Gender-affirming surgery
Gender-affirming surgery is a surgical procedure, or a series of procedures, that alters a person's physical appearance and sexual characteristics to resemble those associated with their gender identity. The phrase is most often associated with transgender health care, though many such treatments are also pursued by cisgender individuals. It is also known as sex reassignment surgery, gender confirmation surgery, and several [|other names].
Professional medical organizations have established Standards of Care, which apply before someone can apply for and receive reassignment surgery, including psychological evaluation, and a period of real-life experience living in the desired gender.
Feminization surgeries are surgeries that result in female-looking anatomy, such as vaginoplasty, vulvoplasty and breast augmentation. Masculinization surgeries are those that result in male-looking anatomy, such as phalloplasty and mastectomy.
In addition to gender-affirming surgery, patients may need to follow a lifelong course of masculinizing or feminizing hormone replacement therapy to support the endocrine system.
Sweden became the first country in the world to allow transgender people to change their legal gender after "reassignment surgery" and provide free hormone treatment, in 1972. Singapore followed soon after in 1973, being the first in Asia.
Terminology
Gender-affirming surgery is known by many other names, including gender-affirmation surgery, sex reassignment surgery, gender reassignment surgery, and gender confirmation surgery. It is also sometimes called a sex change, though this term is usually considered offensive. Top surgery and bottom surgery refer to surgeries on the chest and genitals respectively.Some transgender people who want medical assistance to transition from one sex to another identify as "transsexual".
Trans women and others assigned male at birth may undergo one or more feminizing procedures: genital surgeries such as penectomy, orchiectomy, vaginoplasty, vulvoplasty ; as well as breast augmentation, tracheal shave, facial feminization surgery, and voice feminization surgery among others.
Trans men and others assigned female at birth may undergo one or more masculinizing procedures; such as chest reconstruction, mastectomy, breast reduction, hysterectomy, oophorectomy, salpingectomy. A penis can be constructed through metoidioplasty or phalloplasty, and a scrotum through scrotoplasty, sometimes enhanced with testicular implants.
As knowledge of non-binary genders expands in the medical community, more surgeons are willing to tailor operations to individual needs. Bigenital operations allow individuals to construct a penis or vagina and retain their original organs. Gender nullification is the removal of all external genitalia except the urethral opening, typically pursued by people assigned male at birth.
Gender-affirming surgery can also refer to operations pursued by cisgender people, such as mammaplasty, penile implant, or testicular implants following orchiectomy.
Gender-affirming surgery is often sensationalized and misrepresented by anti-trans activists through terms such as genital-mutilation surgery.
Surgical procedures
The best-known gender-affirming procedures are those that reshape the genitals, which are also known as genital reassignment surgery, genital reconstruction surgery, sex reassignment surgery, and bottom surgery. However, the meaning of "sex reassignment surgery" has been clarified by the medical organization, the World Professional Association for Transgender Health, to include any of a larger number of surgical procedures performed as part of a medical treatment for gender dysphoria.WPATH says medically necessary gender-affirming surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation... including breast prostheses if necessary, genital reconstruction... and certain facial plastic reconstruction." Other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial hair electrolysis.
Genital surgery
Feminizing
For trans women and transfeminine people, genital reconstruction usually involves surgical construction of a vagina. The most common techniques are penile inversion, rectosigmoid vaginoplasty and peritoneal pullthrough vaginoplasty. Another technique, the non-penile inversion technique, uses perforated scrotal tissue to construct the vaginal canal. A less invasive procedure with reduced postoperative care requirements is vulvoplasty, which creates external female genitalia without a vaginal canal. The downside of this procedure is that it does not allow for penetrative sex.Masculinizing
For trans men and transmasculine people, genital reconstruction may involve the construction of a penis through either phalloplasty or metoidioplasty, which is less invasive but results in a smaller penis.Non-binary people
people may elect to get any of the surgeries listed above, depending on their sex assignment. They may also opt for bigenital or gender nullification surgeries. Bigenital operations include androgynoplasty, a vaginoplasty procedure that retains the penis, or vagina-preserving phalloplasty. These procedures tend to be rarely performed. In 2017, one of the leading UK trans surgeons, James Bellringer, commented that he had never received a request for it.Other considerations
Genital surgery may also involve other medically necessary procedures, such as orchiectomy, penectomy, or vaginectomy. Complications of penile inversion vaginoplasty are mostly minor; however, rectoneovaginal fistula can occur in about 1–3% of patients. These require further surgery to correct.Other surgeries
As underscored by WPATH, gender transition may entail a variety of non-genital surgeries that change primary or secondary sex characteristics, any of which are considered "gender-affirming surgery" when done to affirm a person's gender identity. For trans men, these may include mastectomy and chest reconstruction, or hysterectomy and bilateral salpingo-oophorectomy. For some trans women, facial feminization surgery, hair transplants, and breast augmentation are also aesthetic components of their surgical treatment. Voice feminizing surgery is a procedure in which the overall pitch range of the patient's voice is reduced. Adam's apple reduction surgery or tracheal shaving is a procedure in which the most prominent part of the thyroid cartilage is reduced.There is also Adam's apple enhancement therapy, in which cartilage is used to bring out the Adam's apple in female-to-male patients.
History
Reports of people seeking gender-confirming surgery go back to the 2nd century, such as Roman Emperor Elagabalus.20th century
In the US in 1917, Alan L. Hart, an American tuberculosis specialist, became one of the first trans men to undergo hysterectomy and gonadectomy as treatment of what is now called gender dysphoria.Dora Richter is the first known trans woman to undergo complete male-to-female genital surgery. She was one of several transgender people in the care of sexologist Magnus Hirschfeld at Berlin's Institute for Sexual Research. In 1922, Richter underwent orchiectomy. In early 1931, a penectomy, followed in June by vaginoplasty.
In 1930-1931, Lili Elbe underwent four sex reassignment surgeries, including orchiectomy, an ovarian transplant, and penectomy. In June 1931, she underwent her fourth surgery, including an experimental uterine transplant and vaginoplasty, which she hoped would allow her to give birth. However, her body rejected the transplanted uterus, and she died of post-operative complications in September, at age 48.
A previous sex reassignment surgery patient was Magnus Hirschfeld's housekeeper, but their name has not been discovered.
Elmer Belt may have been the first U.S. surgeon to perform gender affirmation surgery, in about 1950.
In 1951, Harold Gillies, a plastic surgeon active in World War II, worked to develop the first technique for female-to-male gender-affirming surgery, producing a technique that has become a modern standard, called phalloplasty. Phalloplasty is a cosmetic procedure that produces a visual penis out of grafted tissue from the patient.
In 1971, Roberto Farina performed Brazil's first male-to-female gender-affirming surgery.
In 1984, Jalma Jurado developed a new surgical technique, which he used in surgeries for more than 500 trans women in Brazil and from around the world.
Following phalloplasty, in 1999, the procedure for metoidioplasty was developed for female-to-male surgical transition by the doctors Lebovic and Laub. Considered a variant of phalloplasty, metoidioplasty works to create a penis out of the patient's present clitoris. This allows the patient to have a sensation-perceiving penis head. Metoidioplasty may be used in conjunction with phalloplasty to produce a larger, more "cis-appearing" penis in multiple stages.
21st century
On 12 June 2003, the European Court of Human Rights ruled in favor of Carola van Kück, a German trans woman whose insurance company denied her reimbursement for sex reassignment surgery as well as hormone replacement therapy. The legal arguments related to the Article 6 of the European Convention on Human Rights as well as the Article 8. This affair is called van Kück vs Germany.In 2011, Christiane Völling won the first successful case brought by an intersex person against a surgeon for non-consensual surgical intervention described by the International Commission of Jurists as "an example of an individual who was subjected to sex reassignment surgery without full knowledge or consent".
some European countries require forced sterilization for the legal recognition of sex reassignment., Japan also requires an individual to undergo sterilization to change their legal sex.
The early history of gender-affirming surgery in trans people has been reviewed by various authors.