Gender reassignment surgery means surgery that is done to convert a male into female (MtF) or female into male (FtM). Gender dysphoria is the term to describe a peculiar medical condition, where a male is born with a female body or vice versa. Gender dysphoria patients start to realize during their early childhood that he or she is born with the body of the opposite sex. So, a male child will try to dress up like a girl. He would play with dolls rather them cars and toy pistols. He would also like to be with other girls. As the child grows up into his teens he feels physically attracted towards a boy. The situation becomes over powering and he would not listen to his parents or anybody else about this abnormal behavior. The patient remains confused and starts hating his male body. Invariably these unfortunate children undergo intense mental anxiety along with various type of abuse. They are harassment by friends/neighbors and also by the parents. Many of these children are taken as mental cases and some are put through heinous acts of physicals torture. There are examples of gender dysphoria patients being labeled as mentally sick and treated, by electric shock therapy.
In recent years some progress has been made towards understanding these transsexual population/ patients. Doctors and psychologist now agree that they should not be treated as psychiatric patients; and that they should be offered gender reassignment treatment.
Dr. Harry Benjamin was the pioneer in modern treatment of Gender Dysphoria: and he wrote a book called "The Transsexual Phenomenon". In 1966 John Hopkins Medical Centre in New York started surgical operations on transsexual patents as per recommendation of Dr. Benjamin. These operation were then reported as neither illegal nor unethical by The New York Times.
In case of MtF the patient undergoes psychiatric evaluation followed by regular female hormone supplement. They are also advised to dress up as females (Real Life Training). When after subsequent evaluations the patient is found to be more settled and happy, he is advised surgery. It is usually done in two or more stages. The first stage includes breast implant and orchidectomy (removal of testes) in the next stage excision of the phallus and vaginoplasty is performed.
In female to male conversion the patients receive & androgen (male hormone) injection which helps in development of facial hairs and male voice. These patients also require stepwise surgery. The first step consists of mastectomy (removal of breasts) and hysterectomy with salphingoophorectomy (removal of uterus and ovaries) In second step a phalloplasty (reconstruction of male genital organ is done). After complete recovery, which takes a number of months, these patients can appear and function as their reassigned gender. MtF patients not only can look like a woman but can also get married and experience normal physical relationship. Similarly an FtM patient can look like a man and can marry a woman. Of course these patients will never be able to bear children.
For the first time in Bangladesh this surgery has been done successfully at Cosmetic Surgery Centre Ltd.
It is responsibility of doctors, psychologist and social workers to address this important issue and facilitate proper counseling and treatment of transsexual patients. Unless we take action now, a big population of these gender dysphoria patients will remain in the dark and continue to suffer from identity crises and social harassment.
