"I don't believe in non-binarity and don't really understand it," says a leading Czech sexologist who specializes in trans patients

Before we get to MUDr. Fifková's words, let us say for the sake of argument what non-binarity is and what all falls under this label. Let's borrow a clear text from the Trans*parent website:

Non-binary people do not fit at all or completely into the category of male or female. This includes people with fluid gender (i.e. gender identity that changes over the course of a lifetime), people with multiple genders at once, people with a gender that is neither male nor female, or people who have no gender at all. Some non-binary people are considered trans, others are not.

Then there are various other divisions of non-binary people, but these are not relevant at this time. Rather, let's hear the words of Dr. Fifkova, a renowned Czech sexologist and psychotherapist with over 30 years of experience in the field. She specialises in working with trans people and is known for her conservative approach to gender identity issues. Her opinions often spark discussions and polarize the public, which is sure to happen thanks to her recent interview for the Rozstřel program on idnes.cz.

"You know, I'm old school. I just think that it's just a man and a woman or a trans man and a trans woman, that's my opinion and just let everyone be as angry as they want," Fifková says at the beginning of Rozstrel.

She said it is important that comprehensive information about transsexuality, homosexuality and heterosexuality is part of school education, but she has doubts about the way children have been informed about these topics in recent years: "That children are being indoctrinated at a very early age with the gender menu, that in second grade a girl is deciding whether she is asexual or pansexual, and in third grade whether she is trans or demi or I don't know what, that's not good at all."

On the other hand, Fifkova points out that there are cases where children show clear signs of gender non-conformity at an early age, without any indoctrination: "There it looks like you have a little girl and the little girl, when she starts talking, she starts talking in boyish gender, she says: I'm a boy. She tries to pee standing up, she demands boy boxers, and she behaves quite naturally."

Recently, the public (media) space has been flooded with a plethora of reports from the "trans" milieu, which provoke various reactions that then successfully divide society. How does Dr. Fifkova feel about this newfound media fame of trans issues? "The situation in the field of people suffering from a serious congenital disorder, gender non-conformity, has really become more dramatic in recent years. But I would reassure the public that it's only about tenths of a per mille of the population. For example, the commission that approves applications for surgical procedures in the Czech Republic confirms that the numbers have increased, but since 2014 it has gone from 150 to only 300. These are still relatively small numbers," he says.

"There is a backlash against the intense propaganda in society. So on one side are the activists who say the more trans the better, give everyone testosterone at the second appointment, and on the other side are the conservative therapists. And I don't mean conservative in a good way. They don't acknowledge transsexuality at all. They've always been there, and they've always said that it's always an acquired problem, that it's always a matter of some trauma in childhood, and it needs to be treated: psychotherapeutically, psychoanalytically, until the identity is cured. These are the two poles, and we sexologists are now somewhere in between," he continues.

Fifkova also points to a change in terminology in sexology, where terms like disease or disorder can be considered pejorative. Thus, the term gender non-conformity is used. "In the new diagnostic manual, gender non-conformity will be taken out of the mental illness box and will now be categorised under sexual health, which on the other hand is another confusion of terms." In the Czech Republic, almost all steps in the process of gender reassignment are covered by health insurance, and if gender non-conformity is not considered a disorder, this entitlement could be jeopardised, Fifková believes.

As for non-binary people, she admits that she does not understand their identity and cannot provide them with adequate care: 'They don't come to me because I said somewhere that I don't believe in non-binarity. And I don't really understand it because no matter how many clients I've talked to who have identified themselves as non-binary, they have not been able to explain to me the origin of this idea of theirs."

A sexological and medical perspective on non-binarity

From a professional perspective, non-binarity is a complex and diverse phenomenon that still needs further research and understanding. Modern sexology struggles to provide a framework that encompasses all gender identities, including non-binary ones. Many experts agree on the importance of approaching people with respect for their identity and providing them with the support and care they need.

Studies on non-binary identities

One important study that has contributed to the understanding of non-binary identities is research published in the online journal "Plos One". This study included over 2,000 participants, many of whom identified as non-binary. The results showed that non-binary individuals often face an increased risk of psychological problems such as anxiety and depression, which is often a result of stigma and lack of understanding from society and health professionals.

The study also highlighted that access to adequate health care and support can significantly improve the quality of life of non-binary people. Specifically, it found that non-binary people who had access to gender-affirming care reported lower levels of psychological distress and higher levels of satisfaction with their lives.

Changes in diagnostic manuals, such as the removal of gender incongruence from the mental illness label, reflect efforts to destigmatize these identities. While these changes are welcomed by many, there is also some concern that it could complicate access to health care, which is often essential for those undergoing the process of gender reassignment.

Challenges in the provision of care

Sexologists, physicians and therapists are thus struggling to find a balance between providing care and respecting their patients' identities, which is particularly important in the context of non-binary identities that defy traditional diagnostic and treatment approaches.

The next step is to expand the education of health professionals on non-binary identities and to raise awareness of the specific needs of this community. This includes not only theoretical knowledge but also practical skills and empathy in approaching patients.

Non-binary identity poses a challenge both to the individuals who identify with it and to the healthcare system, which must find ways to provide appropriate care. Research shows that gender-affirming approaches can make a significant contribution to improving the quality of life of non-binary people. Professionals must therefore continually educate themselves and adapt their approaches to be able to offer the best possible support and care to all people, regardless of their gender identity.