THE TRANSSEXUALʼS REQUEST FOR SURGERY

Publisher Website
Google Scholar
Abstract
This paper discusses the problems of evaluation and the selection criteria currently in use for transsexuals who request sexual reassignment surgery. The discussion is based on the experiences of the Gender Identity Committee of the Johns Hopkins Hospital and the data obtained from 16 transsexuals who presented for evaluation, 9 of whom are in the process of receiving sexual reassignment surgery. The problems encountered in the use of the psychiatric interview for transsexual patient evaluation are reviewed. In data from interviews a high degree of patient motivation to obtain surgery is noted. Patients tend to skew memory and report only those feelings of belonging to the opposite gender. Most transsexual patients describe previous psychiatric experience as anxiety-provoking. Throughout the interview the patient's strong desire to be accepted in the acquired gender role and the prospect of secondary gain may be expected to strongly influence the response to questions. The interviewing of parents and other family members is stressed as necessary for thorough evaluation. The selection criteria are tentative until postoperative data on transsexuals becomes available. The criteria currently applied are discussed. 1) Is the patient a candidate for psychotherapy rather than surgery? The patient's adopted gender role is largely ego-syntonic, and the patient is poorly motivated for any attempt to alter his or her firmly established opposite sex role. When psychotherapy is offered, it is nearly always refused by the patient unless it is an attempt to deal with problems other than gender role. 2) Is the patient authentically motivated? Evidence of patient ambivalence or involvement in some transient situational event is viewed as a contraindication to surgery. An attempt is made to distinguish the transsexual from the passive male homosexual who may be in conflict with his homosexuality. 3) Is the patient psychotic? Some schizophrenic patients demonstrate confusion in sexual identification and gender role. Requests from schizophrenic patients are denied. The issues concerning a sense of gender reversal being a “delusion,” or in itself a psychosis, and the propensity of the transsexual for depressive episodes are discussed. 4) Will the patient undergo sociocultural crisis if he receives the operation? The economic and vocational changes a transsexual patient must make in the opposite sex role need thorough consideration to avoid future crises. Present data tend to indicate that the length of time spent by the patient in actual experience in the opposite sex role prior to surgery is of critical importance.

This publication has 0 references indexed in Scilit: