Asia

Transsexuality: born in the wrong body

At birth you are given three aspects of sexual development: your biological sex, your gender role and your sexual orientation. Although the majority of people accept this information and feel satisfied with it, some people do not feel satisfied with one or more aspects of their sexual development. If you are dissatisfied with your biological sex and possibly also your gender role and sexual orientation, you may be transsexual.
Transsexuality is far from a phenomenon that has only occurred for a few years. In fact, from Greco-Roman antiquity there are already stories of men who did not feel at home in their bodies and associated themselves with a woman’s body. Not infrequently, a surgical procedure was carried out in which the characteristic male genitals were removed.

Characteristics of transsexuality

Most people see transsexuality only as a hatred of their own gender and the desire to be of the opposite gender. However, transsexuality is more than ,a boy who wants to be a girl,.

Psychological identification with the opposite sex

Transsexuals firmly believe that they were born in the wrong body. Despite the contradictory external characteristics, they feel an inner certainty that they are of the opposite sex. This inner security is not transient, not transitory. Transsexuals feel alienated from their own sex every moment of the day and in every situation. Transsexuality occurs both from man to woman and from woman to man.

Desire for sex change

Unlike transvestites, transsexuals desire actual gender reassignment surgery. This involves modifying the external sexual characteristics of one sex as best as possible into external sexual characteristics of the other sex. This wish is deeply anchored in the psyche of the transsexual and cannot be influenced. Transsexuals strive for a sex change that is as inconspicuous as possible.

Rejection of gender-specific characteristics

Transsexuals reject the characteristics of biological sex. This can even go so far as to tie off or mutilate visible sexual characteristics. One feels alienated from one’s own body, which results in a constant contradiction between self-image and reality, which can lead to depressive and suicidal thoughts.

Cross dressing

Wearing clothes typical of the opposite sex is one of the ways to express transsexual feelings. This can start in childhood. One does not feel sexual arousal or anything like that when wearing clothing that does not belong to one’s own sex.

Secondary role of sexuality

A persistent prejudice about transsexuals is that the desire for sex change is purely sexually driven. This is not true, sexuality often plays a subordinate role. Masturbation reminds the transsexual of their biological sex, which can be painful.

Physical characteristics

It has been shown that transsexuals do not have any other hormone balance, genes and internal and external sexual characteristics. However, it has long been thought that transsexuals have a physical ‘deviation’ compared to non-transsexuals.

The psychology of transsexuality

Typically, many transsexuals appear to suffer from mental illness. There is a possible relationship between the suffering of being locked up in the wrong body and a psychological factor in the development of transsexuality. However, what is cause and what is effect is not clear and there may be no causal relationship between the two at all. It appears that the mood of transsexuals improves significantly after surgery in most cases.

The process prior to gender correction surgery

A few decades ago, gender correction operations were virtually unheard of. Instead, people tried to treat transsexual feelings with psychotherapy, among other things. In the 1970s it was recognized that transsexuality cannot be treated with psychotherapy and the first steps were taken towards gender reassignment surgery.

First step

Doctors (fortunately) do not simply proceed with gender correction surgery. There are a number of steps that need to be taken before this decision is made. The first step consists of two years of observation and many conversations. It is investigated what the added value of the gender correction operation will be and whether other possible problems do not get in the way of the client’s happiness.

Second step

During the second step, which lasts a year, the client undergoes the test of daily life. During this year, the client must conform to the gender identity of the desired sex in all areas (both private and business). During this period one can encounter both positive and negative experiences. The second step is the moment when the transsexual takes the step from transsexual in fantasy to transsexual in everyday life.

Third step

In the third step, hormones from the opposite sex are administered. As a result, the external characteristics of the opposite sex come one step closer. In men who want to become women, the need for sex decreases, the skin becomes softer and fat distribution changes. In women who want to become men, the beard begins to grow, the skin becomes coarser and the voice becomes lower.

Fourth step

After using hormones of the opposite sex for approximately 9 months, sex reassignment surgery can be performed. In men, the testicles are removed, the penis is removed (penectomy) and a vagina is constructed. In women, the ovaries are removed (ovariectomy), the uterus is removed (hysterectomy) and the breasts are removed (mastectomy). Creating a penis is a laborious operation. However, for many transsexuals it is especially important that they can urinate while standing and have a male genitalia.

Male-female gender correction surgery

George Burou (sometimes also written as Bourou) was a gynecologist in Casablanca who in 1958 created a technique in which only the shaft of the penis is amputated and the surrounding skin is used to create a vagina between the prostate, the bladder, the rectum and the urethra

The operation will take approximately three hours and takes place under general anesthesia. The hospital stay lasts approximately two weeks. Follow-up treatment in the outpatient clinic is very important for good long-term results. 85% of people are ultimately able to achieve an orgasm to a greater or lesser extent.

The gender correction technique developed by Burou has been further developed and refined. This has resulted in the current treatment technique, which has six steps:

  1. Castration
  2. Create a cavity for the sheath
  3. Removal of the shaft of the penis
  4. Covering the vagina with skin of the penis
  5. Construction of the vulva
  6. Plastic breast surgery

 

1. Castration

Using an incision along the length of the penis up to four centimeters above the anus, the balls and spermatic cords are exposed. After this they are clamped and amputated.

2. Create a cavity for the sheath

An incision is made around the perineum (the area between the anus and the penis) in which a space is created near the pelvic floor muscles next to the intestine. The tendons that become exposed are cut. Another incision is then made to cut the tendon between the rectum and the prostate. The created sheath is temporarily filled with wads of gauze.

3. Removal of the shaft of the penis

The skin of the penis is then separated from the shaft and cut loose at the glans. The erectile tissue at the urethra is exposed and separated from the other erectile tissues of the penis. The remaining erectile tissues are clamped and amputated. The wound is then sutured.

4. Covering the vagina with the skin of the penis

The vagina is lined with the everted skin of the penis.

5. Construction of the vulva

The labia minora and labia majora are formed from the scrotum. The tip of the glans is transformed into a clitoris-like piece of tissue.

6. Plastic breast surgery

In some men, the breasts are not sufficiently developed with the help of female hormones. In them, a bosom can be created with the help of plastic surgery. The breasts are enlarged by inserting a silicone capsule under the skin.

Gender correction surgery female-male

The operation from female to male is a lot more complicated and complex than the operation from male to female. For many, the result of the operation will not meet their wishes and expectations, especially due to the visible scars that remain. The operation from woman to man also takes place in a number of steps:

  1. Removal of the uterus and ovaries
  2. Removal of the breasts
  3. Construction of a penis
  4. Insertion of testicles

 

1. Removal of the uterus and ovaries

The removal of the uterus and ovaries (total uterine extirpation) is usually done by a gynecologist. The operation can be performed through the vagina or through an incision in the abdomen, the decision about this lies with the treating physician.

2. Removal of the breasts

This procedure always leaves visible scars, depending on the size of the breasts before the procedure. During the operation, the female mammary gland (mastectomy) is removed, often at the same time as skin and fatty tissue. The female nipple is adjusted to the shape and size of the male nipple.

3. Construction of a penis

Thanks to ingenious developments in medicine, doctors are now able to move the body’s own tissue and connect both nerves and blood vessels. A penis construction is also called phalloplasty. The penis is created from skin from, for example, the forearm or subcutaneous fatty tissue around the abdominal wall. The latter procedure gives the best results but is very time-consuming because the procedure is spread over three operations.

Another solution is to enlarge the clitoris with the help of hormone injections and supplement it with certain incisions and transplants. During this procedure, the urethra can be brought to the end of the penis, allowing you to urinate while standing.

4. Insertion of testicles

The testicles are formed by inserting silicone prostheses at the site of the labia majora. Because connective tissue capsules are created by the prostheses, the testicles are relatively immobile.