title: Gender Identity and Sex Role of Patients Operated on for Bladder Exstrophy-Epispadias.
abstract: OBJECTIVE
  We evaluated whether genital deformity has an impact on gender identity and sex role in patients operated on for bladder exstrophy-epispadias complex.
  
  
  METHODS
  A total of 62 adolescents and adults operated on for bladder exstrophy-epispadias complex were mailed questionnaires evaluating gender identity (Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults) and sex role (Bem Sex Role Inventory). Of the patients 33 responded and the results were compared with 99 gender matched controls.
  
  
  RESULTS
  On the gender identity questionnaire female patients had median scores similar to those of their gender matched controls (4.93 vs 4.89, p = 0.412) but in males the score was lower compared to controls (4.87 vs 4.96, p = 0.023), indicating somewhat more conflicted gender identity. However, no patient had gender dysphoria. Female sex role index was higher in female patients vs controls (5.9 vs 5.3, p = 0.003) but was comparable between male patients and controls (5.2 vs 5.0, p = 0.459). Masculine sex role indices were comparable between female patients and controls as well as between male patients and controls. Of 32 patients 17 were considered to have androgynous sex role, as were 24 of 97 controls (p = 0.004). The exact diagnosis (bladder exstrophy or epispadias) or dissatisfaction with appearance of the genitals had no impact on gender identity or on sex role indices.
  
  
  CONCLUSIONS
  Male patients had lower gender identity scores compared to controls and female sex role was enhanced among female patients. Androgynous sex role was more common in patients vs controls. Gender dysphoria was not noted in any patient.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Adult Psychiatry, Tampere University Hospital, Tampere (AKM), Finland. Electronic address: seppo.taskinen@hus.fi.
authors.forename: Seppo
authors.initials: S
authors.lastname: Taskinen
authors.affiliation: Department of Pediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Adult Psychiatry, Tampere University Hospital, Tampere (AKM), Finland.
authors.forename: Janne S
authors.initials: JS
authors.lastname: Suominen
authors.affiliation: Department of Pediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Adult Psychiatry, Tampere University Hospital, Tampere (AKM), Finland.
authors.forename: Aino K
authors.initials: AK
authors.lastname: Mattila
mesh_terms: D000293:Adolescent; D000328:Adult; D001746:Bladder Exstrophy / Q000523:psychology / Q000601:surgery*; D016022:Case-Control Studies; D004842:Epispadias / Q000523:psychology / Q000601:surgery*; D005260:Female; D000068116:Gender Dysphoria / Q000175:diagnosis / Q000209:etiology*; D005783:Gender Identity; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis; D011581:Psychological Tests; D012189:Retrospective Studies
keywords: bladder exstrophy; disorders of sex development; epispadias; gender identity