Sex Reassignment Surgery
Sex reassignment surgery (male-to-female) from male to female involves reshaping the male genitals into a form with the appearance of and, as far as possible, the function of female genitalia. Prior to any surgeries, transwomen usually undergo hormone replacement therapy and facial hair removal. Other surgeries undergone by transwomen may include facial feminization surgery and various other procedures.
History
Lili Elbe was the first known recipient of male-to-female sex reassignment surgery in Germany in 1930. She was the subject of five surgeries: penectomy and orchiectomy, one intended to transplant ovaries, one to remove the ovaries after transplant rejection, and vaginoplasty. However, she died three months after her fifth operation. …show more content…
Christine Jorgensen was likely the most famous recipient of sex reassignment surgery, having her surgery done in Denmark in late 1952 and being outed right afterwards. She was a strong advocate for the rights of transsexual people.
Another famous person to undergo male-to-female sex reassignment surgery was Renée Richards. She transitioned and had surgery in the mid-1970s, and successfully fought to have transsexual people recognized in their new sex.
The first male-to-female surgeries in the United States took place in 1966 at the Johns Hopkins University Medical Center.
Genital surgery
Main article: Vaginoplasty
For changing anatomical sex from male to female, the testicles are removed and the skin of foreskin and penis is usually inverted, as a flap preserving blood and nerve supplies (a technique pioneered by Sir Harold Gillies in 1951) to form a fully sensate vagina (vaginoplasty). A clitoris fully supplied with nerve endings (innervated) can be formed from part of the glans of the penis. If the patient has been circumcised (removal of the foreskin), or if the surgeon's technique uses more skin in the formation of the labia minora, the pubic hair follicles are removed from some of the scrotal tissue, which is then incorporated by the surgeon within the vagina. Other scrotal tissue forms the labia majora.
In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from skin grafts from the thighs or hips, or a section of colon may be grafted in (colovaginoplasty). These linings may not provide the same sensate qualities as results from the penile inversion method, but the vaginal opening is identical, and the degree of sensation is approximately the same as that of most women so pleasure should not be less.
Surgeon's requirements, procedures and recommendations in the days before and after, and the months following these procedures vary enormously.
Plastic surgery, since it involves skin, is never an exact art, and cosmetic refining to the outer vulva is sometimes required. Some surgeons prefer to do most of the crafting of the outer vulva as a second surgery, when other tissues, blood and nerve supplies have recovered from the first surgery. This relatively minor surgery, which is usually performed only under local anesthetics, is called labiaplasty.
The aesthetic, sensational, and functional results of vaginoplasty vary greatly. Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability (which is especially affected by smoking), any previous surgery in the area can impact results, and surgery can be complicated by problems such as infections, blood loss, or nerve damage. However, in the best cases, when recovery from surgery is complete, it is often very difficult for anyone, including gynecologists[dubious – discuss], to detect women who have undergone vaginoplasty.
A supporter of colovaginoplasty state that this method is better than use of skin grafts for the reason that colon is already mucosal, whereas skin is not. However, many post-op Trans women report that the skin used to line their vaginas develops mucosal qualities from months to year’s post-op (http://www.gendercare.com/italiano_paper1.html). For others, lubrication is needed when having sex and occasional douching is advised so that a bacterium does not start to grow and give off odors.
Because the human body treats the new vagina as a wound, any current technique of vaginoplasty requires some long-term maintenance of volume (vaginal dilation), by the patient, using medical graduated dilators, dildos, or suitable substitutes, to keep the vagina open. It is very important to note that sexual intercourse is not always an adequate method of performing dilation.
Regular application of estrogen into the vagina, for which there are several standard products, may help but this must be calculated into total estrogen dose. Some surgeons have techniques to ensure continued depth, but extended periods without dilation will still often result in reduced diameter (vaginal stenosis) to some degree, which would require stretching again, either gradually or, in extreme cases, under anaesthetic.
With current procedures, transwomen do not have ovaries or uteruses. This means that they are unable to bear children or menstruate, and that they will need to remain on hormone therapy after their surgery to maintain female hormonal status.
Other related procedures
Facial feminization surgery
Occasionally these basic procedures are complemented further with feminizing cosmetic surgeries or procedures that modify bone or cartilage structures, typically in the jaw, brow, forehead, nose and cheek areas (facial feminization surgery or FFS).
Breast implants
Breast implants is the enlargement of breasts, which some transwomen choose if hormone therapy does not yield satisfactory results.
Voice feminization surgery
See also: Voice therapy (trans)#Vocal surgeries
Some MTF individuals may elect to have voice surgery altering the range or pitch of the person's vocal cords. However, this procedure carries the risk of impairing a trans woman's voice forever, as happened to transsexual economist and author Deirdre McCloskey. Because estrogens by themselves are not able to alter a person's voice range or pitch, some people proceed to seek treatment. Other options are available to people wishing to speak in a less masculine tone. Voice feminization lessons are available to train transwomen to practice feminization of their speech.
Tracheal shaves
Tracheal shaves are also sometimes used to reduce the cartilage in the area of the throat to conform to more feminine dimensions, to greatly reduce the appearance of an Adam's apple.
Buttock augmentation
Because male hips and buttocks are generally smaller than those of a female, some MTF individuals will choose to undergo buttock …show more content…
augmentation.
Hormone replacement therapy (HRT) for transgender and transsexual people replaces the hormones naturally occurring in their bodies with those of the other sex. However, not all cases of hormone replacement therapy are used by transgendered people. Some reasons for this include men who wish to have a hair-free body, as a result of less of the testosterone, androgens in their body. Its purpose is to cause the development of the secondary sex characteristics of the desired gender. It cannot undo the changes produced by the first natural occurring puberty of transgender people, this is done by sexual reassignment surgery and for transwomen by epilation. Some intersex people also receive HRT, either starting in childhood to confirm the gender they were assigned, or later, if this assignment has proven to be incorrect.
While some argue that hormonal therapy does not truly masculinize or feminize, the question is one of definitions. If by masculinize and feminize one means to completely reproduce the male or female biological state, that cannot be done with current medical or surgical therapy. However, the goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their true psychological gender identity. It should be noted that the effects of hormonal therapy are often much more satisfying to transgender men than transgender women. It is easier to produce secondary male sexual characteristics with androgens than it is to rid transgender women of those established characteristics.
Sex change pair sue over side effects of operations
By Darwin Templeton
TWO transsexuals are suing an Ulster health board, claiming problems arising from sex change operations ruined their lives. The pair, who received surgery to switch from male to female, are understood to be demanding total damages of more than £400,000.And experts say the outcome of the cases could force a major re-think in the way health boards treat people who want to change gender. The two were sent by the Eastern Health Board to Scotland for the operation - known as gender reassignment surgery - in 1990.One, Barbara Barrett, is alleging she needed two more corrective operations and is still struggling to cope with the after-effects. Formerly known as Bob, Ms Barrett (45) lived in Belfast and Enniskillen, but has now set up home in England. When traced by the Belfast Telegraph, she said: “I can confirm I am taking legal action against the Eastern Board and named individuals.” As a consequence of the treatment I have had severe physical, social and psychological problems. “I would appeal for people to look beyond the nature of the operation and understand that there are wider issues involved. “And I would ask the media to restrain their curiosity until the full details of the case emerge in court.” A spokesperson for the board said: “Two cases for compensation have been taken against the board and other defendants. “They are being taken by two individuals who underwent gender reorientation surgery nearly 10 years ago. “The board has appointed solicitors and other advisors to deal with our defense. “Because of the legal situation, we cannot comment any further.” Papers have been lodged at the Court of Session, in Edinburgh and legal teams on both sides are formulating their cases, which will probably be heard next year. It is estimated fewer than 10 people in Northern Ireland have had sex change operations. Before being recommended for surgery, candidates undergo a lengthy assessment procedure. They are seen by a psychiatrist and are usually asked to take a “real life test”, which involves living as their preferred gender for a period.
© Copyright Belfast Telegraph Newspapers Ltd.
Sex reassignment surgery (SRS), gender reassignment surgery, or sex-change operation is a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble that of the other sex.
It is part of a treatment for gender identity disorder in transsexual and transgender people. It may also be performed on intersex people, often in infancy. Other terms for SRS include gender reassignment surgery, sex reconstruction surgery, genital reconstruction surgery, gender confirmation surgery, and more recently sex affirmation surgery. The commonly used terms sex change or sex change operation is considered factually inaccurate. The terms feminizing genitoplasty and masculinizing genitoplasty are used medically. The best known of these surgeries are those that reshape the genitals, which are also known as genital reassignment surgery or genital reconstruction surgery (GRS).The meaning of sex reassignment surgery usually differs for transwomen (male to female) rather than transmen (female to male). For transwomen, sex reassignment usually involves the surgical construction of a vagina, whereas in the case of transmen, this term may entail any of a variety of procedures, from the mastectomy (removal of the female breasts) to the shaping of a male-contoured chest to the construction of a penis. Additionally, transmen usually undergo a hysterectomy and bilateral salpingo-oophorectomy.Chest (or "top") surgery is
often the only surgical procedure female-to-male transsexuals choose to undergo, as GRS techniques for transmen are still rather unrefined and typically produce genitalia of compromised aesthetic and functional quality. For some transwomen, facial feminization surgery and breast augmentation are also important parts of the sex reassignment process. People who pursue sex reassignment surgery are usually referred to as transsexual; "trans" - across, through, change; "sexual" - pertaining to the sexual characteristics (not sexual actions) of a person. More recently, people pursuing SRS often identify as transgender instead of transsexual.
Terminology
Transsexual people are often defined as those who undergo sex reassignment surgery, although some in the transgender community reject this definition; the term gender confirmation surgery is preferred by many. Transgender transition is an individualized process. Some individuals require hormone therapy and multiple surgical procedures for their transition to be successful, some may require no medical intervention at all, and others may require some conservative medical interventions. Many use the terms sex reassignment therapy, "sex reassignment” or "sex reassignment surgery" (aka SRS) to describe these medical procedures. However, many in the transgender community find these terms offensive. Implicit in the word "reassignment" is the idea that someone other than the self can "assign" or otherwise decide a person's gender. This is in clear conflict with the concept of "gender identity" which is a person's internal knowledge of their own gender. Many transgender and transsexual individuals feel strongly that their internal sense of their gender - their gender identity- is not subject to the assignment or reassignment by others. While some feel that the term "sex reassignment surgery" would more accurately be called "genital reassignment surgery" or "genital reconstruction surgery", it is important to note that the surgeries related to transgender transition go beyond the genitalia, and that the medical procedures go beyond surgery.
Medical considerations
Those with HIV or hepatitis C may have difficulty finding a surgeon able or even willing to perform surgery because many surgeons operate out of small private clinics that cannot adequately treat potential complications in these populations. Some surgeons charge higher fees for HIV and hepatitis C positive patients (some surgeons in developing countries prefer to dispose of surgical instruments used on these populations).Other health conditions such as diabetes, abnormal blood clotting, and obesity do not usually present a problem to experienced surgeons, but do increase the anesthetic risk and the rate of post-operative complications. Some surgeons require that severely overweight patients reduce their weight by a certain amount prior to surgery and that patient’s refrain from smoking for a period of time before and after surgery, although this is considered common practice regardless of the operation performed.
Results
As a result of SRS, the person will have the external anatomical appearance and function typical of the new sex. At the microscopic level, the individual will retain their previous chromosomes in each of their cells, and their previous susceptibilities to X-linked or Y-linked genetic conditions or predispositions. They are unable to reproduce due to the lack of sex glands (testes or ovaries), except through prior sperm banking or embryonic freezing, which still require a receptive woman with a uterus to act as the surrogate mother (See Reproductive technology.) If the person has the SRS early before puberty, the person will retain the younger "girlish" voice.[citation needed] There is a chance, low currently and shrinking as time passes and techniques improve, that the patient may become in orgasmic after surgery due to nerve damage. Additionally, it is usually necessary for transsexual people to continue hormone replacement therapy in order to maintain their secondary sex characteristics and prevent conditions such as osteoporosis. Transsexual people who do not undergo SRS/GRS are often called non-op, while "gender refusenik" is a slang term used among transgender people. Possible reasons for forgoing SRS include financial, legal, and medical concerns, among others.
Standards of care
Sex reassignment surgery can be difficult to obtain. There are very few surgeons willing to perform SRS. Most jurisdictions and medical boards require a minimum duration of psychological evaluation and living as a member of the target gender full time, sometimes called the real life experience (RLE) or real life test (RLT) before SRS is permitted. However, transsexual and transgender people are often unable to change the listing of their sex in public records until SRS is completed, due to the laws of many jurisdictions. (See legal aspects of transsexualism.)
In many countries or areas, an individual's pursuit of SRS is often governed, or at least guided, by documents called Standards of Care for Gender Identity Disorders (SOC). This most widespread SOC in this field is published and frequently revised by the World Professional Association for Transgender Health (WPATH, formerly the Harry Benjamin International Gender Dysphoria Association or HBIGDA). Standards of Care usually give certain very specific "minimum" requirements as prerequisites to SRS. For this and many other reasons, both the WPATH-SOC and other SOCs are highly controversial and often maligned documents among transgender patients seeking surgery. Some alternative local standards of care exist, such as in the Netherlands, Germany, and Italy. Much of the criticism surrounding the HBIGDA-SOC applies to these as well, and some of these SOCs (mostly European SOC) are actually based on much older versions of the WPATH-SOC. Other SOCs are entirely independent of the WPATH. The criteria of many of those SOCs are stricter than the latest revision of the WPATH-SOC. The majority of qualified surgeons in North America and many in Europe adhere almost unswervingly to the WPATH-SOC or other SOCs.
History
The earliest identifiable recipient of Male to Female Sex Reassignment Surgery was Lili Elbe in Berlin, in 1930-1931. This was started with the removal of the male sex organs and was supervised by Dr. Magnus Hirschfeld. Lili went on to have four more subsequent operations that included an unsuccessful uterine transplant, the rejection of which resulted in death. An earlier known recipient of this was Magnus Hirschfeld's housekeeper,[1] but her identity is unclear at this time.
Sex changes to avoid persecution
Filmmaker Tanaz Eshaghian discovered that the Iranian government's solution for homosexuality is forced sex change operations. The leader of Iran's Islamic Revolution, Ayatollah Ruholla Khomeini, issued a fatwa declaring sex changes permissible for “diagnosed transsexuals.”[2] Eshaghian's documentary, Be Like Others, chronicles a number of stories of Iranian gay men who feel a sex change is the only way to avoid further persecution, jail and/or execution.[2] The head of Iran's main transsexual organization, Maryam Khatoon Molkara—who convinced Khomeini to issue the fatwa on transsexuality—confirmed that some people who undergo operations are gay rather than transsexual.[3] Only Thailand performs more sex change operations than Iran.
History
Lili Elbe was the first known recipient of male-to-female sex reassignment surgery in Germany in 1930. She was the subject of five surgeries: penectomy and orchiectomy, one intended to transplant ovaries, one to remove the ovaries after transplant rejection, and vaginoplasty. However, she died three months after her fifth operation. …show more content…
Christine Jorgensen was likely the most famous recipient of sex reassignment surgery, having her surgery done in Denmark in late 1952 and being outed right afterwards. She was a strong advocate for the rights of transsexual people.
Another famous person to undergo male-to-female sex reassignment surgery was Renée Richards. She transitioned and had surgery in the mid-1970s, and successfully fought to have transsexual people recognized in their new sex.
The first male-to-female surgeries in the United States took place in 1966 at the Johns Hopkins University Medical Center.
Genital surgery
Main article: Vaginoplasty
For changing anatomical sex from male to female, the testicles are removed and the skin of foreskin and penis is usually inverted, as a flap preserving blood and nerve supplies (a technique pioneered by Sir Harold Gillies in 1951) to form a fully sensate vagina (vaginoplasty). A clitoris fully supplied with nerve endings (innervated) can be formed from part of the glans of the penis. If the patient has been circumcised (removal of the foreskin), or if the surgeon's technique uses more skin in the formation of the labia minora, the pubic hair follicles are removed from some of the scrotal tissue, which is then incorporated by the surgeon within the vagina. Other scrotal tissue forms the labia majora.
In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from skin grafts from the thighs or hips, or a section of colon may be grafted in (colovaginoplasty). These linings may not provide the same sensate qualities as results from the penile inversion method, but the vaginal opening is identical, and the degree of sensation is approximately the same as that of most women so pleasure should not be less.
Surgeon's requirements, procedures and recommendations in the days before and after, and the months following these procedures vary enormously.
Plastic surgery, since it involves skin, is never an exact art, and cosmetic refining to the outer vulva is sometimes required. Some surgeons prefer to do most of the crafting of the outer vulva as a second surgery, when other tissues, blood and nerve supplies have recovered from the first surgery. This relatively minor surgery, which is usually performed only under local anesthetics, is called labiaplasty.
The aesthetic, sensational, and functional results of vaginoplasty vary greatly. Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability (which is especially affected by smoking), any previous surgery in the area can impact results, and surgery can be complicated by problems such as infections, blood loss, or nerve damage. However, in the best cases, when recovery from surgery is complete, it is often very difficult for anyone, including gynecologists[dubious – discuss], to detect women who have undergone vaginoplasty.
A supporter of colovaginoplasty state that this method is better than use of skin grafts for the reason that colon is already mucosal, whereas skin is not. However, many post-op Trans women report that the skin used to line their vaginas develops mucosal qualities from months to year’s post-op (http://www.gendercare.com/italiano_paper1.html). For others, lubrication is needed when having sex and occasional douching is advised so that a bacterium does not start to grow and give off odors.
Because the human body treats the new vagina as a wound, any current technique of vaginoplasty requires some long-term maintenance of volume (vaginal dilation), by the patient, using medical graduated dilators, dildos, or suitable substitutes, to keep the vagina open. It is very important to note that sexual intercourse is not always an adequate method of performing dilation.
Regular application of estrogen into the vagina, for which there are several standard products, may help but this must be calculated into total estrogen dose. Some surgeons have techniques to ensure continued depth, but extended periods without dilation will still often result in reduced diameter (vaginal stenosis) to some degree, which would require stretching again, either gradually or, in extreme cases, under anaesthetic.
With current procedures, transwomen do not have ovaries or uteruses. This means that they are unable to bear children or menstruate, and that they will need to remain on hormone therapy after their surgery to maintain female hormonal status.
Other related procedures
Facial feminization surgery
Occasionally these basic procedures are complemented further with feminizing cosmetic surgeries or procedures that modify bone or cartilage structures, typically in the jaw, brow, forehead, nose and cheek areas (facial feminization surgery or FFS).
Breast implants
Breast implants is the enlargement of breasts, which some transwomen choose if hormone therapy does not yield satisfactory results.
Voice feminization surgery
See also: Voice therapy (trans)#Vocal surgeries
Some MTF individuals may elect to have voice surgery altering the range or pitch of the person's vocal cords. However, this procedure carries the risk of impairing a trans woman's voice forever, as happened to transsexual economist and author Deirdre McCloskey. Because estrogens by themselves are not able to alter a person's voice range or pitch, some people proceed to seek treatment. Other options are available to people wishing to speak in a less masculine tone. Voice feminization lessons are available to train transwomen to practice feminization of their speech.
Tracheal shaves
Tracheal shaves are also sometimes used to reduce the cartilage in the area of the throat to conform to more feminine dimensions, to greatly reduce the appearance of an Adam's apple.
Buttock augmentation
Because male hips and buttocks are generally smaller than those of a female, some MTF individuals will choose to undergo buttock …show more content…
augmentation.
Hormone replacement therapy (HRT) for transgender and transsexual people replaces the hormones naturally occurring in their bodies with those of the other sex. However, not all cases of hormone replacement therapy are used by transgendered people. Some reasons for this include men who wish to have a hair-free body, as a result of less of the testosterone, androgens in their body. Its purpose is to cause the development of the secondary sex characteristics of the desired gender. It cannot undo the changes produced by the first natural occurring puberty of transgender people, this is done by sexual reassignment surgery and for transwomen by epilation. Some intersex people also receive HRT, either starting in childhood to confirm the gender they were assigned, or later, if this assignment has proven to be incorrect.
While some argue that hormonal therapy does not truly masculinize or feminize, the question is one of definitions. If by masculinize and feminize one means to completely reproduce the male or female biological state, that cannot be done with current medical or surgical therapy. However, the goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their true psychological gender identity. It should be noted that the effects of hormonal therapy are often much more satisfying to transgender men than transgender women. It is easier to produce secondary male sexual characteristics with androgens than it is to rid transgender women of those established characteristics.
Sex change pair sue over side effects of operations
By Darwin Templeton
TWO transsexuals are suing an Ulster health board, claiming problems arising from sex change operations ruined their lives. The pair, who received surgery to switch from male to female, are understood to be demanding total damages of more than £400,000.And experts say the outcome of the cases could force a major re-think in the way health boards treat people who want to change gender. The two were sent by the Eastern Health Board to Scotland for the operation - known as gender reassignment surgery - in 1990.One, Barbara Barrett, is alleging she needed two more corrective operations and is still struggling to cope with the after-effects. Formerly known as Bob, Ms Barrett (45) lived in Belfast and Enniskillen, but has now set up home in England. When traced by the Belfast Telegraph, she said: “I can confirm I am taking legal action against the Eastern Board and named individuals.” As a consequence of the treatment I have had severe physical, social and psychological problems. “I would appeal for people to look beyond the nature of the operation and understand that there are wider issues involved. “And I would ask the media to restrain their curiosity until the full details of the case emerge in court.” A spokesperson for the board said: “Two cases for compensation have been taken against the board and other defendants. “They are being taken by two individuals who underwent gender reorientation surgery nearly 10 years ago. “The board has appointed solicitors and other advisors to deal with our defense. “Because of the legal situation, we cannot comment any further.” Papers have been lodged at the Court of Session, in Edinburgh and legal teams on both sides are formulating their cases, which will probably be heard next year. It is estimated fewer than 10 people in Northern Ireland have had sex change operations. Before being recommended for surgery, candidates undergo a lengthy assessment procedure. They are seen by a psychiatrist and are usually asked to take a “real life test”, which involves living as their preferred gender for a period.
© Copyright Belfast Telegraph Newspapers Ltd.
Sex reassignment surgery (SRS), gender reassignment surgery, or sex-change operation is a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble that of the other sex.
It is part of a treatment for gender identity disorder in transsexual and transgender people. It may also be performed on intersex people, often in infancy. Other terms for SRS include gender reassignment surgery, sex reconstruction surgery, genital reconstruction surgery, gender confirmation surgery, and more recently sex affirmation surgery. The commonly used terms sex change or sex change operation is considered factually inaccurate. The terms feminizing genitoplasty and masculinizing genitoplasty are used medically. The best known of these surgeries are those that reshape the genitals, which are also known as genital reassignment surgery or genital reconstruction surgery (GRS).The meaning of sex reassignment surgery usually differs for transwomen (male to female) rather than transmen (female to male). For transwomen, sex reassignment usually involves the surgical construction of a vagina, whereas in the case of transmen, this term may entail any of a variety of procedures, from the mastectomy (removal of the female breasts) to the shaping of a male-contoured chest to the construction of a penis. Additionally, transmen usually undergo a hysterectomy and bilateral salpingo-oophorectomy.Chest (or "top") surgery is
often the only surgical procedure female-to-male transsexuals choose to undergo, as GRS techniques for transmen are still rather unrefined and typically produce genitalia of compromised aesthetic and functional quality. For some transwomen, facial feminization surgery and breast augmentation are also important parts of the sex reassignment process. People who pursue sex reassignment surgery are usually referred to as transsexual; "trans" - across, through, change; "sexual" - pertaining to the sexual characteristics (not sexual actions) of a person. More recently, people pursuing SRS often identify as transgender instead of transsexual.
Terminology
Transsexual people are often defined as those who undergo sex reassignment surgery, although some in the transgender community reject this definition; the term gender confirmation surgery is preferred by many. Transgender transition is an individualized process. Some individuals require hormone therapy and multiple surgical procedures for their transition to be successful, some may require no medical intervention at all, and others may require some conservative medical interventions. Many use the terms sex reassignment therapy, "sex reassignment” or "sex reassignment surgery" (aka SRS) to describe these medical procedures. However, many in the transgender community find these terms offensive. Implicit in the word "reassignment" is the idea that someone other than the self can "assign" or otherwise decide a person's gender. This is in clear conflict with the concept of "gender identity" which is a person's internal knowledge of their own gender. Many transgender and transsexual individuals feel strongly that their internal sense of their gender - their gender identity- is not subject to the assignment or reassignment by others. While some feel that the term "sex reassignment surgery" would more accurately be called "genital reassignment surgery" or "genital reconstruction surgery", it is important to note that the surgeries related to transgender transition go beyond the genitalia, and that the medical procedures go beyond surgery.
Medical considerations
Those with HIV or hepatitis C may have difficulty finding a surgeon able or even willing to perform surgery because many surgeons operate out of small private clinics that cannot adequately treat potential complications in these populations. Some surgeons charge higher fees for HIV and hepatitis C positive patients (some surgeons in developing countries prefer to dispose of surgical instruments used on these populations).Other health conditions such as diabetes, abnormal blood clotting, and obesity do not usually present a problem to experienced surgeons, but do increase the anesthetic risk and the rate of post-operative complications. Some surgeons require that severely overweight patients reduce their weight by a certain amount prior to surgery and that patient’s refrain from smoking for a period of time before and after surgery, although this is considered common practice regardless of the operation performed.
Results
As a result of SRS, the person will have the external anatomical appearance and function typical of the new sex. At the microscopic level, the individual will retain their previous chromosomes in each of their cells, and their previous susceptibilities to X-linked or Y-linked genetic conditions or predispositions. They are unable to reproduce due to the lack of sex glands (testes or ovaries), except through prior sperm banking or embryonic freezing, which still require a receptive woman with a uterus to act as the surrogate mother (See Reproductive technology.) If the person has the SRS early before puberty, the person will retain the younger "girlish" voice.[citation needed] There is a chance, low currently and shrinking as time passes and techniques improve, that the patient may become in orgasmic after surgery due to nerve damage. Additionally, it is usually necessary for transsexual people to continue hormone replacement therapy in order to maintain their secondary sex characteristics and prevent conditions such as osteoporosis. Transsexual people who do not undergo SRS/GRS are often called non-op, while "gender refusenik" is a slang term used among transgender people. Possible reasons for forgoing SRS include financial, legal, and medical concerns, among others.
Standards of care
Sex reassignment surgery can be difficult to obtain. There are very few surgeons willing to perform SRS. Most jurisdictions and medical boards require a minimum duration of psychological evaluation and living as a member of the target gender full time, sometimes called the real life experience (RLE) or real life test (RLT) before SRS is permitted. However, transsexual and transgender people are often unable to change the listing of their sex in public records until SRS is completed, due to the laws of many jurisdictions. (See legal aspects of transsexualism.)
In many countries or areas, an individual's pursuit of SRS is often governed, or at least guided, by documents called Standards of Care for Gender Identity Disorders (SOC). This most widespread SOC in this field is published and frequently revised by the World Professional Association for Transgender Health (WPATH, formerly the Harry Benjamin International Gender Dysphoria Association or HBIGDA). Standards of Care usually give certain very specific "minimum" requirements as prerequisites to SRS. For this and many other reasons, both the WPATH-SOC and other SOCs are highly controversial and often maligned documents among transgender patients seeking surgery. Some alternative local standards of care exist, such as in the Netherlands, Germany, and Italy. Much of the criticism surrounding the HBIGDA-SOC applies to these as well, and some of these SOCs (mostly European SOC) are actually based on much older versions of the WPATH-SOC. Other SOCs are entirely independent of the WPATH. The criteria of many of those SOCs are stricter than the latest revision of the WPATH-SOC. The majority of qualified surgeons in North America and many in Europe adhere almost unswervingly to the WPATH-SOC or other SOCs.
History
The earliest identifiable recipient of Male to Female Sex Reassignment Surgery was Lili Elbe in Berlin, in 1930-1931. This was started with the removal of the male sex organs and was supervised by Dr. Magnus Hirschfeld. Lili went on to have four more subsequent operations that included an unsuccessful uterine transplant, the rejection of which resulted in death. An earlier known recipient of this was Magnus Hirschfeld's housekeeper,[1] but her identity is unclear at this time.
Sex changes to avoid persecution
Filmmaker Tanaz Eshaghian discovered that the Iranian government's solution for homosexuality is forced sex change operations. The leader of Iran's Islamic Revolution, Ayatollah Ruholla Khomeini, issued a fatwa declaring sex changes permissible for “diagnosed transsexuals.”[2] Eshaghian's documentary, Be Like Others, chronicles a number of stories of Iranian gay men who feel a sex change is the only way to avoid further persecution, jail and/or execution.[2] The head of Iran's main transsexual organization, Maryam Khatoon Molkara—who convinced Khomeini to issue the fatwa on transsexuality—confirmed that some people who undergo operations are gay rather than transsexual.[3] Only Thailand performs more sex change operations than Iran.