Sex reassignment surgery (initialized as
SRS; also known as
gender reassignment surgery,
genital reconstruction surgery,
sex affirmation surgery,
sex realignment 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
sexIn biology, sex is a process of combining and mixing genetic traits, often resulting in the specialization of organisms into a male or female variety . Sexual reproduction involves combining specialized cells to form offspring that inherit traits from both parents...
. It is part of a treatment for
gender identity disorderGender identity disorder is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria . It describes the symptoms related to transsexualism, as well as less severe manifestations of gender dysphoria...
/gender dysphoria in transsexual and
transgenderTransgender is a general term applied to a variety of individuals, behaviors, and groups involving tendencies to vary from culturally conventional gender roles....
people. It may also be performed on
intersexIntersex, in humans and other animals, is the presence of intermediate or atypical combinations of physical features that usually distinguish female from male...
people, often in infancy and without their consent.
Other terms for SRS include
sex reconstruction surgery, gender confirmation surgery, and more clinical terms, such as
feminizing genitoplasty or
penectomy, orchidectomy and vaginoplastythumb|right|300px|Vaginoplasty: the pre-operative aspect , and the post-operative aspect of a [[Labiaplasty|labial reduction]].Vaginoplasty is a reconstructive plastic surgery procedure for correcting the defects and deformities of the vaginal canal and its mucous membrane, and of vulvo-vaginal...
are used medically for trans women, with
masculinizing genitoplasty often similarly used for trans men.
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
transgenderTransgender is a general term applied to a variety of individuals, behaviors, and groups involving tendencies to vary from culturally conventional gender roles....
instead of transsexual.
Scope and procedures
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). However, the meaning of "sex reassignment surgery" has been clarified by the medical subspecialty organization, the World Professional Association for Transgender Health (WPATH), to include any of a larger number of surgical procedures performed as part of a medical treatment for "gender dysphoria", "transsexualism" or "gender identity disorder". According to WPATH, medically necessary sex reassignment surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation [...] including breast prostheses if necessary, genital reconstruction (by various techniques which must be appropriate to each patient[...])[...] and certain facial plastic reconstruction." In addition, other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial electrolysis.
A growing number of public and commercial health insurance plans in the United States now contain defined benefits covering sex reassignment related procedures, usually including genital reconstruction surgery (MTF and FTM), chest reconstruction (FTM), breast augmentation (MTF), and hysterectomy (FTM). In June 2008, the American Medical Association House of Delegates declared that discrimination, stating that the denial to patients with Gender Identity Disorder of otherwise covered benefits represents discrimination, and that the AMA supports "public and private health insurance coverage for treatment for gender identity disorder as recommended by the patient's physician." Other organizations have issued similar statements, including WPATH, the American Psychological Association, and the National Association of Social Workers.
Differences between trans women and trans men SRS
The array of medically necessary surgeries differs for trans women (male to female) rather than trans men (female to male). For trans women, genital reconstruction usually involves the
surgical construction of a vaginathumb|right|300px|Vaginoplasty: the pre-operative aspect , and the post-operative aspect of a [[Labiaplasty|labial reduction]].Vaginoplasty is a reconstructive plastic surgery procedure for correcting the defects and deformities of the vaginal canal and its mucous membrane, and of vulvo-vaginal...
, whereas in the case of trans men, genital reconstruction may involve construction of a penis through either
phalloplastyPhalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....
or
metoidioplastyMetoidioplasty, sometimes referred to as a meto or meta or spelled "metaoidioplasty", is an alternative to phalloplasty for trans men...
. In both cases, for trans women and trans men, genital surgery may also involve other medically necessary ancillary procedures, such as orchiectomy or
vaginectomyVaginectomy is a medical procedure to remove all or part of the vagina. It is usually used as a treatment for vaginal cancer. Vaginectomy is also used as part of some types of female-to-male sex reassignment surgery.-Cancer:...
.
As underscored by WPATH, a medically-assisted transition from one sex to another may entail any of a variety of non-genital surgical procedures, any of which are considered "sex reassignment surgery" when performed as part of treatment for transsexualism. For trans men these may include
mastectomyMastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
(removal of the female breasts) and chest reconstruction (the shaping of a male-contoured chest), or
hysterectomyA hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
and bilateral
salpingo-oophorectomyOophorectomy is the surgical removal of an ovary or ovaries. The surgery is also called ovariectomy, but this term has been traditionally used in basic science research describing the surgical removal of ovaries in laboratory animals...
. For some trans women,
facial feminization surgeryFacial feminization surgery is a set of reconstructive surgical procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features...
and
breast augmentationBreast augmentation denotes the breast implant and fat-graft mammoplasty procedures for correcting the defects, and for enhancing the size, form, and feel of a woman’s breasts...
are also medically necessary components of their surgical treatment.
Medical considerations
People with
HIVHuman immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
or
hepatitis CHepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
may have difficulty finding a surgeon able or willing to perform surgery. 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; other medical professionals assert that it is unethical to deny surgical or hormonal treatments to transsexuals solely on the basis of their HIV or hepatitis status.
Other health conditions such as diabetes, abnormal blood clotting, and
obesityObesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
do not usually present a problem to experienced surgeons. The conditions do increase the anesthetic risk and the rate of post-operative complications. Surgeons may require overweight patients to reduce their weight before surgery and smoking patients to refrain from
smokingTobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
before and after surgery. Surgeons commonly stipulate the latter regardless of the type of operation.
Results
Medical advances may eventually make childbearing possible by using a donor
uterusThe uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
long enough to carry a child to term as
anti-rejection drugsImmunosuppressive drugs or immunosuppressive agents are drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy to:...
do not seem to affect the fetus. The
DNADeoxyribonucleic acid is a nucleic acid that contains the genetic instructions used in the development and functioning of all known living organisms . The DNA segments that carry this genetic information are called genes, but other DNA sequences have structural purposes, or are involved in...
in a donated
ovumAn ovum is a haploid female reproductive cell or gamete. Both animals and embryophytes have ova. The term ovule is used for the young ovum of an animal, as well as the plant structure that carries the female gametophyte and egg cell and develops into a seed after fertilization...
can be removed and replaced with the DNA of the receiver. Further in the future
stem cell biotechnologyThis article is about the cell type. For the medical therapy, see Stem Cell TreatmentsStem cells are biological cells found in all multicellular organisms, that can divide and differentiate into diverse specialized cell types and can self-renew to produce more stem cells...
may also make this possible, with no need for anti-rejection drugs.
Standards of care
Sex reassignment surgery can be difficult to obtain, due to a combination of financial barriers and lack of providers. An increasing number of surgeons are now training to perform such surgeries. In many regions, an individual's pursuit of SRS is often governed, or at least guided, by documents called
Standards of Care for Gender Identity DisordersThe Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People are non-binding protocols outlining the usual treatment for individuals who wish to undergo hormonal or surgical transition to the other sex...
(SOC). The 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). Many jurisdictions and medical boards in the United States and other countries recognize the WPATH Standards of Care for the treatment of transsexualism. For many individuals, these may require a minimum duration of
psychological evaluationA psychological evaluation or mental examination is an examination into a person's mental health by a mental health professional such as a psychologist. A psychological evaluation may result in a diagnosis of a mental illness...
and living as a member of the target gender full time, sometimes called the real life experience (RLE) (sometimes mistakenly referred to as the real life test (RLT)) before genital reconstruction or other sex reassignment surgeries are permitted.
Standards of Care usually give certain very specific "minimum" requirements as guidelines for progressing with treatment for transsexualism, including accessing cross-gender hormone replacement or many surgical interventions. 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. Alternative local standards of care exist, such as in the Netherlands, Germany, and Italy. Much of the criticism surrounding the WPATH/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. Many qualified surgeons in North America and many in Europe adhere almost unswervingly to the WPATH-SOC or other SOCs. However, in the United States many experienced surgeons are able to apply the WPATH SOC in ways which respond to an individual's medical circumstances, as is consistent with the SOC.
Many medical professionals and numerous professional associations have stated that surgical interventions should not be required in order for transsexual individuals to change sex designation on identity documents. However, depending on the legal requirements of many jurisdictions, transsexual and
transgenderTransgender is a general term applied to a variety of individuals, behaviors, and groups involving tendencies to vary from culturally conventional gender roles....
people are often unable to change the listing of their sex in public records unless they can furnish a physician's letter attesting that sex reassignment surgery has been performed, in other instances legal gender change is prohibited even after genital or other surgery or treatment without recourse, while in other cases, such statutes may specify that genital surgery has been completed.
History
The earliest identified recipient of male to female sex reassignment surgery was 'Rudolf (Dora-R), "He took the first step towards changing his sex in 1921, when he had himself castrated, As a result his sexual instinct was enfeebled, but the homosexual tendency, as well as his own feelings, remained the same. This step, however, was not sufficient for him, and he tried to obtain a still greater degree of femininity in his sexual parts. Finally, in 1930, the operation which he himself had attempted at the age of six was performed upon him, that is, the removal of his penis, and six months afterwards the transformation was completed by the grafting of an artificial vagina."
This was followed by
Lili ElbeLili Elbe was an Intersex person and one of the first identifiable recipients of male to female sex reassignment surgery. Elbe was born as a male in Denmark. Born as Einar Mogens Wegener, she identified as male for most of her life and was a successful artist with that name...
in Berlin during 1930-1931. She started with the removal of the male sex organs, the operation(s) supervised by Dr.
Magnus HirschfeldMagnus Hirschfeld was a German physician and sexologist. An outspoken advocate for sexual minorities, Hirschfeld founded the Scientific Humanitarian Committee, which Dustin Goltz called "the first advocacy for homosexual and transgender rights."-Early life:Hirschfeld was born in Kolberg in a...
. Lili went on to have four more subsequent operations that included an unsuccessful
uterineThe uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
transplantOrgan transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
, the rejection of which resulted in death. An earlier known recipient of this was
Magnus HirschfeldMagnus Hirschfeld was a German physician and sexologist. An outspoken advocate for sexual minorities, Hirschfeld founded the Scientific Humanitarian Committee, which Dustin Goltz called "the first advocacy for homosexual and transgender rights."-Early life:Hirschfeld was born in Kolberg in a...
's
housekeeperA housekeeper is an individual responsible for the cleaning and maintenance of the interior of a residence, including direction of subordinate maids...
, but her identity is unclear at this time.
Filmmaker
Tanaz EshaghianTanaz Eshaghian is an Iranian-American documentary filmmaker.Eshaghian, who left Iran with her mother at age 6, grew up in New York, went to Trinity School and graduated from Brown University in 1996 with a BA in Semiotics....
discovered that the Iranian government's "solution" for homosexuality is to endorse, and fully pay for, sex reassignment surgery. The leader of Iran's Islamic Revolution, Ayatollah Ruhollah Khomeini, issued a
fatwaA fatwā in the Islamic faith is a juristic ruling concerning Islamic law issued by an Islamic scholar. In Sunni Islam any fatwā is non-binding, whereas in Shia Islam it could be considered by an individual as binding, depending on his or her relation to the scholar. The person who issues a fatwā...
declaring sex reassignment surgery permissible for "diagnosed transsexuals." Eshaghian's documentary,
Be Like OthersBe Like Others is a 2008 documentary film written and directed by Tanaz Eshaghian about transsexuals in Iran. It explores issues of gender and sexuality while following the personal stories of some of the patients at a Tehran clinic...
, chronicles a number of stories of
Iranian gay menLGBT rights in Iran since the Iranian Revolution of 1979 have come in conflict with the penal code, with international human rights groups claiming floggings and death sentences of lesbian, gay and bisexual individuals. Transsexuality in Iran is legal if accompanied by a sex change operation;...
who feel transitioning is the only way to avoid further persecution, jail and/or execution. 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.
ThailandKathoey or katoey is a male-to-female transgender person or an effeminate gay male in Thailand. Related phrases include sao praphet song , or phet thi sam . The word kathoey is thought to be of Khmer origin...
performs the most sex reassignment surgeries, followed by
IranIran , officially the Islamic Republic of Iran , is a country in Southern and Western Asia. The name "Iran" has been in use natively since the Sassanian era and came into use internationally in 1935, before which the country was known to the Western world as Persia...
.
On June 12 2003,
European Court of Human RightsThe European Court of Human Rights in Strasbourg is a supra-national court established by the European Convention on Human Rights and hears complaints that a contracting state has violated the human rights enshrined in the Convention and its protocols. Complaints can be brought by individuals or...
judged human rights violation for Van Kück, a German transsexual woman to be refused the pay for gender reassignment surgey as well as
hormone replacement therapyHormone replacement therapy for transgender and transsexual people changes the balance of sex hormones in their bodies. Some intersex people also receive HRT, either starting in childhood to confirm the sex to which they were assigned, or later, if this assignment has proven to be incorrect...
relating the Article 6 of the European Convention on Human Rights as well as the Article 8. This affair is called "
Van Kück vs Germany"
See also
- Baptist Medical Center sex reassignment surgery controversy
The Baptist Medical Center sex reassignment surgery controversy occurred in 1977 in Oklahoma City, Oklahoma. Surgeons at the Baptist Medical Center, a hospital owned by the Southern Baptist Convention, were prohibited from performing sex reassignment surgery....
- Reproductive health
Within the framework of the World Health Organization's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system...
- The Yogyakarta Principles
- LGBT people in prison
Lesbian, gay, bisexual and transgender people in prisons often face additional challenges as inmates to those of straight, cisgender inmates....