| disease | Transvestism |
The characteristic of transvestism is achieving sexual satisfaction by wearing clothing of the opposite sex. This can range from occasionally donning one or two items to complete cross-dressing. Some transvestites are effeminate homosexuals or individuals with gender dysphoria. Heterosexual male transvestites are exclusively male, while almost all female transvestites are lesbians or individuals with gender identity disorder. The prevalence rate has not been reported.
bubble_chart Etiology
The study found no abnormalities in the patient's sex chromosomes or sex hormones. Some reports have noted temporal lobe EEG abnormalities, but these are only seen in very few cases. The most plausible explanation remains the one given for fetishism: normal sexual development was hindered and compounded by conditioned learning.
bubble_chart Clinical Manifestations
Cross-dressing typically begins during adolescence, starting with just one or two pieces of opposite-sex clothing and gradually increasing until the individual is fully dressed in opposite-sex attire, both inside and out. At this stage, it often leads to penile erection and masturbation. Cross-dressing usually does not occur in public but rather in private spaces like one's own room. The individual may own one or multiple sets of opposite-sex clothing, sometimes even wearing the latest fashion openly, using wigs, perms, or makeup. The duration of daily cross-dressing varies, often starting sporadically but becoming increasingly frequent over time, with some even sleeping in such attire. Some engage in masturbation or intercourse while cross-dressing to achieve sexual satisfaction. Family attitudes toward cross-dressing vary—most reluctantly tolerate it, while others show forgiveness and sympathy, even assisting in dressing in opposite-sex clothing.
bubble_chart DiagnosisThe diagnostic criteria for transvestism in CCMD-2-R are as follows: ① Meeting the diagnostic criteria for sexual deviation; ② Adults wearing clothing of the opposite sex, not due to specific cultural backgrounds or prevailing social customs, but purely as an individual behavior primarily aimed at achieving sexual excitement; ③ This behavior occurs repeatedly for over six months, driven by strong desires, and its suppression causes significant emotional distress; ④ Apart from cross-dressing, there is no desire to alter one's own anatomical or physiological sex characteristics—otherwise, the diagnosis would be transsexualism. Homosexual individuals who cross-dress to attract same-sex partners, where the act itself does not induce sexual excitement, are not included in this diagnosis.
bubble_chart Treatment Measures
Rosen (1979) reported psychoanalytic therapy, while Marks and Gelder (1967) described aversion therapy. Treatment should be tailored to individual circumstances. For heterosexual transvestism, repeated psychotherapy can enhance self-control, whereas homosexual cases may refer to the chapter on homosexuality.
Most transvestism persists for many years and diminishes as sexual desire declines in middle age.
Transvestic fetishism: Individuals with transvestic fetishism are satisfied with the specific details of cross-dressing, whereas those with transsexualism are not particularly concerned about cross-dressing. The duration of cross-dressing is longer in transvestic fetishism than in transsexualism. Transvestic fetishism begins in early childhood, while transsexualism often emerges after the consolidation of gender identity in later years. Cross-dressing in transvestic fetishism is symbolic or sexually arousing, whereas in transsexualism, it is purely based on a preference for their female gender.
