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SEX REASSIGNMENT SURGERY

srs Nov 17, 2021

Sex reassignment[1] is the act or process of changing from living as a person of one sex to living as a person of the opposite sex by undergoing surgery, hormone treatment, etc. to obtain the physical appearance of the opposite sex. This unease that a person might have because of a mismatch between their biological sex and the gender they identify with, is termed as gender dysphoria. Such a sexual conflict had long been observed in transgender individuals[2], but the advent of successful sex reassignment surgeries came much later. Though this surgery proved to be a boon for many transgenders who were relieved of their gender dysphoria, it remains a topic of intense discussion among medical professionals and researchers.

The world’s first documented sex reassignment surgery was done not earlier than 1931 on a Danish painter Lili Elbe (birth name- Einer Wegner) who was assigned male at birth, later operated by a German gynecologist Kurt Warnekros[3]. The series of operations removed her testicles and penis and then transplanted ovaries and a uterus into her. Unfortunately, she died of complications not long after the fifth procedure in 1931. From 1931 till the present, a large number of transsexuals have undergone sex reassignment, many of them being huge successes showing a significant decrease in death rates. A US study[4] showed that from 2000 to 2011, the rate of surgical sex reassignment measures among trans persons rose from 72% to 83.9%. Despite these promising results, these surgeries remain a matter of concern amongst physicians.

To start with, an SRS (Sex Reassignment Surgery) predisposes a healthy body to a bunch of unnecessary risks, many surgical attempts facing rejection of surgical organs. Even if the surgery goes well by the grace of modern surgical and hormonal techniques; transsexuals having undergone SRS have been observed to face many psychiatric problems. Their suicide rate[5] has been found to be 20 times above the comparable population. In addition to this, they have an increased risk of depression, anxiety disorders, and self-harm without lethal intent. Many transgenders have revealed their persistent sense of confusion about their gender, even after the surgery. Such observations challenge the surgery prescription.

Intensive research and observations on this topic have paved the way to new techniques such as special skin grafts and hormone treatments[6] to accommodate the genital implants and hormone administration to make the transition easier. Alongside, it has been seen that a clinical protocol[7] consisting of a multi-disciplinary team is essential in which the patient can seek psychological help regarding dysphoria so that they develop a sense of well-being post-surgery. A long-term follow-up with the physician as well as a therapist would also improve the quality of life of the individual.

Considering risks associated with SRS along with keeping the protection of transsexual rights in place, countries have come up with certain laws and medical policies on SRS. These include maintaining an age bar before which SRS won’t be allowed. Alongside, abuse of drugs containing sex hormones has been curtailed under law. A patient can ask for an SRS only if a sanctioned letter for the same is present and drugs prescribed must be endorsed by World Professional Association for Transgender Health[8]. Everything about an SRS makes it paramount that potential risks and consequences be discussed in detail with the patient as well as their family by the physician.


References:

[1] Merriam-Webster. (n.d.). Gender reassignment. In Merriam-Webster.com medical dictionary. Retrieved July 8, 2021, from
[2] Merriam-Webster. (n.d.). Transgender. In Merriam-Webster.com dictionary. Retrieved July 8, 2021, from
[3] Blumberg, N. (2021, April 8). Lili Elbe. Encyclopedia Britannica.
[4] Weinforth, G., Fakin, R., Giovanoli, P., & Nuñez, D. G. (2019). Quality of Life Following Male-To-Female Sex Reassignment Surgery. Deutsches Arzteblatt international, 116(15), 253–260.
[5] P Fitzgibbons R. (2015). Transsexual attractions and sexual reassignment surgery: Risks and potential risks. The Linacre quarterly, 82(4), 337–350.
[6] Slongo H, Riccetto CLZ, Junior MM, Brito LGO, Bezerra LRPS. Tilapia Skin for Neovaginoplasty after Sex Reassignment Surgery. J Minim Invasive Gynecol. 2020 Sep-Oct;27(6):1260. doi: 10.1016/j.jmig.2019.12.004. Epub 2019 Dec 16. PMID: 31837476.
[7] de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014 Oct;134(4):696-704. doi: 10.1542/peds.2013-2958. Epub 2014 Sep 8. PMID: 25201798.
[8] Stroumsa D. (2014). The state of transgender health care: policy, law, and medical frameworks. American journal of public health, 104(3), e31–e38. https://doi.org/10.2105/AJPH.2013.301789

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Tanishka Kochhar

Through my writing I hope to bring my readers closer to the less talked about areas pertaining to health, and be able to change the way people think and do health.

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