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SEX CHANGE

Also known as

    SEX REASSINMENT SURGERY (SRS)
    GENDER ASSINMENT SURGERY
    GENITAL RECONSTRUCTIVE SURGERY
    GENDER CONFIRMATION SURGERY
    SEX CHANGE SURGERY/ OPERATIONS

This is a term for the surgical procedures and medical treatment (hormonal therapy) by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble that of the other gender. It is part of a treatment of gender identity/gender dysphasia in Tran’s sexual people. Other terms for SRS include gender reassignment surgery, sex reconstruction surgery, genital reconstruction surgery, gender confirmation surgery. For sex reassignment multiple surgical procedures are required. At the same time they need medical intervention to change their hormonal axis.

SEX- two types of Sex one is male and another is female. Lets us first know how we define sex of human body

Human Sexuality

We describe sex of body on basic three criteria.

     Physical sex
     chromosomal sex
     Mental Sex

Physical sex--Physical or anatomical sex means external appearance of human body. This external appearance is also divided in two parts. One is sexual organ or reproductive organs which are present at the time of birth of baby, and by mealy presence of these organs we label child as male and female. As we know male child have a penis and a pair of testicles. Internal male organs are prostate and vas difference. And female child has a pair of labia, clitoris and a vagina. Female child has internal organs as a pair of ovary, uterus and fallopian tubes. So these are basic organs on which we label human body as male or female. Then other criteria for sex establishment are secondary sexual characters. These are sets of changes in body because of sex hormones. Under the influence of sex hormones these changes starts at time of puberty. For male average age of puberty is around 14 yrs and for female around 12 yrs of age with variation of one to two years. For male these sets of changes are voice change, appearance of Adams, moustaches and beards, masculine body and hair on other part of body .For female change in voice, breast starts growing and staring of menstrual cycle. These changes appear when their body is producing hormones as per their sex. There can be normal variations in secondary sexual characters. We are not describing them in details and hormonal aspect here.

CROMOSOMAL SEX (Genetic Sex)--Sex of human body is determined by chromosomes it has. Every human body has total 46 chromosomes. Forty four chromosomes are same in male and female but remaining two are different. In male they are XY and in female these are XX.So a body having male sex chromosomes 44XY with male external genital as (penis and a pair of testis), and male secondary sexual characters are called true male. True female body has 44XX chromosomes, female reproductive organs (labia, clitoris, vagina, uterus ovary, fallopian tubes) with female secondary sexual characteristics.

MENTAL SEX--Preference for one or other side develop at the time when baby is in the womb of mother. In the 12th to 14th weeks of intra uterine life, a developing foetus will be under the influence of hormones over its brain. Boy babies get effect of testosterone and girl baby will be affected by estrogens. Chemical effect of hormone is for short period but this effect is "locks in" the brain to a bias toward the neurology or the biochemistry. It is this bias that makes a mind more focused on logic or more concerned with feelings. Finally, it must be considered that each of us has an inherent body map in our brains. This blueprint gives us a feeling for the shape in which we expect to find our physical selves. (Melanie Anne Phillips)

GENITAL DYSPHORIA- stress caused by feeling one is in the wrong body is called genital dysphoria

GENDER DYSPHORIA- stress caused by feeling that he is living in the wrong role, is called gender dysphoria.

TRANS SEXUALISM--Some people feel that their minds and bodies don't quite match up. This feeling is commonly known as transsexualism -- a type of gender identity disorder. Transsexuals are dissatisfied with their sexual identity, body characteristics or gender role. They wish to live as the opposite gender and may transform their bodies through gender reassignment surgery -- a collection of procedures commonly known as “Sex Change.”

A biologically born man who identifies as woman is known as Trans-woman, or transsexual woman. A biologically born woman who identifies as a man is known as trans-man, or transsexual man. Cross-dressers almost always know they don't want surgery, even though they may fantasize about it for erotic or adventurous purposes. In contrast, most transsexuals start out believing they are cross-dressers, and spend many years suffering an internal conflict wondering if it is something more, even while they try to deny it to themselves. However, transgender is used as a general, non-medical term to describe anyone with any type of gender identity issue.It's estimated that one in 11,900 males and one in 30,400 females are transsexual adults [source: WPATH Standards of Care]. Lynn Conway, a professor emerita at the University of Michigan, estimates that one in 2,500 United States citizens has undergone male-to-female gender reassignment surgery [source: Advocate].

The gender reassignment process begins long before surgery. There are five steps to the process:
I. Diagnostic assessment,
II. Psychotherapy,
III. Real-life experience,
IV. Hormone therapy
V. Surgery.

A transsexual begins by consulting a mental health professional who performs sessions of psychotherapy and formulates a diagnosis. To become a candidate for gender reassignment surgery, an individual must first be diagnosed with Gender Identity Disorder (GID). GIDs, including Trans sexualism, are considered mental disorders. The International Classification of Diseases-10 (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) consider transsexualism a GID

Treatment of Gender Identity Issues

In addition to diagnosing patients and providing counsel, mental health professionals also assess an individual's eligibility and readiness for hormone therapy and surgery. Not all transsexuals need all three phases of therapy; each path to gender reassignment is tailored to the individual. Before a patient can begin hormone therapy or breast surgery, a mental health professional must write a letter of recommendation to the physician providing medical treatment.

In addition to the letter, the World Professional Association for Transgender Health's Standards of Care requires several eligibility and readiness criteria for hormone therapy. A patient must:

    Be 18 years of age
    Understand what hormones can and cannot do medically and understand their social benefits and risks
    Have either a minimum of three months of psychotherapy or a documented three month real-life experience
    Show stable or improved mental health
    Demonstrate ability to take hormones in a responsible manner [source: WPATH Standards of Care].

After a patient meets these criteria and undergoes a basic physical examination, a physician will then prescribe hormones.

Androgens are given to biological females transitioning to male. Estrogen, progesterone, and testosterone-blocking agents are given to biological males transitioning to female. Hormones are taken orally, by injection or transdermally (a patch).

Hormone Therapy Side Effects

Biological males undergoing hormone treatment can expect, among other changes, breast growth, decrease in body hair, redistribution of body fat, decreased fertility and testicular size and less frequent and firm erections. Most of these changes are reversible if hormone therapy is stopped. The negative side effects include, but are not limited to: an increased risk for blood clots, weight gain, infertility, liver disease and hypertension.

Biological females undergoing hormone treatment can expect, among other changes, an increase in facial hair, body hair and male pattern baldness, weight gain, increased sexual interest, clitoral enlargement and a deepening voice. The negative side effects include, but are not limited to: infertility, acne, increased risk of cardiovascular disease and the increased potential of benign and malignant liver tumours [source: WPATH Standards of Care].

The Real-Life Experience immerses the individual into life as his or her preferred gender. The candidate is required to maintain full or part-time employment (or attend school full or part-time), legally change his or her first name to one that is gender appropriate and prove that people other than the therapist and doctor know his or her desired gender.

After 12 months of continuous and successful hormone therapy and Real-Life Experience, the individual is eligible for genital surgery. Two letters of recommendation, usually one from the mental health professional and one from the hormone-prescribing physician, are required for surgery. The patient chooses a surgeon -- a gynecologist, urologist, plastic surgeon or general surgeon -- to join the gender reassignment team.

SURGERY FOR SEX CHANGE

After full filling all criteria we start the SEX CHANGE SURGERY. Multiples procedures are required for SRS.

MALE TO FEMALE- patients may have several genital surgeries including orchiectomy (removal of both testis), penectomy (removal of penis), vaginoplasty (construction of vagina), clitoroplasty (construction of clitoris) and labiaplasty (construction of both labis). A transwoman might also choose reduction thyroid chondroplasty, suction-assisted lipoplasty of the waist, rhinoplasty, facial bone reconstruction (which may include hairline correction, forehead recontouring, brow lift, cheek implants, lip lift, lip filling, chin recontouring, jaw recontouring and blepharoplasty. Some patients have vocal cord surgery or voice training.

FEMALE TO MALE-patients may include hysterectomy (removal of uterus), salpingo-oophorectomy (removal of ovaries and fillopian tubes), vaginectomy (oblitration of vagina), placement of testicular prostheses and phalloplasty (the creation of a neophallus or surgically constructed penis). A transman may also undergo elective surgeries like liposuction to reduce fat in hips, thighs and buttocks.

Social Aspects

In true sense SRS does not change the sex of patient means transformed person can not produce baby, also it does not change the chromosome of patient. So newly form sex is anatomically similar externally but not internally. Transsexuals face unique issues involving marriage, sex and fertility. Although most states do not allow homosexual marriages, transsexuals are able to marry legally. A satisfying sex life post-operation depends on the transsexual's surgical choices. In female-to-male gender reassignment surgery, an affordable, realistic and functional penis is considered a fantasy. Some female-to-male patients choose to have a metoidioplasty -- a procedure where a clitoris enlarged through hormone therapy is repositioned at the end of a neophallus, or surgically constructed penis that is able to perceive sensation. In male to female transitions, the head of the penis becomes a neoclitoris.

Fertility issues and reproductive options need to be discussed before hormone therapy begins. Biological males might consider banking their sperm, while biological females sometimes consider cryopreserving, or freezing their eggs or fertilized embryos. In a survey reported by the International Journal of Transgenderism, 76 percent of the respondents favored that transwomen be made aware of the option to bank sperm before starting hormone therapy [source: IJT].

LEGAL ASPECT

An individual begins the legal name changing process by filing a court order. This usually requires completing paperwork, publishing a notice in a local newspaper. Many transsexuals find themselves denied employment, housing, places to worship, marriage and child custody. Surgeons who see their roles as restorers of bodily function or creators of body alterations for self-image purposes sometimes feel gender reassignment surgeries do not fall into those categories and object to performing such operations [source: WPATH Standards of Care].

NOTE—It is very important for the SRS team to evaluate the mental stability of person undergoing SRS. At the same person should give enough time himself before undergoing for surgery. He shall understand all social aspect of this procedure, and once SRS done, and then it cannot be changed.