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History, Societal Attitudes, and Contexts

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Gender Confirmation Surgery

Abstract

Gender confirmation surgery as we know it today originated in western Europe in the early twentieth century. This chapter introduces the social context and the scientific theories and surgical experience that brought forth “transsexualism” and ultimately led to the contemporary efforts to alleviate the stress and anxiety that can often accompany a given individual’s disconnect between their gender identity and their body. Today, this condition may be called gender dysphoria (DSM-5) or gender incongruence (ICD-11), depending on what system of nomenlature is operative in one’s healthcare delivery/payment system. In any case, people who require gender confirmation surgery are often judged according to criteria established by persons who cannot imagine what it would feel like to experience this dissonance. As we enter the twenty-first century, “trans” people have become much more articulate and better equipped to self-advocate, and the surgeon’s role has become even more challenging and yet rewarding as the surgical results improve and the medical necessity of treatment becomes more self-evident.

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Notes

  1. 1.

    For a detailed discussion of the transsexual narrative and its conflation with sexual deviance, erotic pleasure, and especially homosexuality, see Sharpe [3].

  2. 2.

    Incidence = the number of new cases arising in a given period, e.g. a year

  3. 3.

    Prevalence = the number of individuals having a condition, divided by the number of people in the general population

  4. 4.

    For example, significant differences from the Dutch figures are noted in Singapore [29], Thailand [31], Serbia [32], and New Zealand [33].

  5. 5.

    A simple Google Scholar search on “transsexual sex workers” yields over 26,000 articles on the subject, revealing studies conducted in Europe, Asia, Africa, North and South America, Australia, and numerous Pacific Island cultures.

  6. 6.

    Over 43,000 articles are available via Google Scholar on the subject of “transgender HIV prevention”.

  7. 7.

    Note the story of the murder of Chanelle Pickett, for which her killer was acquitted, as described in Thomas [38].

  8. 8.

    For example, the American television series “Law & Order” has featured several such characters.

  9. 9.

    The eugenics movement in Britain and in the USA, as well as American miscegenation laws, attests to this.

  10. 10.

    See, for example, Collyer [41]; see also, Green [42].

  11. 11.

    For example, the extremely popular novel and film, Silence of the Lambs, in which an FBI agent declares, “There’s no correlation between transsexualism and violence”, and her brilliant antagonist says, “Transsexuals are very passive – clever girl”. It is not an inherently bad statement, just one that is overgeneralising and rooted in assumptions.

  12. 12.

    Pauly [47: 465]; see also Carroll [12: 134]; also, the interdisciplinary professional society, the World Professional Association for Transgender Health has nearly 2500 members as of May 2019, the majority of whom concur with Benjamin’s perspective in this regard because of their own clinical experience.

  13. 13.

    The Erickson Educational Foundation was established by an independently wealthy transsexual man, Reed Erickson, who also supported the work of Harry Benjamin, and the early interdisciplinary scientific symposia on gender identity, held in London (1969), Copenhagen (1971), Dubrovnik (1973), and again in London (1974), plus several other meetings, clinics, and educational groups in the USA and Europe, which he hoped would establish, rationalise, validate, and institutionalise medical treatment for transsexual people like himself. See Devor [53].

  14. 14.

    Standards of Care were created in 1979 by the founding committee of the Harry Benjamin International Gender Dysphoria Association, Inc., or HBIGDA. The members of HBIGDA voted in 2008 to change the Association’s name to the World Professional Association for Transgender Health, or WPATH. See http://www.wpath.org (retrieved 30 April 2019).

  15. 15.

    Currently Great Britain and Spain permit legal status change without evidence of genital reconstruction and/or sterilisation. Many countries (and three US states) refuse to consider any change to birth records and/or identity documents. See, for example, Whittle et al. [60].

  16. 16.

    First Things magazine published by the Institute on Religion and Public Life defines itself as “an interreligious, nonpartisan research and education institute whose purpose is to advance a religiously informed public philosophy for the ordering of society” http://www.firstthings.com/masthead (retrieved 30 April 2019).

  17. 17.

    http://www.medterms.com/script/main/art.asp?articlekey=13211 (retrieved 30 April 2019).

  18. 18.

    Green [45: 104]. Green uses the old language, “real-life test”, which was removed from the HBIGDA Standards of Care (SOC) in 1980. Continued use of the obsolete term has contributed widespread misunderstanding of the SOC among trans people that creates antagonism between the community and medical providers.

  19. 19.

    This requirement refers to the Standards of Care: Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons that emerged in 1979, with Richard Green a contributor: Walker [74]. Revisions were published in 1980, 1981, 1990, 1997, 2001, and 2011. Version 8 is anticipated to be released in 2020. Current and past versions of the SOC may be found on the website www.wpath.org

  20. 20.

    Gooren [77].

  21. 21.

    See, for example, Professor Lynn Conway’s “Transsexual Women’s Successes” website at http://ai.eecs.umich.edu/people/conway/TSsuccesses/TSsuccesses.html and “Successful TransMen” at http://ai.eecs.umich.edu/people/conway/TSsuccesses/TransMen.html

  22. 22.

    One example of a surgeon who fell out of favour in the USA is Dr. David Gilbert, who was reported to have remarked in a presentation (at the International Foundation for Gender Education annual conference, Houston, TX, April 1992) concerning radial forearm flap transfer phalloplasty procedure that women who partner with transsexual men “love to suck on forearms” (anonymous personal communication, April 1992).

  23. 23.

    See Diamond [81: 50]. His theory that transsexual people are intersexed mentally was articulated in Diamond [82], Pediatric Management of Ambiguous and Traumatized Genitalia. [National Kidney Foundation Lecture] in The Journal of Urology, 162, 1021–1028, but it was not elaborated upon until the 2000 article, and developed further in Diamond [82].

  24. 24.

    Personal communication with Prof. Milton Diamond, 15 May 2010.

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    Jamison Green

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    Loren S. Schechter

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Green, J. (2020). History, Societal Attitudes, and Contexts. In: Schechter, L. (eds) Gender Confirmation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-29093-1_1

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