Sexuality

Gender identity is a child’s sense of maleness or femaleness. It is established by age 3. Sexual identity is determined by secondary sexual characteristics.

• Gender dysphoria is a “disconnect” between gender identity and sexual identity. Boys > girls.
• Gender role is determined by behaviors exhibited by a child. It can be congruent or incongruent to the child’s gender identity (usually congruent).

Sexual orientation is determined by gender identity and attraction to other gender identities:

• Homosexuality: same gender identity (can be ego-syntonic or ego-dystonic; when ego-dystonic, is pathological)
• Heterosexuality: opposite gender identity
• Bisexuality: either gender identity
• Asexuality: neither gender identity

Masturbation is normal at all ages and equal in both genders. When it interferes with normal functioning, it is pathological.

Exploring human sexuality is normal, especially during teenage years, even with same sex partners.

Because the onset and progression of puberty are so variable, the Tanner Stages of Development (developed by pediatrician James Tanner) help to determine whether development is normal for a given age. Boys and girls are rated on a 5-point scale; boys for genital development and pubic hair growth, and girls for breast development and pubic hair growth.

Table 3-3. Tanner Stages of Development

	Female	Both	Male
Stage	Breast	Pubic hair	Genitalia
I	Preadolescent	None	Childhood size
II	Breast bud	Sparse, long, straight	Enlargement of scrotum, testes
III	Areolar diameter enlarges, breast elevates	Darker, curling, increased amount	Penis grows in length; testes continue to enlarge
IV	Secondary mound; separation of contours	Coarse, curly, adult type	Penis grows in length/breadth; scrotum darkens, testes enlarge
V	Mature female	Adult, extends to thighs	Adult shape/size