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"Masalah psikososial yang paling banyak dirasakan oleh klien gangguan fungsi seksual adalah ansietas dan perilaku kekerasan. Ansietas dan perilaku kekerasan bukan hanya mempengaruhi lama rawat klien di rumah sakit dan mempengaruhi juga kualitas hidup klien. Penelitian ini untuk melihat pengaruh terapi relaksasi otot progresif terhadap ansietas dan perilaku kekerasan klien gangguan fungsi seksual di rumah sakit provinsi Jawa Barat. Desain penelitian menggunakan quasi experiment pre post test with control group. Sampel penelitian sebanyak 76 klien gangguan jiwa yang direkrut dengan simple random sampling dibagi menjadi 2 kelompok yaitu 38 orang responden kelompok kontrol dan 38 orang responden kelompok intervensi. Ansietas diukur dengan menggunakan the sex anxiety inventory dan perilaku kekerasan diukur dengan menggunakan aggressive sexual behavior inventory. Data yang terkumpul dianalisis dengan chi square dan independent sample t test.Hasil penelitian menunjukan terdapat penurunan ansietas dan perilaku kekerasan setelah dilakukan terapi relaksasi otot progresif (pvalue < 0.05). Terapi relaksasi otot progresif direkomendasikan sebagai terapi lanjutan untuk menurunkan ansietas dan perilaku kekerasan pada klien gangguan fungsi seksual.

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Most psychological problem experienced by sexual disfunction client are anxiety and violent behavior. Anxiety and violent behaviour experienced by the client with sexual disfunction not only effecting the lenght of stay of hospitalization but olso affect the client?s quality of life. This study aimed to obtain the effect of progressive muscle relaxation for anxiety and violent behavior of client?s with sexual disfunction in West Java Central Mental Hospital. Quasy experimental reaserch design pre ?post with control group, design was used for this study. Sample for 76 sexual disfunction clients, consisting of 38 intervention group and 38 control group.The result showed that the decreasing of anxiety level and violent behavior who received progressive muscle relaxation therapy greater than the group who did not get progressive muscle relaxation therapy (pvalue < 0,05). Progressive muscle relaxation therapy is recommended as advanced nursing treatment for sexual disfunction clients with anxiety and violent behavior."

"Latar Belakang Masalah utama bagi pasien Mayer-Rokitansky-Kuster-Hauser (MRKH) adalah ketidakmampuan berhubungan seksual dengan baik. Solusinya adalah membuatkan vagina (neovagina) yang diharapkan dapat mengembalikan fungsi seksualnya. Tujuan penelitian ini adalah untuk mengetahui fungsi seksual pasien MRKH yang telah dilakukan neovagina amnion graft di RSCM secara kuantitatif, mengetahui data genital hiatus dan panjang vagina pasien pasca neovagina dan hubungan antara keduanya dengan fungsi seksual, serta mengetahui persepsi dan pengalaman fungsi seksual pasien pasca neovagina amnion graft secara kualitatif.Metode Penelitian kuantitatif menggunakan desain cross-sectional dengan menilai fungsi seksual pada perempuan MRKH pasca neovagina amnion graft menggunakan kuesioner Female Sexual Function Indeks (FSFI) dengan diameter (genital hiatus) dan panjang vagina sebagai faktor yang berperan terhadap fungsi seksual. Untuk penelitian kualitatif dilakukan pengumpulan data menggunakan wawancara mendalam (cross-sectional survey).Hasil Rerata skor FSFI pada pasien pasca neovagina amnion graft di RSCM adalah 21,4 dengan rerata genital hiatus 2,9 cm, dan rerata panjang vagina 7 cm. Genital Hiatus melebihi 3,14 cm dan panjang vagina kurang dari 6,51 cenderung berkorelasi dengan skor FSFI yang rendah (kurang atau sama dengan 19). Dari pendalaman kualitatif, didapatkan pasien pasca neovagina amnion graft mampu memiliki fungsi seksual dengan baik dan pemendekan vagina menyebabkan disfungsi seksual karena nyeri. Kurangnya komunikasi dan pemanasan, serta kualitas hubungan dengan pasangan mempengaruhi faktor gairah, rangsangan, lubrikasi, orgasme dan kepuasan seksual.Kesimpulan Pentingnya memiliki target panjang vagina minimal 7-9 cm saat pembuatan neovagina pasien MRKH dan kepatuhan pasien dalam melakukan dilatasi untuk menjaga panjang vagina yang cukup. Penelitian lanjutan multisenter diperlukan.

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Background The main problem of Mayer-Rokitansky-Kuster-Hauser (MRKH) patients is the inability to have proper sexual intercourse. Neovagina is one of the solution which is expected to restore patient’s sexual function. The purpose of this study is to determine the sexual function of MRKH patients who had undergone a neovaginal amnion graft at RSCM quantitatively, to assess the genital hiatus and vaginal length of post neovaginal data, and to determine the relationship between perceptions and experiences of sexual function with post-neovaginal amnion graft patients qualitatively.

Methods This quantitative study used a cross-sectional design by assessing sexual function in MRKH patients post-neovaginal amnion graft by Female Sexual Function Index (FSFI) questionnaire with genital hiatus and vaginal length as factors that play role in sexual function. Data collection in qualitative study uses in-depth interviews (cross-sectional survey).

Results The mean FSFI score in post-neovaginal amnion graft patients at RSCM was 21.4 with an average genital hiatus of 2.9 cm and average vaginal length of 7 cm. Genital hiatus greater than 3.14 cm and vaginal length less than 6.51 tend to correlate with a low FSFI score (less or equal to 19). Post-neovaginal amnion graft patients were able to have better sexual function and vaginal shortening leads to sexual dysfunction due to pain. Lack of communication and foreplay, as well as the quality of relationships with partners affect patient’s arousal, stimulation, lubrication, orgasm and sexual satisfaction.

Conclusion It is important to have a target vaginal length of at least 7-9 cm when undergoing neovaginal in MRKH patients. Patient compliance in dilating to maintain sufficient vaginal length also plays an important role. Further multicenter follow-up research is needed."

"Latar belakang Disorders of sex development (DSD) 46,XY adalah kelainan bawaan perkembangan gonad maupun struktur genitalia interna dan eksterna yang berhubungan dengan kromosom 46,XY. Manifestasi klinis DSD yang bervariasi, diagnosis akhir, gender assignment, tata laksana terapi hormon dan pembedahan dapat memberikan dampak pada kualitas hidup dan psikososial. Tujuan Penelitian ini dilakukan untuk mengetahui gambaran spektrum klinis, luaran (diagnosis akhir, gender assignment, pembedahan), kualitas hidup, gangguan psikososial dan faktor-faktor yang memengaruhinya. Metode Studi dilakukan terhadap 122 anak yang berusia kurang dari 18 tahun dengan DSD 46,XY yang berobat ke RSUPN Cipto Mangunkusumo pada 5 tahun terakhir. Pengambilan data sekunder seperti spektrum dan luaran klinis dilakukan mulai Januari hingga Mei 2022. Sebanyak 56 subyek dilakukan wawancara untuk evaluasi kualitas hidup dengan instrumen The Pediatric Quality of Life Inventory (PedsQLTM) dan gangguan psikososial dengan instrumen Strength and Difficulties Questionnaire (SDQ).Hasil Manifestasi klinis terbanyak pada DSD 46,XY adalah hipospadia (97,5%), mikropenis (82,8%), skor EMS < 7 (81,1%), dan skrotum bifidum (75,4%). Sebagian besar individu dengan DSD 46,XY ditetapkan (gender assignment) sebagai lelaki (98,4%), dengan 5,74% subyek yang mengalami perubahan gender assignment dari perempuan. Diagnosis akhir pada DSD 46,XY adalah gangguan maskulinisasi (89,34%), disgenesis gonad (7,38%) dan gangguan sintesis/fungsi androgen (3,28%). Prevalensi gangguan kualitas hidup dan psikososial pada DSD 46,XY rendah. Analisis fungsi domain PedsQLTM dan SDQ menunjukkan 10,71% dan 25,64% subyek mengalami gangguan pada salah satu fungsi kualitas hidup dan/atau salah satu komponen psikososial. Pembedahan pada DSD 46,XY berhubungan dengan fungsi emosi kualitas hidup (p = 0,012) dan psikososial (p = 0,025), sedangkan skor EMS berhubungan dengan fungsi sekolah (p = 0,038).

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Background : Clinical Manifestations, Outcomes, and Quality of Life in Children with 46,XY Disorder of Sex Development (DSD) : Dr. Frida Soesanti, Sp.A(K) DR. Dr. Irfan Wahyudi, Sp.U(K) DR. Dr. Bernie Endyarni Medise, Sp.A(K), MPH Disorders of sex development (DSD) 46,XY is a developmental disorder of gonadal, external, and internal genitalia associated with chromosome 46,XY abnormalities. Varied clinical manifestations, definitive diagnosis, gender assignment, hormone replacement therapy, and surgery may have an impact on the quality of life and psychosocial problems. Objective The study aims to describe clinical manifestations, outcomes (definitive diagnosis, gender assignment, surgery), quality of life, psychosocial problems, and their related factors in children with 46,XY DSD. Methods A study was conducted on 122 subjects below 18 years of age who had been initially diagnosed with 46,XY DSD for the past 5 years (2017-2022) in Cipto Mangunkusumo General Hospital, Jakarta. Secondary data such as clinical manifestations and outcomes were collected from both paper-based and electronic-based medical records from January until May 2022. Fifty-six subjects were able to join telephone interviews assessing their quality of life using The Pediatric Quality of Life Inventory (PedsQLTM) and psychosocial problems using the Strength and Difficulties Questionnaire (SDQ). All data were statistically analyzed with SPSS version 25.0.

Results The most common clinical manifestations in 46,XY DSD were hypospadias (97.5%), micropenis (82.8%), EMS score < 7 (81.1%), and bifid scrotum (75.4%). The majority of the subjects were finally assigned as male (98,4%) with only 5.74% of subjects having gender assignment change from female to male. The definitive diagnosis of DSD 46,XY was undermasculinization disorder (undefined) (89.34%), gonadal dysgenesis (7.38%), and androgen insensitivity syndromes (3.28%). The prevalence of quality of life disorders and psychosocial problems was low. PedsQLTM and SDQ subscale analysis showed that 10.17% and 25.64% of subjects had abnormal scores of quality of life and psychosocial problems, respectively. Surgery was associated with lower emotional function in PedsQLTM (p = 0,012) and its total score (p = 0,023), and emotional component of SDQ (p = 0.025). Scores of EMS were also associated with the school function of PedsQLTM (p = 0.038). Conclusion Surgery is an important factor affecting the emotional function of the quality of life and psychosocial problems; whereas an EMS score < 7 is associated with school function."

"Tindak pidana yang dilakukan oleh seorang pengidap eksibisionisme, yang merupakan salah satu bentuk dari gangguan parafilia atau suatu kelainan seksual merupakan hal yang kerap terjadi berbagai negara, terutama di Indonesia. Hal tersebut menjadi suatu masalah hukum dikarenakan disatu pihak perilaku ini adalah suatu gangguan berupa kelainan seksual sementara di pihak lainnya perilaku ini menjadi suatu gangguan dalam tatanan sosial masyarakat. Sanksi pidana tidak dapat menjadi satu-satunya alat untuk mengendalikan angka tindak pidana yang dilakukan oleh seorang pengidap eksibisionisme. Dalam praktik, penjatuhan sanksi pidana yang dijatuhkan terhadap pelaku tindak pidana pengidap eksibisionisme cenderung tidak sesuai karena hakim kerap tidak mempertimbangkan kondisi psikis dari pelaku tindak pidana pengidap eksibisionisme tersebut. Padahal, faktor tersebut perlu untuk selalu dipertimbangkan oleh hakim mengingat kondisi pelaku tindak pidana pengidap eksibisionisme yang kerap membutuhkan suatu terapi dan pengobatan medis karena munculnya dorongan yang tidak terkontrol akan hasrat seksual untuk memamerkan alat kelamin miliknya dan melakukan aktivitas seksual yang tidak normal di tempat umum. Mengingat saat ini telah ada pengaturan mekanisme penjatuhan sanksi tindakan dan pemidanaan secara bersamaan dengan konsep Double Track System, maka diharapkan konsep tersebut dapat menciptakan suatu fleksibilitas dalam sistem pemidanaan di Indonesia terhadap pelaku tindak pidana pengidap eksibisionisme. Adapun penelitian ini bertujuan untuk menentukan porsi pemidanaan yang tepat terhadap pelaku tindak pidana pengidap eksibisionisme dengan memanfaatkan konsep pemidanaan Double Track System. Lebih lanjut, metodologi yang digunakan dalam penelitian ini adalah yuridis-normatif dengan wawancara untuk melengkapi data temuan. Dengan mengangkat topik terkait pemidanaan dengan menggunakan konsep Double Track System terhadap pelaku eksibisionisme, diharapkan penelitian ini dapat menjadi bahan diskursus dan mampu memberikan solusi terkait cara penjatuhan pemidanaan yang tepat agar dapat mencegah timbulnya residivisme maupun munculnya korban-korban lainnya dari pelaku kejahatan yang mengidap kelainan seksual berupa eksibisionisme.

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Criminal acts committed by a person with exhibitionism, which is a form of paraphilia or a sexual disorder, are common in various countries, especially in Indonesia. This becomes a legal issue because, on the one hand, such behaviour is a form of sexual disorder. Meanwhile, on the other hand, this behaviour also brings a social disorder to society. Criminal sanction cannot be the only way to control the number of crimes that are committed by exhibitionists. In practice, the imposition of criminal sanctions imposed on perpetrators of crimes with exhibitionism tends to be inappropriate because judges often do not consider the psychological condition of the perpetrators of crimes with exhibitionism. In fact, it is necessary for the judges to always consider this factor since the condition of the perpetrators of exhibitionism often requires therapy and medical treatment due to the emergence of an uncontrolled urge for sexual desire to show their genitals and engage in abnormal sexual activity in public places. Subsequently, considering that currently there is a mechanism for imposing sanctions in the form of treatment and criminal sanction simultaneously within the concept of the Double Track System, one might hope that this concept can create flexibility in the Indonesian sentencing system for the perpetrators of exhibitionism. This study aims to determine the appropriate portion of punishment for perpetrators of exhibitionism by utilizing the Double Track System sentencing concept. Furthermore, the methodology of this research is juridical-normative with interviews to complete the research findings. By discussing the topic regarding the imposition of criminal sentencing by utilizing the Double Track System concept for the perpetrators of exhibitionism, it is expected that this research could become the foundation of discourse and be able to provide solutions regarding the appropriate way of imposing punishments towards the perpetrators of exhibitionism in order to prevent recidivism from occurring and the emergence of other victims who suffer from such sexual disorders."

"The rapid advances in medicine over the last 50 years have totally changed the outlook for children with disorders of sex development (DSD), but there is still much to learn. This book crystallizes the combined experience of a leading dedicated unit over 25 years in delivering expert medical and surgical care to children with DSD in a holistic environment. It documents the most recent advances in the molecular biology and embryology of sex development, and describes each disorder in detail. The clinical presentation and approach to diagnosis are described both for babies and for children presenting later in childhood or at adolescence. The chapters on management highlight all the latest knowledge and include the shared wisdom of the authors on current controversies, such as the timing of surgical treatment. Finally, the authors describe their short-, medium-, and long-term outcomes, which demonstrate the strengths of holistic team management."