Sex change surgery

Definition

Also known as sex reassignment surgery, sex change surgery is a procedure that changes genital organs from one gender to another.

Purpose

There are two reasons to alter the genital organs from one sex to another.

• Newborns with intersex deformities must early on be assigned one sex or the other. These deformities represent intermediate stages between the primordial female genitals and the change into male caused by male hormone stimulation.
• Both men and women occasionally believe they are physically a different sex than they are mentally and emotionally. This dissonance is so profound they are willing to be surgically altered.

In both cases, technical considerations favor successful conversion to a female rather than a male. Newborns with ambiguous organs will almost always be assigned to the female sex, unless the penis is at least an inch long. Whatever their chromosomes, they are much more likely to be socially well adjusted as females, even if they cannot have children.

Precautions

Sexual identity is probably the most profound characteristic humans have. Assigning it must take place immediately after birth, both for the child's and the parents' comfort. Changing sexual identity may be the most significant change one can experience. It therefore should be done with every care and caution. By the time most adults come to surgery, they have lived for many years with dissonant identity. The average in one study was 29 years. Nevertheless, even then they may not be fully aware of the implications of becoming the other sex.

Description

Converting male to female anatomy requires removal of the penis, reshaping genital tissue to appear more female, and constructing a vagina. A vagina can be successfully formed from a skin graft or an isolated loop of intestine. Following the surgery, female hormones (estrogen) will reshape the body's contours and grow satisfactory breasts.

Female to male surgery has achieved lesser success, due to the difficulty of building a functioning penis from the much smaller clitoral tissue available in the female genitals. Penis construction is not attempted less than a year after the preliminary surgery to remove the female organs. One study in Singapore found that a third of the patients would not undergo the surgery again. Nevertheless, they were all pleased with the change of sex. Besides the genital organs, the breasts need to be surgically altered for a more male appearance. This can be done quite successfully.

Orgasm, or at least "a reasonable degree of erogenous sensitivity," can be experienced by patients after surgery.

Preparation

In-depth psychological counseling should precede and follow these procedures.

Aftercare

Social support, particularly from the family, is important for readjustment as a member of the opposite sex. If patients were socially or emotionally unstable before the operation, over 30, or had an unsuitable body build for the new sex, they tend to do poorly. In no case studied did the procedure diminish their ability to work.

Risks

All surgery runs the risk of infection, bleeding, and a need to return for repairs. This surgery is irreversible, so the patient must have no doubts about the results.

The most common complication of the male to female surgery is narrowing of the new vagina.

Key Terms

Chromosomes

The carriers of genes, which determine sex and characteristics.

For Your Information

Books

• Hensle, Terry W., and William A. Kennedy. "Surgical Management of Intersexuality." In Campbell's Urology, ed. Patrick C. Walsh, et al. Philadelphia: W. B. Saunders Co., 1998.
• Jordan, Gerald H. "Surgery of the Penis and Urethra." In Campbell's Urology, ed. Patrick C. Walsh, et al. Philadelphia: W. B. Saunders Co., 1998.

Periodicals

• Eldh, J., A. Berg, and M. Gustafsson. "Long-term Follow Up After Sex Reassignment Surgery." Scandinavian Journal of Plastic & Reconstructive Surgery & Hand Surgery 31 (Mar. 1997): 39-45.
• Hage, J. J., and P. J. van Kesteren. "Chest-wall Contouring in Female-to-male Transsexuals: Basic Considerations and Review of the Literature." Plastic & Reconstructive Surgery 96 (Aug. 1995): 386-391.
• Hage, J. J., and R. B. Karim. "Sensate Pedicled Neoclitoroplasty for Male Transsexuals: Amsterdam Experience in the First 60 Patients." Annals of Plastic Surgery 36 (June 1996): 621-624.
• Huang, T. T. "Twenty Years of Experience in Managing Gender Dysphoric Patients: I. Surgical Management of Male Transsexuals." Plastic & Reconstructive Surgery 96 (Sept. 1995): 921-930, 931-934.
• Karim, R. B., J. J. Hage, and J. W. Mulder. "Neovaginoplasty in Male Transsexuals: Review of Surgical Techniques and Recommendations Regarding Eligibility." Annals of Plastic Surgery 37 (Dec. 1996): 669-675.
• Siemssen, P. A., and S. H. Matzen. "Neovaginal Construction in Vaginal Aplasia and Sex-Reassignment Surgery." Scandinavian Journal of Plastic & Reconstructive Surgery & Hand Surgery 31 (Mar. 1997): 47-50.
• Tsoi, W. F., et al. "Follow-up Study of Female Transsexuals." Annals of the Academy of Medicine (24 Sept. 1995): 664-667.

Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is J. Ricker Polsdorfer MD.

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