Gender dysphoria is a psychosexual disorder, characterized by a powerful cross-gender identification and a continuous disturbance with biological gender role. Congenital Adrenal Hyperplasia (CAH) is a sexual developmental disorder, resulting from congenital deficiency and functional impairment of enzymes that provide cortisol synthesis. 5,2 % of CAH patients may develop gender dysphoria. In this case, the sexual abuse and exploitation of an adolescent girl with gender dysphoria and CAH will be discussed. 17-year-old girl was admitted to our clinic with the complaints of increasing sexual desire for girls, dissatisfaction of being a girl, desire of being male, harming herself and overcoming personal borders. She touched sexually the girls forcibly, tried to kiss the girls, wanted to sex with the girls, when they rejected sexual intercourse, threatened them by knife, when her demands are not met, attacked to the officials of the institution, cut her arm. In her medical history, 46 XX simple virilization type CAH diagnosis had been made on the basis of labioscrotal fusion and single urogenital opening at 1 month, then operated to be raised as a girl at 1-year 6-month old and surgical reconstruction was completed. As a result of inadequate care of parents, she had been taken to institutional care at the age of four. It was learned that the patient who was in the institution until this age, was frequently playing truant from the institution and exposed to sexual abuse once. Also, we learned that she threatened a girl in her last institution and sexually abused her for 3 months. Gender dysphoria and personality disorder traits were detected in patient. Gender dysphoria may occur depending on CAH or inadequate care and lack of sexual boundaries. As in our case, interest in same sex partner and forced sexual contact are challenges of gender dysphoria. It should be emphasized that individuals with genetic or environmental risk factors of gender dysphoria should consider the risk of developing gender dysphoria and, the sexual abuse risk is increased in these cases.
Key words: Gender Dysphoria, Congenital Adrenal Hyperplasia, Sexual Abuse
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