Gender affirmation surgery remains one of the greatest challenges in transgender medicine. In recent years, there have been continuous discussions on bioethical aspects in the treatment of persons with gender dysphoria. Gender reassignment is a difficult process, including not only hormonal treatment with possible surgery but also social discrimination and stigma. There is a great variety between countries in specified tasks involved in gender reassignment, and a complex combination of medical treatment and legal paperwork is required in most cases. The most frequent bioethical questions in transgender medicine pertain to the optimal treatment of adolescents, sterilization as a requirement for legal recognition, role of fertility and parenthood, and regret after gender reassignment. We review the recent literature with respect to any new information on bioethical aspects related to medical treatment of people with gender dysphoria.

Background.Investigations in the field of gender identity disorder (GID) have been mostly related to psychiatric comorbidity and severe psychiatric disorders, but have focused less on personality and personality disorders (PDs).Aims.The aim of the study was to assess the presence of PDs in persons with GID as compared to cisgendered (a cisgender person is a person who is content to remain the gender they were assigned at birth) heterosexuals, as well as to biological sex.Methods.The study sample consisted of 30 persons with GID and 30 cisgendered heterosexuals from the general population. The assessment of PDs was conducted by application of the self-administered Structured Clinical Interview for DSM-IV Axis II PDs (SCID-II).Results.Persons with GID compared to cisgender heterosexuals have higher presence of PDs, particularly Paranoid PD, avoidant PDs, and comorbid PDs. In addition, MtF (transwomen are people assigned male at birth who identify as women) persons are characterized by a more severe psychopathological profile.Conclusions.Assessment of PDs in persons with GID is of great importance as it comprises a key part of personalized treatment plan tailoring, as well as a prognostic factor for sex-reassignment surgery (SRS) outcome.

Sexual dysfunctions have been the most prevalent group of sexual disorders and include a large number of populations of both sexes. The research of sexual behavior and treatment of women with sexual distress arises many questions related to differences in sexual response of men and women. The conceptualization of this response in modern sexology has changed over time. The objective of our paper was to present the changes and evolution of the female?s sexual response concept in a summarized and integrated way, to analyze the expanded and revised definitions of the female sexual response as well as implications and recommendations of new approaches to diagnostics and treatment according to the established changes. The lack of adequate empirical basis of the female sexual response model is a critical question in the literature dealing with this issue. Some articles report that linear models demonstrate more correctly and precisely the sexual response of women with normal sexual functions in relation to women with sexual dysfunction. Modification of this model later resulted in a circular model which more adequately presented the sexual response of women with sexual function disorder than of women with normal sexual function. The nonlinear model of female sexual response constructed by Basson incorporates the value of emotional intimacy, sexual stimulus and satisfaction with the relationship. Female functioning is significantly affected by multiple psychosocial factors such as satisfaction with the relationship, self-image, earlier negative sexual experience, etc. Newly revised, expanded definitions of female sexual dysfunction try to contribute to new knowledge about a highly contextual nature of woman?s sexuality so as to enhance clinical treatment of dysfunctions. The definitions emphasize the evaluation of the context of women?s problematic sexual experiences.

Introduction Transsexual phenomenon is very complex, which is confirmed in everyday practice with these patients. There are many reasons why we have chosen to present this patient's case report. Case outline The aim of this case report was to indicate how our female-to-male (FtM) transsexual patient tried to change her own sexual drive with the purpose of showing high adaptation in social environment as her personal representation of mental health. At the same time, this was an attempt to escape from gender dysphoria by becoming heterosexual escaping from her basic sexual drive. Our patient could not put her erotic attributes in sexual relations, so she had numerous heterosexual, bisexual and homosexual relationships. Conclusion By this case report, we want to present how conviction of belonging to the opposite sex can affect erotic contact with the same and different sex.

Gender dysphoria is a complex phenomenological entity in various aspects. One if them is interdisciplinary treatment approach which carries numerous bioethical questions: timing and the extend of offered therapeutic options, right of mental health professionals to offer and conduct partial treatment etc. Term 'partial' is however contraversal and in colision with elementary bioethical principles regarding patient's fundamental right to obtain complete treatment allways. Bioethical challenges proceedes in postoperative clinical experiences related to reconversions and bioethical reasonablenes as sometimes it's caused by poor differential diagnosis and unrecognised motives? De-transition case reports and long term follow-up's could contribute to clarification of clinical indicators pointing out the non/validity of reversal transition. Accepted professional ethics of mental health professionals prescribe obligation to treat gender incogruent/dysphoric children and adoelscents. Bioethical accuracy of gender dysphoric prepubertal children treatment includes necessity of clear definitions and complete diagnostic procedure reliability. Important questions are child maturity, capacity and capability to adapt to extreme transitional hormonal body changes. Prepubertal period impose question of adequate patient's informing consent fully satisissfying legal criteria of informing and competency. Expert's opinion differs from critisized considering inappropriateness of parents imposing personal standards to their children to affirmative considering parents as most appropriate reference group to give social value judgement after consultation with doctors. Health professions included in the treatment of gender dysphoric patients have equal ethical obligation to guarantee happy and productive life to children by medical or any other intreventions. Discussion on fertility preservation in some fields of clinical medicine is routine, but contraversal in gender dysphoria on expert and general public level. Such discrimination deeply undermines patient's basic bioethical rights as informing and counseling of transgender persons on contemporary opportunities of reproductive techologies is an imperative. Posttransitional parenthood has specificity in reversal parents identities and roles which makes this question much more contraversal.