Psychosomatic Medicine 24:249-256 (1962)
© 1962 American Psychosomatic Society

Physiological Test Findings in Adolescents Having Ovarian Dysgenesis

¹ Department of Psychiatry, Children's Hospital Medical Center, Boston, Mass.

Our purpose was to investigate the psychological characteristics of a group of girls with ovarian dysgenesis in order to understand these girls and help make their treatment as effective as possible.

The data do not reveal a "right" age for the initial administration of estrogen and other "female-enhancing" hormones. Rather, it makes evident the important variables that should be considered in the treatment plan for each girl. Hormone treatment will have a different meaning for each girl, depending upon her level of psychological maturity and her consequent perception of the purpose and result of treatment. For this reason, it was important to learn how the psychological development of these sexually immature girls compares with that of biologically healthy adolescents. We turned to an analysis of fantasy and drawings, using data from these to learn about the psychological correlates of ovarian dysgenesis.

In our sample, 3 of the patients showed themselves in their attitudes, fantasies, and drawings to be in the process of establishing a satisfactory identification with their biologically determined sex. In these girls, we see desires for boy friends and marriage as a dominant part of their fantasy lives. As can be expected, there are competitive feelings with other women and concern over their adequacy as women. Hormone treatment for these girls can be explained as helping them to become more feminine, helping them menstruate, and helping them to be more attractive to boys. Girls of this level of maturity need only an explanation of the procedures to be followed and the results to be expected. To be sure, the amount of anxiety may increase as their physiology changes, but the changes will be congruent with their psychological feelings and fantasies of being feminine and grown up. The physician will recognize the usual psychological changes of the biologically healthy adolescent girl. The important problem of these girls' inability to bear children can be handled realistically when they are emotionally ready to discuss it, and they can be encouraged to adopt children when they are ready for parenthood.

However, for the remaining 7 girls in the sample, the problem of determining when to begin estrogen therapy appears more difficult. The data suggest that these girls need considerable help with their feelings before they are psychologically ready for drugs. Often their important need gratifications center almost exclusively in their relationships with their mothers; the sexual and aggressive feelings which accompany the desire to be independent, mature females are quite absent. The data suggest that these patients have not mastered the first two of the four developmental problems mentioned above: the modification of the all-powerful concept of parents, and the identification with the biologically determined sex role.

In these girls, the need to be dependent, asexual, good children, or the wish to enjoy the bisexual gratifications of doing what both boys and girls do, will necessarily conflict with the physical changes produced by the drugs, and with the psychological effects intended. Their methods for coping with anxieties arising from instinctual wishes resemble those of 8- to 10-year-old girls who have not yet experienced biological changes. Therefore, vigorous attempts to bring about more adolescent attitudes and feelings of these girls will probably generate considerable anxiety, despite their rather good defensive structures. Sudden pressure to give up established patterns of adjustment, especially when these have kept anxiety to a minimum well into the teen years, can have disastrous consequences. After psychotherapy to prepare and motivate them, most of the girls will probably be able to deal with the changes produced by estrogen. The few others who cannot accept the changed physiology as sexual change, could perhaps be given reasons compatible with their personalities: e.g., that estrogen therapy is necessary to prevent premature aging, or that it will help them grow.

These psychological test results suggest that those administering hormone treatment to girls who have ovarian dysgenesis should be aware of the fantasy life of each girl treated, and should take into account each patient's ability to assimilate those personality changes which lead to a more mature femininity.