Gender Reassignment Surgery

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Gender Reassignment Surgery

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Overview

 Background
 Distinctions
 Two ways to view gender
dysphoria
 Ethical issues
 Further thinking



Background Assumptions
 Sex has three meanings
 Genetic (XY, XX, XXY, etc.)
 Phenopytic (what you look like physically)
 Social (how you are raised, how you present)
 Gender has one (main) meaning: the social or
behavior aspects of sexual identity.
 There is no 1:1 relationship between sex and
gender




 Sexual dimorphism is part of the mental
landscape in our culture.
 First question when baby is born
 “treatment” of intersex babies
 As species go, we are not too dimorphic; variations within
the sexes are greater than the variations between them.




 There is a lot we don’t know about sexual and
gender development
 How genotype is translated into phenotype
 What hormone surges (in utero and at puberty) do; what
can go wrong
 How people “feel” like women or men apart from social
conditioning



Distinctions
 Heterosexual
 Homosexual
 Bisexual
 Transvestite
 Transsexual
 Transgender



Distinctions
 Heterosexual, homosexual, and bisexual describe
sexual attraction, grounded in biology but affected by
culture.
 Medically speaking, these are not disorders.
 Attraction is fluid and changing; most people think attraction
is established before birth.
 DSM-III (1974)
 Transvestite describes people who wear clothes of the
other gender. Motives differ.



Catholic Teaching:
 Sexual function has two purposes
 Fun (aka “union”)
 Babies (aka “procreation”)
 Double effect
 Good or morally neutral act
 One effect intended, one foreseen
 Bad effect is not a means to the good



Transsexual/Transgender
 terms refer to the same thing
 gender dysphoria (DSM-IV)
 Transgendered persons can self-identify as gay
or straight.
 Some transgendered persons get married;
some engage in homosexual relationships with
members of their new sex.



Gender Dysphoria: one view
 Objectively disordered
 Psychiatric in nature
 You don’t do surgery for psychiatric
symptoms (unless you do; see Elliot)
 Gender reassignment surgery mutilates and
results in sterilization, therefore it is wrong.



Gender Dysphoria: other view
 Biological in nature; hormone surge in utero
contributes to sexualization of fetus. Disruption
can “cause” GD.
 Male and female brains differ; in some
respects, m->f brains look like female brains
and f->m brains look like male brains.



GD: other view
 If GD is biological, then surgical correction is
appropriate.
Other surgical corrections:
 Strabismus
 Cochlear implant
 Aortic repair
 Lasik surgery; septoplasty
 Mutilation and sterilization are side effects.
(see Double Effect)



Surgery is last step in transition
 Transition includes
 Psychological counseling
 Living as “the other”
 Hormone treatments to affect secondary sex
characteristics (hair growth, breast size, voice)
 Plastic surgery to fashion new genital and urethral
equipment; mastectomy for f->m; breast
augmentation for m->f.*
*cause of action in Seton lawsuit



Some transitions are finished
without surgery

 Expense
 Mutilation
 Irreversibility



Ethical Issues
 Should surgeons be allowed to perform gender
reassignment surgery?
 How do we take care of patients after surgery?
 How do we take care of transgendered persons
in the hospital for other reasons?



Allowing surgery for GRS
 Patient must be part of program
 Program must be rigorous
 Surgeon must have experience; double
boarded in some cases (e.g., urology and
plastic surgery)
 Treat these patients fairly



Ethical Issues
Respect for transgendered persons means:
Using the form of address and pronoun he or she chooses. How the
person presents is the person’s social identity and should be
honored.
Protecting privacy, especially with regard to roommate if there is
one.
Private rooms are nice but not always possible.
No one taking care of the patient should be surprised; confidence
must be held carefully.



Stoke your imagination
 Stories of Native Americans
 Middlesex by Jeffrey Eugenides
 Oscar-nominated film Transamerica
 Carl Elliot, “A New Way to Be Mad.” Atlantic
Monthly, Dec 2000.
 Call Me Malcolm (UCC: Office of LGBT Concerns
in Cleveland has copies)


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Gender Reassignment Surgery