The participants were 107 Dutch speaking participants that had the surgery between 1986 and 2001 (Cuypere et al. 2005). The results demonstrate that those participants going form Female-to-males had more problems establishing a secure relationship following the transition (Cuypere et al. 2005). In fact the study found that a third of the female-to-males did not have a sexual partner following the surgery even though their sexual drives were intact (Cuypere et al. 2005). The results also found that in spite of the fact that participants had masculine presentations and sex organs, many of them steered clear of a relationship with a potential partner. This avoidance was present because he participants were not yet confident in their maleness (Cuypere et al. 2005). The study also found that when transsexual participants were able to establish a stable relationship, they were sexually satisfied. This finding is in contradiction with the findings of prior research (Bodlund & Kullgren, 1996), "who reported that male-to-females have, after transition, more frequently a new partner whereas the female-to-males tend to remain with the same partner, we observed no significant difference between the two groups (Cuypere et al. 2005, pg 679)."

Indeed, the results of treatment via reassignment surgery in adults can vary greatly. In his study of Male to Female sex reassignment surgery Lawrence (2005) explains that the sexual behaviors and attitudes of male-to-female (MtF) transsexuals before and after sex reassignment surgery (SRS) have long been of interest to sex researchers, clinicians, and MtF transsexuals themselves. One of the most important reasons MtF transsexuals undergo SRS is to acquire genitalia that will allow them to engage in sexual activity, specifically penile-vaginal intercourse, as women (Schroder & Carroll, 1999). Consequently, clinicians have sought to understand the sexological outcomes of SRS in order to inform and counsel their transsexual patients. Sexual orientation and sexual activity before SRS have often been regarded as important predictors of the success of sex reassignment (Lawrence 2005)."

The current study involved Male to Female transsexuals who had SRS between May 1994 and March 2000. All of the participants were patients of Toby Meltzer, M.D., who practices in Portland, Oregon. In addition all participants had undergone the surgery using a similar technique, which involved penile-inversion vaginoplasty and clitoroplasty using a fraction of the glans penis on a dorsal neurovascular pedicle (Lawrence 2005). The article explains that a total of 232 valid questionnaires were returned, this represented 32% of the patients that were believed to of had the surgery. In addition this number was representative of 65% of the patients that received the questionnaire. The mean age of the SRS patient when they underwent surgery was 44 years and their mean age at the time the survey was carried out was 47 (Lawrence 2005).

The article explains that is was hypothesized that this study would reflect other studies that found that Male to Female participants would change in sexual attraction and behavior and prefer male partners following the surgery (Lawrence 2005). This hypothesis was correct; however the study found that the median changes were small as it related to both sexual attraction and sexual behavior. However, there were some participants who reported a significant change in their sexual orientation. These participants were completely or nearly completely sexually oriented toward women prior to the surgery and completely or nearly completely sexually oriented toward men following the surgery (Lawrence 2005). The study also found that "these participants were virtually indistinguishable from participants who were exclusively or almost exclusively sexually oriented toward women both before and after SRS, based on the preoperative characteristics examined in this study (Lawrence 2005)."

The study also found that participants that experienced a significant change in sexual orientation were nearly impossible to differentiate from participants who were completely or nearly completely sexually oriented toward men prior to and following the surgery (Lawrence 2005). In addition, as it related to postoperative characteristics evaluated in the study; number of male partners following surgery was the most significant exception (Lawrence 2005).

The participants that noticed a significant change in the sexual orientation may have chosen a male partner following the surgery for the purposes of experimentation as opposed to a commitment (Lawrence 2005). Approximately 50% of the participants that reported having only female partners prior to the surgery and only male partners following the surgery asserted that they only had one male partner following the surgery (Lawrence 2005). If this assumption is not the case, the variable that were evaluated in the study do not provide a hypothesis to explicate why some Male to Female transsexuals experienced significant changes in sexual orientation following surgery and others do not experience such changes (Lawrence 2005).

In addition to the above hypothesis it was also hypothesized that the amount of sexual partners...

This hypothesis was also correct. The study found that the distribution of the amount of sexual partners reported by survey participants prior to surgery was closely correlated to the distribution of the amount of partners the participants had since the age of 18 reported by the NHSLS men (Laumann et al., 1994). This amount was markedly higher than the number reported by the NHSLS women. Even though the participant in the current survey were older than those in the NHSLS study and as such giving them more opportunity to accumulate partners -- this age difference was not consistent with the observed distribution of the amount of partners, since younger survey participants tended to report have more partners than the older individuals that took part in the survey (Lawrence 2005).
Recommendations for Practitioners

Debates concerning the treatment of GID are likely to continue well into the future, as there is still a great deal that is unknown about GID. A great deal of the research that currently exists on this topic is focused on treatment for children. The treatments that are available to children seemed to be geared toward assisting them in the area of self acceptance and some research indicates that these children are able to function well as homosexual adults. However, there is not a great deal of research available for individual that are diagnosed with GID as an adult. It seems the only treatment offered to adults is reassignment surgery which can be extremely problematic on both a physical and emotional level.

Because the research is scarce and somewhat difficult to determine, practitioners must attempt the different approaches that do seem to have some positive outcomes. It is recommended that practitioners seek out others in the field that has treated people with GID successfully. Beyond this, there must be more comprehensive studies that are conducted and that gradually improve practitioners' understanding of individuals with GID.

Conclusion

The purpose of this discussion was to examine the current treatment strategies for clients affected by Gender Identity Disorder. The discussion also includes a review of the literature and recommendations for practitioners. The research indicates that GID treatment for children is inclusive of individual and group therapy and also separate individual and group therapy for parents. The research also found that GID treatment for adults is also inclusive of therapy in addition to hormone therapy and reassignment surgery. The research indicates that there is still a great deal that is unknown about GID and as such practitioners must attempt treatments that have realized some positive outcomes.