Sex reassignment surgery
Definition
Also known as sex change or gender reassignment surgery, sex reassignment surgery is a procedure that changes genital organs from one gender to another.
Purpose
There are two main reasons to alter the genital organs from one sex to another.
- Newborns with intersex deformities must early on be assigned to one sex or the other. These deformities represent intermediate stages between the primordial female genitals and the change into male genitals 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 that 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 gender 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.
Demographics
Reliable statistics are extremely difficult to obtain. Many sexual reassignment procedures are conducted in private facilities that are not subject to reporting requirements. Sexual reassignment surgery is often conducted outside of the United States. The number of gender reassignment procedures conducted in the United States each year is estimated at between 100 and 500. The number worldwide is estimated to be two to five times larger.
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 stimulate the growth of satisfactory breasts.
Female to male surgery has achieved lesser success due to the difficulty of creating 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 persons 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 successfully accomplished.
The capacity to experience an orgasm, or at least "a reasonable degree of erogenous sensitivity," can be expected by almost all persons after gender reassignment surgery.
Diagnosis/Preparation
Gender identity is an extremely important characteristic for human beings. Assigning it must take place immediately after birth, for the mental health of both children and their parents. Changing sexual identity is among the most significant changes that a human can experience. It should therefore be undertaken with extreme care and caution. By the time most adults come to surgery, they have lived for many years with a dissonant identity. The average in one study was 29 years. Nevertheless, even then they may not be fully aware of the implications of becoming a member of the opposite gender.
In-depth psychological counseling should precede and follow any gender reassignment surgical procedure.
Sex change surgery is expensive. The cost for male to female reassignment is $7,000 to $24,000. The cost for female to male reassignment can exceed $50,000.
Aftercare
Social support, particularly from one's family, is important for readjustment as a member of the opposite gender. If surgical candidates are socially or emotionally unstable before the operation, over the age of 30, or have an unsuitable body build for the new gender, they tend not to fare well after gender reassignment surgery. However, in no case studied did the gender reassignment procedure diminish their ability to work.
Risks
All surgery carries the risks of infection, bleeding, and a need to return for repairs. Gender reassignment surgery is irreversible, so a candidate must have no doubts about accepting the results and outcome.
Normal results
Persons undergoing gender reassignment surgery can expect to acquire the external genitalia of a member of the opposite gender. Persons having male to female gender reassignment surgery retain a prostate. Individuals undergoing female to male gender reassignment surgery undergo a hysterectomy to remove the uterus and oophorectomy to remove their ovaries. Developing the habits and mannerisms characteristic of the patient's new gender requires many months or years.
Morbidity and mortality rates
The risks that are associated with any surgical procedure are present in gender reassignment surgery. These include infection, postoperative pain, and dissatisfaction with anticipated results. Accurate statistics are extremely difficult to find. Intraoperative death has not been reported.
The most common complication of male to female surgery is narrowing of the new vagina. This can be corrected by dilation or using a portion of colon to form a vagina.
A relatively common complication of female to male surgery is dysfunction of the penis. Implanting a penile prosthesis is technically difficult and does not have uniformly acceptable results.
Psychiatric care may be required for many years after sex-reassignment surgery.
The number of deaths in male-to-female transsexuals was five times the number expected, due to increased numbers of suicide and death from unknown cause.
Alternatives
There is no alternative to surgical reassignment to alter one's external genitalia. The majority of persons who experience gender disorder problems never surgically alter their appearance. They dress as members of the desired gender, rather than gender of birth. Many use creams or pills that contain hormones appropriate to the desired gender to alter their bodily appearance. Estrogens (female hormones) will stimulate breast development, widening of the hips, loss of facial hair and a slight increase in voice pitch. Androgens (male hormones) will stimulate the development of facial and chest hair and cause the voice to deepen. Most individuals who undergo gender reassignment surgery lead happy and productive lives.
See also Breast implants ; Penile prostheses .
Resources
BOOKS
Bostwick, John. Plastic and Reconstructive Breast Surgery, 2nd edition. St. Louis: Quality Medical Publishers, 1999.
Engler, Alan M. Body Sculpture: Plastic Surgery of the Body for Men and Women, 2nd edition. New York: Hudson, 2000.
Tanagho, Emil A. and Jack W. McAninch. Smith's General Urology, 15th Edition. New York: McGraw-Hill, 2000.
Walsh, Patrick C. and Alan B. Retik. Campbell's Urology, 8th Edition. Philadelphia: Saunders, 2002.
Wilson, Josephine F. Biological Foundations of Human Behavior. New York: Harcourt, 2002.
PERIODICALS
Asscheman, H., L. J. Gooren, and P. L. Eklund. "Mortality and Morbidity in Transsexual Patients with Cross-Gender Hormone Treatment." Metabolism 38, No. 9 (1989): 869–73.
Docter, R. F. and J. S. Fleming. "Measures of Transgender Behavior." Archives of Sexual Behavior 30, No. 3 (2001): 255–71.
Fugate, S. R., C. C. Apodaca, and M. L. Hibbert. "Gender Reassignment Surgery and the Gynecological Patient." Primary Care Update for Obstetrics and Gynecology 8, No. 1 (2001): 22–4.
Harish, D., and B. R. Sharma. "Medical Advances in Transsexualism and the Legal Implications." American Journal of Forensic Medicine and Pathology 24, No. 1 (2003): 100–05.
Jarolim, L. "Surgical Conversion of Genitalia in Transsexual Patients." British Journal of Urology International 85, No. 7 (2000): 851–56.
Monstrey, S., P. Hoebeke, M. Dhont, G. De Cuypere, R. Rubens, M. Moerman, M. Hamdi, K. Van Landuyt, and P. Blondeel. "Surgical Therapy in Transsexual Patients: A Multi-disciplinary Approach." Annals of Surgery (Belgium) 101, No. 5 (2001): 200–09.
ORGANIZATIONS
American Medical Association. 515 N. State Street, Chicago, IL 60610, Phone: (312) 464-5000. http://www.ama-assn.org/ .
American Psychiatric Association. 1400 K Street NW, Washington, DC 20005, (888) 357-7924. Fax: (202) 682-6850. apa@psych.org.
American Psychological Association. 750 First Street NW, Washington, DC, 20002-4242. (800) 374-2721 or (202) 336-5500. http://www.apa.org/ .
American Urological Association. 1120 North Charles Street, Baltimore, MD 21201-5559. (410) 727-1100. http://www.auanet.org/index_hi.cfm .
OTHER
Health A to Z [cited March 24, 2003]. <http://www.healthatoz.com/healthatoz/Atoz/ency/sex_change_surger .html> .
Hendrick Health System [cited March 24, 2003]. http://www.hendrickhealth.org/healthy/001240.htm .
Intersex Society of North America [cited March 24, 2003]. http://www.isna.org/newsletter/ .
University of Missouri-Kansas City [cited March 24, 2003]. http://www.umkc.edu/sites/hsw/gendid/srs.html .
L. Fleming Fallon, Jr., MD, DrPH
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Gender reassignment surgery is performed by surgeons with specialized training in urology, gynecology, or plastic and reconstructive surgery. The surgery is performed in a hospital setting, although many procedures are completed in privately owned clinics.
QUESTIONS TO ASK THE DOCTOR
- What will my body look like afterward?
- Is the surgeon board-certified in urology, gynecology, or plastic and reconstructive surgery?
- How many gender reassignment procedures has the surgeon performed?
- How many of the type similar to the one being contemplated (i.e., male to female or female to male) has the surgeon performed?
- What is the surgeon's complication rate?
I am interested to know do you do PHALLOPLASTRY (PENIS ENLARGEMENT0 surgery. I am very keen in doing,.
1.Can you advise the cost
2. Can have it done in Singapore or Thailand
3. How long does the entire surgery take (duration)
Thank you so much
Sean
WHY?
This is surely the biggest error you can make. Such assumptions have been made where the risk that the wrong gender is chosen and the individual in later life is left truly stuck in the wrong gender. The individual should be allowed from the very beginning to express which gender they identify with.
What is wrong with the individual directly affected by this situation having a choice in the matter? And for that matter, what is wrong in acknowledging by birth a third physical sex?
Making uninformed decisions on behalf of other people on such basic personal issues can only de described as a human rights violation.
Thank you.
I was just wondering when you get the male to female surgery, how many operations does it take for it to be final, I am considering this operation and its what i want to be happy and I am going to need it before college starts and i only want to have the vaginolplasty (sorry if thats mispelled) surgery, hopefully just one operation...thank you =)
i was wanting to know rufly hwo much a gender chage would cost and what i would be able to do after the sex reassignment surgery what i would Experience.
many thanks jane
Also do you have to be a certain age when you get this done i know you have to go through a counciling thing to get it done ive talked to councilers about it befor and they said i seem in the right state of mind and i know what im doing. Thank you
I am intersted to change my sex from female to male,,
i want to know about its cost and all
if it surgery do any organiztion in tailand and also near to india,
plz tel me
I have a desire to be a Navy Seal.
I am also a Female. By law i CANNOT be a seal. Is this fair?
I was talking to my friend about it and she mentioned a sex change(jokingly)
But now that im thinking about it...It might be the only way.
I know that laws are changing but im not sure if the laws will change fast enough that i might
have a chance. Is this reasonable? does the navy accept gender changed individuals?
DOes anyone know any other way?
all help is accepted.
~Cayla
BIG HUGS AND KISSES
PARIS XO
Where would the Cheapest place to go for a surgerys like this?
Also,i know this might sound silly but i'm nervous about the counseling since i've never had to go through it before. Can you give me an idea of what it'll be like?
i'm interested in FtM surgery, I wake up each morning thinking I could be living a different, better life. But knowing I have to spend several more years through the difficulty, its unbearable and I'm also wondering if theres a age requirement, details on counseling and such.
my mail robbinhood_2006@hotmail.com
thaks a lot
what process of that give me detail whre m go so chnge my sex
-lilliana
thank you for informations
thank you so much
My name is Alex I need help how I can get help by removing my Vagina I am really straggling
my family abused me since age 3 and I am 32 years old they almost killed me and finally I stand up for my self but I am so poor so I don`t Know how to remove my Vagina and to fix my pines please let me know how you can help me god bless you .
the penis of ftm is very small can i make it bigger or like man penis
thank`s
WILL THE BODY SHAPE CHANGE TO MALE SHAPE AFTER SURGERY N HORMONE THERAPY?
As far as the changes, my husband started taking hormones a year before surgery and developed breasts which are very large now. She also went through psychological counseling for a year previous to the surgery which is recommended.
NO insurance does not cover anything for this surgery and one day maybe they will as it is not the person's fault they were born that way.
Reason I've wanted to be a boy ever since
I was about six or so, I am still a young
Minor, I never liked the fact of surgery
Itself but I am wanting a prostetic penis
When I am older. I am interested in men
But they might be confused. I want to
Know were I can get a fake penis I can
Urinate through, and possibly masturbate
With, like a real penis, and I'm also looking
Into man horomone pills. Email me @ ryanm35@gmail.com
I've also always liked the name Ryan.
Be silent, help out urself. It u n ur soul to decide who u are.
Dr angga muthu 07 2228858
Dr rajakumar 03 32322239
N there is lot in MY. Add me in fb for further info ajayrish.tq
To date, there still is no genuine set of rules that the patients and Doctors actually work by, and it is ashame because there are so many people that want the surgery, and they can search and search until they find a surgeon that will not require things such as Psychotherapy, initiation of Hormone Therapy (but no definite amount of time required with many M.D.'s).
Without the "basics" prior to initiation of Hormones and eventual surgery, all too frequently these patients are grossly dissatisfied with the results, even though they know that they did not follow Guidelines such as the Harry Benjamin Standards for Sex Reassignment Surgery, began at Stanford University.
There were a number of suicides, both pre and post-op, and this generally was when the patient did not follow Protocol. Some horribly self-mutilations happened, and sometimes I was the first one to see what mess the patient had made, and see if there was something that could be done to correct at least part of the Surgical Procedure that had been performed.
All in all, I do not recommend it as the results are almost less that the patient was hoping for, as the surgery is not "magic", and it does not cure all problems like some hope for, being a "Quick Fix". I am retired now, but worked with the Transgender Community for somewhere between 10-15 years, and had about 100+ patients that were Transgender- some pre-op, some post-op, and many just starting to learn about what will be happening to their bodies from the very beginning. Most couples (generally Gay) did not stay together post-op as what their partners were looking for had been surgically removed, or the results were far from satisfactory.
i am a male, 17 years old, and no one knows that i want to become a female.
Im curious about the M-to-F surgery: first of all, throughout the surgery, is there any pain involved to the patient? (even before surgery?) and what complications can happen post-surgery? I want to be a normal female, not have an abnormally shaped vagina, or one that malfunctions. Also, during surgery, what is the condition of the patient?(are they sleeping, awake but numb, or what? and what is done to ensure the patient does not receive any pain?) Also, after surgery, how long does it take for the vagina to be prepared for intercourse, and will it hurt when the patient urinates? (or must they urinate using a bag/etc). Please explain to me these things in detail, for I am looking forward to getting this surgery done, and want to be completely aware of what i am going to undergo -- since i can not contact a doctor in real due to the fear of anyone finding out, i'd appreciate it greatly if you would help. Thank You! =)
thank you ,Angela C. Benson
I am 21 now and I have always been a very feminine male and I have always wanted to be a girl, I haven't spoken to my parents about it though as they aren't the most supportive people in the world with this type of thing. I have however told my friends and most of them support me, a few think it's not right. Basically I wanted to know if there were any decent doctors in the UK would be best as I would rather not travel outside of the country to talk about it. I was wanting to know, when I go to the doctors will they tell anyone such as immediate family? As I am over the age of 18 I pressume not but would be best to know. I was also wondering the same as someone else on the comments, what is the state of the person going in for the surgery eg. awake, numb etc. I really want to talk more about it with someone as I try to act as manly as I can in front of people who don't know or those who think I am joking with them. I literally have no idea how to get things started or if I would be able to go in and tell a doctor because I am petrified of what people will think, I know that doctors have the whole non judgmental saying but in all fairness I have been judged by doctors before and it has made me scared to tell them anything personal about my health. If you could e-mail me more details about how I would start off the proccess that would be great also how much it would cost in GBP to have the surgery as I am working and I am guessing it may take me a little bit to save up for. Thank you in advance.
Thanks.
But Doctors, please help me (and my children) to cope with the consequences. Stanislaus/Stacey will definitely lose his job, have to change his whole life, and probably move away. We live in Virginia, and if my son-in-law becomes my daughter-in-law, their marriage will immediately become null and void. In this state, they would never be allowed to adopt children. But most importantly, they just DON'T WANT to live far away from home. I will, of course, support (and if necessary, defend) them; but I can't bear the sacrifice of seeing them forced to pick up and move to a state with a more liberal atmosphere. I'm confused, befuddled, and most of all, SCARED. Can anybody out there off me comfort?
~Lyudmila
I'm too scared to tell my dad, because he really hates homosexuals and transgenders...How do I tell him? More importantly, how do I tell my best friend? I'm really scared to tell her because I'm worried that it will ruin our friendship.
Thanks for the information.
~Jayden
Would I be able to orgasim and cum normaly?
1.) How much does an average MTF sex change cost in the US?
2.) How long does an average surgery take time wise?
3.) What is the age when getting this surgery becomes legal without a parent signature?
4.) Would I be able orgasm the same way a natural born male does if I were to get a sex change?
i have always figured i was a man in a womens body and i still do im only 16 but hen i turn 18 im gonna talk to my doctor about the sex change. how long does it take to get a sex change from the time u start taking the male hormones till you can have sex
I'm 17, almost 18. I have just a couple questions. One: I was born a female. But from day one I never felt like a girl. I wore boy clothes. Looked at other girls. First kiss was with a girl. Then in middle school I decided to liked girls, but hid it so my parents wouldn't abandon me. Then I came out freshman year. Then I thought I was transgender. But now I just don't even feel like a gender. I just feel like Damien. I only like girls. But I am not in anyway a gender. What does this mean? And question 2: I hate having breasts, an hourglass curve and having a high voice. But I'm not wanting a penis. Would I still have to undergo testosterone therapy?
You guys, this message board is marked as "User Contributions." This means that there is no "Doctor" that will read your message; rather, it is intended to be here to add something to the discussion of sex changes and provide any information that is missing here.
Other researchers only will read your messages.
(I know this is a bit hypocritical, but it's kind of saddening that people are asking questions.)
I've been on happy for such a long time and I can't take it any more. I live in Columbia, MO and was wondering if there are any doctors in the State of Missouri that perform gender reassignment surgery. Thank you.
I want to know what the complications are to male to female vaginal plasty surgery
the feeling before, during, and after the vaginal plasty surgery
am I able to have a period like a girl would
will I be able to have a G-Spot orgasm
how am I able to pee
how long does it take for dilation
HELP im only 13 and I want this done ASAP