Medical advances have come a long way since the first sex change operation took place in Germany in 1930, but the operation still remains complex, both on physiological and psychological levels.
Let’s Talk About (Changing) Sex
Sexual reassignment surgery (SRS), or as many prefer to call it Gender Affirmation Surgery (GAS), is the blanket term for a number of medical procedures that transforms a transgender person’s appearance to that of their identified sex.
While it is commonly referred to as a sex change, and the major element of the surgery is changing of the person’s genitals, the procedures also involve changing other physical characteristics such as bone structure, breast augmentation (male-to-female), hysterectomy (female-to-male) and various hormonal treatments, including psychiatric evaluation.
It’s About Identity
Reasons for going through this major life-changing procedure are usually psychological, and according to Vanessa (name changed) who is currently going through a male-to-female change, it’s more about identity than it is about sex or gender. Mental health plays a major factor in these decisions, as many transgender people have struggled with their gender identity since childhood, often pushed to the brink of suicide.
Getting Down to Business
The biggest aspect of the entire process is undoubtedly the genital surgery. Organ reconstructive surgery is extremely complex, however, the physical and cosmetic aspects of reconstructing the sex organs substantially add to this complexity. They are usually preceded by hormonal treatments that continue after the surgery has been performed, and in most cases indefinitely. Here are the major types of genital reassignment surgeries:
1. Male-to-female: There are three main types of procedures for a male-to-female transition, namely penile inversion, colovaginoplasty, and vaginoplasty.
- Penile inversion: Penile inversion is the most common of the three and involves creating a vagina from the skin of the penis, using the tissue from the head of the penis (glans penis) to construct a clitoris, and shortening the urethra to fit the female genital anatomy.
- Colovaginoplasty: This procedure is similar to penile inversion, but instead of using the penis, skin grafts from the thigh or abdomen and a segment from the sigmoid colon (pelvic colon) to construct a vagina. This procedure, however, can result in major complications, which have prompted surgeons to prefer this procedure only in cases where there is no alternative.
- Vaginoplasty: Where penile inversion and colovaginoplasty use specific parts of the body to construct a vagina, vaginoplasty (in the case of transsexual women – male-to-female) entails using a variety of tissue from the patient’s body, including skin grafts, penile skin and tissue and oral or intestinal mucosa (the inner membrane lining the inside of the mouth and gastrointestinal tract respectively). Since skin containing hair follicles are often used, it’s important for surgeons to depilate the skin, especially when used internally.
2. Female-to-male: Many transsexual men (female-to-male) prefer not to have the genital surgery performed and opt only for procedures such as a hysterectomy, having both breasts removed, and chest contouring (for a typically male chest shape). However, when genital reconstructive surgery is chosen, there are two main options, metoidioplasty and phalloplasty.
- Metoidioplasty: In this procedure, the clitoris is enlarged by hormones, the urethra rerouted and the vulva used to construct a scrotum and prosthetic testicles added.
- Phalloplasty: For phalloplasty tissue is grafted from the arm, thigh or belly and used in conjunction with a penile prosthesis. Similar to metoidioplasty, the urethra is also rerouted and scrotum constructed from the vulva, with prosthetic testicles added.
Many argue that SRS is essential to the wellbeing of those who consider it, as the mental anguish these individuals experience can be life-threatening and many resorting to extremes such as suicide. In addition, due to the complexity of the procedure it is extremely expensive and way beyond the means of most, and proponents of SRS, or at least those who support having the choice, feel it’s imperative that governments step in and help with funding, as it would with other procedures that enhance the basic quality of life of its people.
Sadly, despite great strides towards the acceptance of different sexual orientations, until very recently governments have been reluctant to fund procedures such as these. However, things are rapidly changing and government aided health care programs increasingly support the procedure, such as the 2014 ruling that Medicare in the US can no longer automatically deny transsexuals this procedure. This comes after a similar ruling in Germany in 2003 that set the tone in the European Union. According to a 2007 article published in The Guardian, Thailand leads the world in the number of SRS performed, followed (quite surprisingly) by Iran.
This support comes with a caveat though, as Vanessa points out that the average waiting time for government supported SRS can be up to 25 years.
The magnitude of deciding to go through with SRS should not be underestimated. Physical changes aside, the potential psychological effects of the procedure can be immense as it is literally a life-changing operation, and learning to live with a newly appointed sex can be a challenge, both mentally and physically. It is therefore of utmost importance for the person to be 100% sure that they want to follow through with the procedure. Due to this, SRS is often supported by psychiatric evaluation and monitoring in order to facilitate the full transition to another sex, and are sometimes considered (and required) as part of the process.
Before the internet, finding support and guidance around SRS was incredibly difficult, especially within a society that frowned upon such practices. Thankfully times have changed and resources are freely available online.
Some of the most prominent resources include The World Professional Association for Transgender Health (WPATH), and the Gay, Lesbian and Straight Education Network (GLSEN), there are also sites dedicated to warning people about the dangers of the procedure, such as Sex Change Regret.