What is a Sex Change, How to Change Gender, and Why people need to change gender and sex

Why do people need to change gender?

What an erection feels like is very difficult to put into words as it doesnt feel pleasurable in itself. It’s just a hard tight feeling that breaks your concentration and makes you restless and gives one an almost overwhelming desire to either have sex or masturbate. You only get pleasurable feelings, when its manipulated or touched. For a lot of transsexuals an erection is one of the most embarrassing and confronting things that can happen, I know personally that the feelings of an erection use to make me feel dirty and disgusted with my body, for some they would go as far as to mutilate them selves because of such events.

There are two main reasons for having a sex change or sexual reassignment surgery:

1. Newborns with inter-sex deformities – Deformities present intermediate stages between the primordial female genitals and the change into male ones caused by male hormone stimulation and one sex or the other needs to be assigned quite early on.
2. The patient desires the change – Some men or women believe that they are physically a different sex to the one that they are mentally and emotionally and this discord is sometimes so profound they wish to be surgically changed.

Technical considerations favour conversion from a male to a female and newborns with ambiguous organs will almost always be changed to the female sex except in the case where the penis is at least one inch long. Regardless of their chromosomes they are much more likely to be become socially well adjusted females even they will not be able to have children that they would be well adjusted males.

What Is Sex Change Surgery?

Sex change surgery which is technically known as sex reassignment surgery is a procedure that changes the genital organs from one gender to another.

Safety Measures

Sexual identity is probably the most profound characteristic that humans have and if a change needs to be made then it is highly preferable that it is done as soon as possible after birth.

By the time most adults decide on surgery they have lived for many years in there birth gender and according to studies the average age is 29 years old. Even after having lived with the said dissonance for such an extended period of time the person may not be fully aware of the implications of changing their sex and in depth psychological counselling should both precede and follow all procedures.

Additionally it is preferable that the patient will have the support of family and friends after the surgery to help him or her to adjust to the new identity.

In Australia although there are vastly varying theory’s from state to state and doctor to doctor, it will take no less than 2 years to be eligible for SRS (Sexual Reassignment Surgery).

This is made up of a minimum of 3 months intensive psychiatric evaluation before going on hormonal reassignment, then a minimum of 1 year living in your chosen gender also know as the real life test.

After which according to the Harry Benjamin standards of care you will need not one but two psychiatrists letters of recommendation to proceed with surgical reassignment.

The Sugery

MALE TO FEMALE

Changing the male to female anatomy requires removal of the penis and some reshaping of the genital tissue in order to make it appear more female and also the structuring of a vagina. A vagina can generally be successfully formed from with either a skin graft or an isolated loop of intestine.

Before and after the surgery, female hormones (estrogen) are generally given to reshape the body’s contours and to help grow satisfactory breasts.

FEMALE TO MALE

Due to the difficulty of building a functioning penis from the much smaller clitoral tissue available in the female genitals, female to male surgery has been far less successful and penis construction is not attempted until at least a year after the preliminary surgery to remove the female organs.

Studies suggest that around a third of patients would not undergo the surgery again even though they were all pleased with the change of sex. In addition to the genital organs the breasts also need to be surgically altered to give a more masculine appearance and this can be done quite successfully.

Angel Paris-Jordan – Born A Boy had SRS at 17

Orgasm?

An orgasm, or at least a reasonable degree of erogenous sensitivity can be experienced by most patients after the surgery.

What Are The Risks

As with all surgery there are the risks of infection and bleeding and the most common complication following male to female surgery is a narrowing of the new vagina.

As this is an irreversible procedure two letters of therapy clearance are required. One therapist (a psychologist, psychiatrist, social worker or sexologist) must have a doctoral degree and one of the two therapists must have known the patient for an extended period of time.

Sex change surgery, more appropriately known as sex reassignment surgery (SRS) or gender reassignment surgery (GRS), is the final stage in the physical transitioning of a transsexual or transgendered male-to-female or female-to-male. SRS is a surgical procedure that entails removing the genitalia of one sexand constructing genital organs of the opposite sex. The procedure meets with high rates of success when performed by responsible and experienced surgeons, particularly for male-to-female procedures. Surgery of this type has been performed for 50 or more years and, while the number is much lower than in the 1970s, more than 25 male-to-female SRSs are performed each week in North America alone. When done by experts, orgasm, or at least “a reasonable degree of erogenous sensitivity,” can be experienced by individuals who have undergone SRS.

To help the transgendered individual cope with the multitude of psychophysiological issues involved with their gender identity, experts recommend the support of a broad range of skilled professionals well versed in gender identityissues. Ideally, these professionals-which could include a general practitioner, surgeon, psychiatrist, psychologist, and endocrinologist–would work independently as well as cooperatively to provide the client and his or her family members with a fully-informed support network to help them through the manydifferent stages and phases of adjustment. The psychosocial as well as physiological adaptation process may take several years, even after SRS is successfully completed.

Apart from the surgery itself, changing gender identity requires unique social, legal, and hormonal involvement. The entire process is often referred to as “sexual transitioning,” as it truly does require a transition over time. Social reassignment, which is often highly recommended before the individual commits to SRS, entails living and working for perhaps two years as if the individual were already a member of the opposite sex. This often gives some indication of the possible success-emotionally and psychologically-of SRS.

Hormonal reassignment usually takes place before SRS is decided upon. For male-to-female transsexuals, estrogen therapy helps suppress the physical male characteristics and encourages physical female characteristics. Electrolysis of facial and bodily hair is still necessary, however, as estrogen does not halt hair growth. While treatment of female-to-male transsexuals with androgensdoes lower the pitch in voice, estrogen does not raise the voice pitch in the male-to-female transsexual. In order to ensure the SRS candidate is fully aware that some irreversible changes will occur even with hormone therapy alone, and that often difficult psychological changes will be experienced, initiation of psychological counseling is highly recommended beginning six months prior to the initiation of hormone therapy and continuing through the entire SRS process.

From a legal aspect, in the Australia, changing ones’ sex legally simply means having one’s birth certificate changed to match their new chosen gender. In other countries, the procedure is much more complicated.

Most surgeons who perform SRS have very strict requirements and protocols. For example, many surgeons require two legitimate psychiatric evaluations from either psychiatrists or psychologists recognized or licenses in the field ofgender identity. These evaluations must state that the individual is an appropriate candidate for SRS or, indeed, even for breast augmentation (if from male-to-female). One surgeon from Wisconsin is hesitant to even schedule a consultation to discuss the procedure unless the candidate has had at least ninemonths of counseling and psychiatric evaluation. Under some protocols, the candidate is required to meet eligibility criteria for sexual reassignment as listed in the DSM IV, ICD 10. Even then, the surgeon retains the right to have the final consultation with the candidate the day prior to surgery. Ensuring the candidate is absolutely certain about their choice is critical, for oncethe surgery has been performed, it is totally irreversible.

Once the decision has been made and the surgeon is satisfied the candidate is psychologically as well as physically eligible, lab work and an HIV test isdone. It is not unusual for a surgeon to refuse surgery to anyone with HIV, herpes, or any other form of venereal disease. Overweight and obese people arepoor candidates, and are often refused. Because loss of blood is common, patients may be advised to donate two units of their own blood, to be transfusedback following the surgery. Following an interview during which the client is fully informed of the procedures involved in surgery and the implications of its irreversible nature, the client signs a written consent for treatment by all individuals involved in the procedure. Once again, psychological treatment that runs parallel to the entire process is highly recommended.

In the case of male-to-female SRS, some surgeons recommend the cessation of hormone therapy for three weeks prior to the surgery itself. It appears that the female hormones in the genetic female have a blood clotting action that isnot present when a genetic male takes female hormones, increasing the risk of severe bleeding. As stated earlier, male-to-female GRS is considerably moreeffective and successful than female-to-male GRS. The male-to-female procedure can take anywhere from three to five hours, depending upon whether additional skin grafts are required.

The goal of male-to-female SRS is to create female sexual organs that look asnatural as possible and that allow as much sexual arousal as possible. Thisincludes removal of the penile muscle and tissue, the testicles, and reshaping external genitalia to appear female and natural. It also involves creatinga vagina, one deep enough to allow satisfactory intercourse for those who desire intercourse. SRS is therefore cosmetic as well as constructive.

Several techniques can be used to create the vagina; however, the most favored and least invasive technique is using the inverted skin of the penis to line the newly created vaginal cavity. An incision is made from the base to thehead of the penis, and the skin is peeled away from the shaft while remainingattached to the torso. In many procedures, a portion of the penis head (theglans) with its nerve supply in tact is formed into a clitoris. This technique preserves sexual stimulation and enjoyment. If the penis is long enough, noadditional skin grafts will be necessary. If the penis is short, a skin graft will be necessary to line the deepest part of the vaginal cavity. This skinmay be taken from the lower flanks, sides, or above the pubic bone. Unfortunately, this will leave scarring. It is sometimes possible to use the scrotalskin, but all hair must have been removed by several electrolysis treatmentsprior to surgery to prevent hair growth inside the vagina at a later date.

In another type of procedure, the vagina is created using what are called “full thickness” skin grafts. These grafts are obtained from hairless portions of the sides or flanks and the penile skin is then used to create the labia minora and the scrotum skin to create the labia majora. The width and dept of the vagina are usually greater than with the inverted penile skin, and the newvagina has less of a tendency to shrink over time.

Rectosigmoid vaginoplasty utilizes a piece of the rectosigmoid colon insteadof skin grafts or inverted penile tissue. This technique allows for the creation of a deep and lubricated vagina, but is a more invasive and dangerous procedure and rarely the technique of choice.

To keep the new vagina from closing, a balloon-type device called a vaginal stent is inserted and remains in place for the length of the hospital stay, which averages around six days with complete bed rest. Demerol or morphine areusually given intravenously to ease the pain, and the surgical area is kept packed with ice to decrease swelling and bleeding. Because the entire reconstructive procedure cannot be performed in one operation, many individuals choose to have a second operation three months later to enhance the cosmetic appearance of the labia and clitoris.

The most common complication of male-to-female surgery is the strong tendencyfor the vagina to shrink and eventually obliterate itself. Surgery to correct the situation is more difficult and extensive than the initial procedure. It involves making incisions in the inverted penile skin and inserting full thickness skin grafts.

Patients should return to their surgeon for six-month, 12-month, and 24-monthassessment, and seek routine examinations for any particular personal problem that may arise. Follow-up assessments are important to track the social andpsychological development of the individual. Also following surgery, the patient will return to the female hormone regimen, which will continue to reshape the body to a more feminine contour and encourage the growth of breasts. (If larger breasts are desired, saline-filled breast implants can be inserted through an incision along the border of the areola under the breast tissue andthe pectoralis major muscles.) The hormone regimen will continue for the rest of the individual’s life, and the individual should obtain check-ups at least annually.

To enhance their overall femininity, the male-to-female transsexual may alsodecide to have a “cosmetic thyroid cartilage reduction” (tracheal shaving), which reshapes the Adam’s Apple, making it inconspicuous. Also, several voicemodification techniques are available to help raise the pitch of the voice for a more feminine tone. One common and perhaps the safest technique is a “cricothyroid approximation (CTA). In this procedure, the Adam’s Apple is pushedagainst the cricoid cartilage to which it is then stitched. This puts pressure on the vocal cords, tightening them and raising their pitch. This is a reversible procedure, and is of little risk to the vocal chords because the larynx is not involved. However, the permanence of this procedure remains to be determined.

Laser assisted voice adjustment (LAVA) is another option. This endoscopic surgery is irreversible and still considered experimental; however, it has shownsome success in raising the frequency of the male-to-female transsexual’s voice by as much a 100 Hz. The procedure involves reducing the thickness of thevocal chords with a carbon dioxide laser. Reduction in the vocal chord mass,and because as the vocal chords stiffen as they heal, cause they vibrate faster once healed, creating a higher pitch. Drawbacks to this procedure are thepossibility of permanent hoarseness, bleeding, swollen airways that may require hospitalization, and sore throat.

Other surgical procedures may also be considered, such as reshaping of the chin and cheeks, forehead contouring, and rib removal.

Female-to-male surgery has achieved lesser success, due to the difficulty ofbuilding a functioning penis from the much smaller clitoral tissue availablein the female genitals. In some instances, simply removing the breasts adequately satisfies the female-to-male transsexual. Others use a prosthetic penisthat is either glued or strapped on, while yet others choose to undergo a phalloplasty (plastic surgery to attach a penis). Penis construction is not attempted less than a year after the preliminary surgery during which the uterusand ovaries are removed. The procedure entails several surgeries during whicha tube-shaped structure is constructed by peeling and rolling skin from theabdomen or upper thigh and ultimately attaching it over the clitoris to preserve as much sexual stimulation as possible. This procedure often creates unsatisfactory urination ability and, while the penis can be used for intercourse, it is less than perfect. However, the presence of a penis is often highly important to the individual’s overall concept of their body image. While one study in Singapore found that a third of individuals who underwent female-to-male SRS would not choose to do so again, they were all pleased with the reassignment of their gender.

Whether the transition if male-to-female, or female-to-male, once the GRS hasbeen completed continued counseling and social support, particularly from the family, is highly important to enable the individual to readjust in societyas a member of his or her chosen sex. If the individual were socially or emotionally unstable before the operation, more than 30 years of age, or had anunsuitable body build for the new sex, they tend to do less well. In no casestudied did the procedure diminish their ability to work, however.