alters the development of monoamine neurotransmitters and affects their degree of laterality… Teicher et al. , 2003

CUMMULATIVE FREQUENCY OF EXPERIENCES WITH FORCEFULL SEXUAL ACTIVITY 174 female students and 137 male students of Medical School % age (years) Raboch, 1996 1 st.

REDUCTION OF BRAIN STRUCTURES DEPENDENT ON AGE OF THE CHILD STRUCTURE HIPPOCAMPUS CORPUS CALLOSUM FRONTAL CORTEX AMYGDALA AGE AT CSA 3 – 5, 11 – 13 9 – 10 14 – 16 No differences Teicher et al. , 2008

Plasticity of the brain n n n EVOLUTIONARY REACTIVE ADAPTIVE REPARATIVE SYNAPTIC LEVEL LOCAL CIRCUITS DISTANT CIRCUITS n n PROLIFERATION MIGRATION DIFERENTIATION CRITICAL (SENSITIVE) PERIODS

HIPPOCAMPUS AND DEPRESSION Vaidya a Duman, 2001

Neuroanatomical sex-specific differences n MALE BRAIN CONTAINS ON AVERAGE 16% NEURONS MORE n MALE CORPUS CALLOSUM IS BIGGER n n FEMALE TEMPORAL CORTEX HAS ON AVERAGE 11% GREATER DENSITY OF NEURONS THE MOST SIGNIFICANT DIFFERENCES - HYPOTHALAMUS Sickel a Mc. Carthy, 2000

Sexual diferentiation of the brain n n HYPOTHALAMUS SDN-POA (sexually dimorphic nucleus of praeoptic area) - rats INAH 1, 2, 3, 4 (interstitial nuclei of the anterior hypothalamus) – human beings Bed nucleus of stria terminalis

DEVELOPMENT OF HYPOTHALOAMIC SDN-POA (INAH)

SEXUAL DEVELOPMENT

BED NUCLEUS OF STRIA TERMINALIS DEVELOPMENT Chung et al. , 2002

VOLUMES OF BED NUCLEUS OF STRIA TERMINALIS MTF-T – malet to female transsexuals N=6 Zhou et al. , 1995

Criteria of sexual „normality“ Adequate gender identity n PREFERENCE OF n Heterosexuality (? ) n Mature object n Mutual contrived (voluntary) n Adequate interaction technique n Other… n

F 64 Gender identity disorders n n n F 64. 0 Transsexualism F 64. 1 Transvestitism of the double role F 64. 2 Gender identity disorder in childhood

F 66 Mental and behavioral disorders connceted with the sexual development and orientation n F 66. 0 Sexual maturation disorder F 66. 1 Ego-dystonic sexual orientation F 66. 2 Sexual relationships disorder

F 65 Disorders of sexual preferences F 65. 0 F 65. 1 F 65. 2 F 65. 3 F 65. 4 F 65. 5 F 65. 6 – Fetishism – Transvestic fetishism – Exhibitionism – Voyerism – Pedophilia – Sexual sadism, masochism – Multiple disorders of sexual preferences

Treatment of paraphilias § § n n voluntary involuntary out-patient in-patient Psychotherapy • individual • group • CBT Sociotherapy n n Pharmacoterapy • (estrogens) • antiandrogens • gestagens • lithium • neuroleptics • LH-RH analogs Operations (? ) • hypothalamothomy • castration

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