Everything about Sexual Reassignment Surgery totally explained
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 are 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. 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- isn't 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's 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 can't 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 don't 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 patients 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. 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.)
Additionally, it's 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 don't 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
transgendered 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
Harry Benjamin International Gender Dysphoria Association (HBIGDA). Standards of Care usually give certain very specific "minimum" requirements as prerequisites to SRS. For this and many other reasons, both the HBIGDA-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 HBIGDA-SOC. Other SOCs are entirely independent of the HBIGDA. The criteria of many of those SOCs are stricter than the latest revision of the HBIGDA-SOC. The majority of qualified surgeons in
North America and many in
Europe adhere almost unswervingly to the HBIGDA-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 carried out 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, but her identity is unclear at this time.
Further Information
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