Genitoplastia feminizante en paciente transgénero / Feminizing genitoplasty in a transgender patient

Introducción. La ausencia vaginal tiene un impacto devastador en paciente transgénero de hombre a mujer, por lo tanto, es primordial crear una neovagina de funcionamiento normal con satisfacción sexual, apariencia estética óptima y a su vez las características de micción femenina. Para tal objetivo existen diferentes procedimientos quirúrgicos. La genitoplastia feminizante con colgajo pene escrotal invertido cumple con las necesidades y expectativas del paciente.1-6 Método. En este caso se realizó un análisis descriptivo y retrospectivo de 28 pacientes, transgénero, en los cuales se realizó genitoplastia feminizante con colgajo pene escrotal invertido, con edades entre 18 y 46 años, en un período de 2,5 años desde febrero de 2018 a agosto de 2020. Resultados. La vitalidad del colgajo fue un 100% con una satisfacción sexual del 96,4%, con bajo porcentaje de complicaciones (3%) que incluyen hematoma, dehiscencia y estenosis. Estéticamente la satisfacción fue del 100%. Para muchas pacientes la genitoplastia feminizante es la etapa final de muchas mujeres transgénero en su proceso de confirmación de género.

Introduction. Vaginal absence has a devastating impact on a male to female transgender patient, therefore, it is essential to create a normally functioning neovagina with sexual satisfaction, optimal aesthetic appearance and in turn the characteristics of female urination. For this purpose there are different surgical procedures. Feminizing Genitoplasty with inverted scrotal penis flap meets the needs and expectations of the patient.1-6 Method. In this case, a descriptive and retrospective analysis of 28 transgender patients was performed, in which Feminizing Genitoplasty was performed with an inverted scrotal penis flap, aged between 18 and 46 years, over a period of 2.5 years from february 2018 to august 2020.For many patients, Feminizing Genitoplasty is the final stage for many transgender women in their gender confirmation process. Results. The vitality of the flap was 100% with a sexual satisfaction of 96.4%, with a low percentage of complications in 3% that include hematoma, dehiscence and stenosis, aesthetically we present 100% satisfaction

[Life after sexual reassignment surgery: significance for gender and transsexuality]. / Vidas após a cirurgia de redesignação sexual: sentidos produzidos para gênero e transexualidade.

The Transsexualization Process is the main service directed to trans-specific health in Brazil, which provides services such as hormone therapy and sexual reassignment surgeries to the trans population. In this article, the significance surrounding the surgical procedure, the new genitalia, gender and transsexuality among women who underwent sexual reassignment surgery at the Cassiano Antônio de Moraes University Hospital (HUCAM), located in Vitória, Espírito Santo State, Brazil, was analyzed. Qualitative research was carried out, narrative interviews were recorded, and thematic content analysis was performed. The sample was composed of 9 participants selected by snowball sampling. The conclusion drawn is that the surgeries are related to the search for the humanization of bodies. The comprehension about being a woman was not limited to a biological status for gender. Transsexuality was presented as a transitional experience between genders. The sexual reassignment surgery was seen as a strategy of corporal correction in line with expectations about social relationships in gender by participants, the success of which is evaluated from the standpoint of beauty, pleasure and passability.

O Processo Transexualizador é o principal serviço direcionado à saúde trans-específica no Brasil, o qual oferta aquisições como hormonioterapia e cirurgias de redesignação sexual à população trans. Neste artigo, analisaram-se os sentidos produzidos em torno do procedimento cirúrgico, da nova genitália, sobre gênero e transexualidade entre mulheres que realizaram cirurgia de redesignação sexual no Hospital Universitário Cassiano Antônio de Moraes (HUCAM), localizado em Vitória, Estado do Espírito Santo, Brasil. Foi realizada pesquisa qualitativa com entrevistas narrativas gravadas em áudio, e realizada análise de conteúdo. Foram selecionadas 09 participantes a partir da metodologia bola de neve. Conclui-se que as cirurgias estão relacionadas à busca pela humanização dos corpos. As compreensões sobre ser mulher não se limitaram a um estatuto biológico para os gêneros. A transexualidade foi apresentada como uma experiência de transição entre os gêneros. A cirurgia de redesignação sexual foi apontada como estratégia para a construção de um corpo em consonância com a experiência das participantes nas relações sociais de gênero, cujo sucesso é avaliado sob signos de beleza, prazer e passabilidade.

Male-to-Female Gender-Affirming Surgery Using Nile Tilapia Fish Skin as a Biocompatible Graft.

STUDY OBJECTIVE: Insufficient penile skin is common during vaginoplasty for male-to-female transition. This issue may be compensated by a scrotal skin flap, with the drawback of hair growth [1]. In recent studies, Nile tilapia skin was successfully used for the surgical management of Mayer-Rokitansky-Küster-Hauser syndrome [2,3] and vaginal stenosis [4,5]. This study aims to describe a novel technique for primary vaginoplasty in male-to-female gender-affirming surgery using Nile tilapia skin as a biocompatible graft to ensure adequate vaginal depth. DESIGN: Stepwise demonstration of the procedure with narrated video footage. SETTING: Transgender health clinic. INTERVENTIONS: A 29-year-old patient with gender dysphoria was referred to our office because of a desire for gender-affirming surgery. A physical examination revealed normal male genitalia with a 14-cm-long penis. Before surgery, approval from the institutional review board and written permission from the patient were obtained. After orchiectomy, penile disassembly, perineal dissection, and urethroplasty were performed, and a hollow Nile tilapia skin mold was prepared and sutured to the distal edge of the remaining penile skin. This structure was inverted, covering the newly created canal. The neocavity was then filled with a handmade inflatable vaginal mold, held in place by sutures in the labia majora. Finally, labiaplasty and clitoroplasty were conducted. After 7 days, the inflatable mold was removed, and the use of progressively larger dilators was initiated. After 3 weeks, a neovagina that was 16 cm long and able to accommodate the width of 2 fingers was detected. At that time, the Nile tilapia skin was completely reabsorbed into the neovaginal mucosa. There were no complications in the early postsurgical period. CONCLUSION: Nile tilapia skin, a safe, low-cost, and easy-to-use biocompatible material, may be an alternative option to scrotal skin grafts for neovaginal augmentation in primary vaginoplasty for male-to-female gender transition. However, further studies are needed to confirm this assertive.

Vidas após a cirurgia de redesignação sexual: sentidos produzidos para gênero e transexualidade / Life after sexual reassignment surgery: significance for gender and transsexuality

Resumo O Processo Transexualizador é o principal serviço direcionado à saúde trans-específica no Brasil, o qual oferta aquisições como hormonioterapia e cirurgias de redesignação sexual à população trans. Neste artigo, analisaram-se os sentidos produzidos em torno do procedimento cirúrgico, da nova genitália, sobre gênero e transexualidade entre mulheres que realizaram cirurgia de redesignação sexual no Hospital Universitário Cassiano Antônio de Moraes (HUCAM), localizado em Vitória, Estado do Espírito Santo, Brasil. Foi realizada pesquisa qualitativa com entrevistas narrativas gravadas em áudio, e realizada análise de conteúdo. Foram selecionadas 09 participantes a partir da metodologia bola de neve. Conclui-se que as cirurgias estão relacionadas à busca pela humanização dos corpos. As compreensões sobre ser mulher não se limitaram a um estatuto biológico para os gêneros. A transexualidade foi apresentada como uma experiência de transição entre os gêneros. A cirurgia de redesignação sexual foi apontada como estratégia para a construção de um corpo em consonância com a experiência das participantes nas relações sociais de gênero, cujo sucesso é avaliado sob signos de beleza, prazer e passabilidade.

Abstract The Transsexualization Process is the main service directed to trans-specific health in Brazil, which provides services such as hormone therapy and sexual reassignment surgeries to the trans population. In this article, the significance surrounding the surgical procedure, the new genitalia, gender and transsexuality among women who underwent sexual reassignment surgery at the Cassiano Antônio de Moraes University Hospital (HUCAM), located in Vitória, Espírito Santo State, Brazil, was analyzed. Qualitative research was carried out, narrative interviews were recorded, and thematic content analysis was performed. The sample was composed of 9 participants selected by snowball sampling. The conclusion drawn is that the surgeries are related to the search for the humanization of bodies. The comprehension about being a woman was not limited to a biological status for gender. Transsexuality was presented as a transitional experience between genders. The sexual reassignment surgery was seen as a strategy of corporal correction in line with expectations about social relationships in gender by participants, the success of which is evaluated from the standpoint of beauty, pleasure and passability.

Body construction and health itineraries: a survey among travestis and trans people in Rio de Janeiro, Brazil.

The article examines health itineraries followed by Brazilian travestis, trans men and trans women in the affirmation of their gender, based on the survey Trans Uerj: Health and Citizenship of Trans People in Brazil. The survey's main objectives were to gauge the trans/travesti population's diversity and sociodemographic profile; and to map the various ways they access their rights as citizens, especially to healthcare services and body modification technologies. Interviewers, mainly trans people and travestis, applied 391 questionnaires in the city of Rio de Janeiro and its metropolitan region to interviewees of different social classes, schooling levels and gender identity configurations, contacted through the interviewers' social networks. For defining respondents' gender identities the survey used an original method based on self-definitions, which were then aggregated into 6 categories for data analysis purposes. This article discusses the multiple strategies used by this trans population in gender affirmation processes to gain access to regulated and/or unregulated use of hormones and surgical procedures.

Refinamentos estéticos na aparência da vulva na cirurgia de adequação genital / Esthetic refinements to the appearance of the vulva in sex reassignment surgery

Introdução: A cirurgia de adequação genital tem se mostrado uma opção segura e confiável, com redução drástica na disforia e melhora da qualidade de vida das pessoas transgênero. A técnica mais estudada e utilizada é a inversão peniana com suas modificações, com aparência estética e funcionalidade adequadas, porém sem padronização da técnica cirúrgica. Índices de até 38% de satisfação parcial e 15% de insatisfação podem levar até 66% dos casos a realizar procedimentos adicionais. O objetivo é sugerir refinamentos estéticos na aparência da vulva e comparar com algumas das técnicas descritas, buscando aumentar a satisfação estética e funcional pós-operatória. Métodos: Estudo retrospectivo com 7 pacientes submetidas à cirurgia de readequação sexual entre agosto de 2017 e fevereiro de 2018. O clitóris é feito com a glande em formato de tridente, utilizando a coroa para construir os corpos cavernosos do clitóris e aumentar a área de sensação erógena. Faixa de prepúcio é usada para aumentar a cobertura do clitóris e cobrir a face interna dos pequenos lábios, que são definidos com o uso de suturas. Resultados: Sensibilidade adequada e satisfação com o resultado e capacidade de orgasmo em todas as pacientes observadas. Não houve estenose, fístula ou necrose do clitóris com essa técnica. Somente 1 caso precisou de procedimento adicional para melhor definição estética. Conclusão: A técnica apresentada tem alta satisfação das pacientes e sensibilidade erógena, com algumas vantagens em relação a outras técnicas. Porém, estudos prospectivos com número maior de pacientes são necessários para definir a técnica cirúrgica mais efetiva.

Introduction: Sex reassignment surgery is a reliable and safe option, which has drastically reduced dysphoria and improved the quality of life of transgender individuals. The most studied and used technique is penile inversion with modifications, which results in appropriate esthetic appearance and functionality, but the surgical technique has not been standardized. Partial satisfaction rates up to 38% and dissatisfaction rates of 15% may cause up to 66% of cases to undergo additional procedures. The objective is to suggest esthetic refinements to the appearance of the vulva and compare some of the techniques described, seeking to increase the postoperative esthetic and functional satisfaction. Methods: A retrospective study with 7 patients undergoing sex reassignment surgery between August 2017 and February 2018 was conducted. The clitoris is constructed with the glans in the form of a trident, using the corona to build the corpus cavernosa of the clitoris and increase the area of erogenous sensation. A section of the prepuce is used to increase the coverage of the clitoris and cover the inner surface of the labia minora, which are defined with the use of sutures. Results: Adequate sensitivity and satisfaction with the result and capacity of orgasm in all patients were observed. There was no stenosis, fistula, or necrosis of the clitoris with this technique. Only 1 case needed an additional procedure for better esthetic definition. Conclusion: The technique presented leads to high patient satisfaction and erogenous sensitivity, with some advantages compared to other techniques. However, prospective studies with larger numbers of patients are needed to define a more effective surgical technique.

Body construction and health itineraries: a survey among travestis and trans people in Rio de Janeiro, Brazil / A construção do corpo e itinerários de saúde: um estudo entre travestis e pessoas trans no Rio de Janeiro, Brasil / Construcción corporal e itinerarios de salud: una encuesta entre travestis y personas trans en Río de Janeiro, Brasil

The article examines health itineraries followed by Brazilian travestis, trans men and trans women in the affirmation of their gender, based on the survey Trans Uerj: Health and Citizenship of Trans People in Brazil. The survey's main objectives were to gauge the trans/travesti population's diversity and sociodemographic profile; and to map the various ways they access their rights as citizens, especially to healthcare services and body modification technologies. Interviewers, mainly trans people and travestis, applied 391 questionnaires in the city of Rio de Janeiro and its metropolitan region to interviewees of different social classes, schooling levels and gender identity configurations, contacted through the interviewers' social networks. For defining respondents' gender identities the survey used an original method based on self-definitions, which were then aggregated into 6 categories for data analysis purposes. This article discusses the multiple strategies used by this trans population in gender affirmation processes to gain access to regulated and/or unregulated use of hormones and surgical procedures.

O artigo examina os itinerários de saúde seguidos por travestis e mulheres e homens trans brasileiros na afirmação do seu próprio gênero, com base no inquérito Trans Uerj: Health and Citizenship of Trans People in Brazil. O inquérito teve como objetivos avaliar a diversidade e o perfil sociodemográfico da população trans/travesti e mapear as diversas maneiras pelas quais garantem seus direitos de cidadania, principalmente nos serviços saúde e em tecnologias de modificação do corpo. Os entrevistadores, majoritariamente pessoas trans e travestis, aplicaram 391 questionários na cidade e Região Metropolitana do Rio de Janeiro, com entrevistados/as de diferentes classes sociais, níveis de escolaridade e configurações de identidade de gênero, contatados através das redes sociais dos entrevistadores. A definição da identidade de gênero dos entrevistados usou um método original baseado nas autodefinições; as definições foram agregadas depois em seis categorias para fins de análise dos dados. O artigo discute as múltiplas estratégias utilizadas pela população trans nos processos de afirmação de gênero para obter acesso ao uso regulado e/ou não regulado de hormônios e procedimentos cirúrgicos.

El artículo examina los itinerarios de salud seguidos por travestis brasileños, hombres trans y mujeres trans para la afirmación de su género, está basado en la encuesta Trans Uerj: Health and Citizenship of Trans People in Brazil. Los objetivos principales de esta encuesta fueron evaluar la diversidad de la población trans/travesti y su perfil sociodemográfico; así como mapear los diferentes caminos gracias a los que consiguen tener acceso a sus derechos como ciudadanos, especialmente en lo que concierne a servicios de salud y técnicas de modificación corporales. Se entrevistaron principalmente a personas trans y travestis, de quienes se recabaron 391 cuestionarios en la ciudad de Río de Janeiro y su región metropolitana, procedentes de diferentes clases sociales, niveles educacionales y configuraciones de identidad de género, que fueron contactados a través de redes sociales por parte de los entrevistadores. Con el fin de definir las identidades de género de quienes respondieron la encuesta, se usó un método original basado en autodefiniciones, que posteriormente fueron añadidas a 6 categorías para fines de análisis de datos. Este artículo discute las múltiples estrategias utilizadas, por parte de esta población trans en procesos de afirmación de género, para conseguir acceso al uso de hormonas reguladas y/o irregulares, así como procedimientos quirúrgicos.

Step by step male to female transsexual surgery

ABSTRACT Introduction After the diagnosis of transsexualism is confirmed therapy commences with psychotherapeutic preparation for the conversion, and after conversion, long-term patient rehabilitation is maintained for at least two years. The indication for surgery is chronic discomfort caused by discord with the patient's natural gender, intense dislike of developing secondary sex characteristics and the onset of puberty. The surgical conversion of transsexuals is the main step in the complex care of these problematic patients (1). This surgery was first described by Benjamin H, using a flap of inverted penile skin (2) and is considered the gold standard since then. Male-to-female transsexual surgical techniques are well defined and give good cosmetic and functional results. Sex reassignment surgery promotes the improvement of psychological aspects and social relationships as shown in the World Health Organization Quality of Life Assessment applied in the patients submitted to this procedure (3). Techniques include the creation of a normal appearing female introitus, a vaginoplasty allowing sexual intercourse and the capability of clitoral orgasm (4). Various methods for neovaginoplasty have been described and can be classified into five categories, i.e. pedicled intestinal transplants, penile skin grafts, penile skin flaps, non-genital skin flaps and non-genital skin grafts (5). In our Hospital, we use penile and scrotal skin flaps. Until now, 174 procedures have been performed by our team using this technique with high rates of satisfaction (3). Patients and methods We present a step-by-step male to female transsexual surgery. Conclusion Surgical gender reassignment of male transsexuals resulted in replicas of female genitalia which enabled coitus with orgasm (1). With this video we show step by step that a surgery using penile skin flaps is able to be performed with good cosmetic results.

Step by step male to female transsexual surgery.

INTRODUCTION: After the diagnosis of transsexualism is confirmed therapy commences with psychotherapeutic preparation for the conversion, and after conversion, long-term patient rehabilitation is maintained for at least two years. The indication for surgery is chronic discomfort caused by discord with the patient's natural gender, intense dislike of developing secondary sex characteristics and the onset of puberty. The surgical conversion of transsexuals is the main step in the complex care of these problematic patients (1). This surgery was first described by Benjamin H, using a flap of inverted penile skin (2) and is considered the gold standard since then. Male-to-female transsexual surgical techniques are well defined and give good cosmetic and functional results. Sex reassignment surgery promotes the improvement of psychological aspects and social relationships as shown in the World Health Organization Quality of Life Assessment applied in the patients submitted to this procedure (3). Techniques include the creation of a normal appearing female introitus, a vaginoplasty allowing sexual intercourse and the capability of clitoral orgasm (4). Various methods for neovaginoplasty have been described and can be classified into five categories, i.e. pedicled intestinal transplants, penile skin grafts, penile skin flaps, non-genital skin flaps and non-genital skin grafts (5). In our Hospital, we use penile and scrotal skin flaps. Until now, 174 procedures have been performed by our team using this technique with high rates of satisfaction (3). PATIENTS AND METHODS: We present a step-by-step male to female transsexual surgery. CONCLUSION: Surgical gender reassignment of male transsexuals resulted in replicas of female genitalia which enabled coitus with orgasm (1). With this video we show step by step that a surgery using penile skin flaps is able to be performed with good cosmetic results.

Serum concentrations of brain-derived neurotrophic factor in patients diagnosed with gender dysphoria undergoing sex reassignment surgery.

INTRODUCTION:: Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one's assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. OBJECTIVES:: To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. METHODS:: Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post-SRS blood collections was also measured. RESULTS:: No significant difference was found in pre-SRS or post-SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. CONCLUSION:: Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person's gender identity.

Serum concentrations of brain-derived neurotrophic factor in patients diagnosed with gender dysphoria undergoing sex reassignment surgery / Concentração sérica de fator neurotrófico derivado do cérebro em pacientes diagnosticados com disforia de gênero que realizaram cirurgia de redesignação sexual

Abstract Introduction: Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one's assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. Objectives: To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. Methods: Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post-SRS blood collections was also measured. Results: No significant difference was found in pre-SRS or post-SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. Conclusion: Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person's gender identity.

Resumo Introdução: O transexualismo (CID-10) é uma condição caracterizada por forte e persistente dissociação com o gênero atribuído. A cirurgia de redesignação sexual (CRS) e a terapia hormonal (TH) permitem que indivíduos transexuais se sintam mais congruentes com seu gênero e, por isso, têm desempenhado papel importante nos últimos 70 anos. O fator neurotrófico derivado do cérebro (BDNF) parece desempenhar um papel fundamental na recuperação do trauma cirúrgico agudo e vulnerabilidade ambiental à psicopatologia. Nós hipotetizamos que o BDNF pode ser um biomarcador de alívio do sofrimento de incongruência de gênero pós-CRS. Objetivos: Mensurar os níveis séricos de BDNF no pré e pós-operatório em indivíduos transexuais como biomarcador de alívio de estresse relacionado à incongruência de gênero após a CRS. Métodos: Trinta e duas pessoas transexuais masculino para feminino submetidas a cirurgia e tratamento hormonal foram selecionadas de nossa amostra inicial. O nível sérico de BDNF foi avaliado antes e depois da CRS pela técnica ELISA. O tempo decorrido entre as coletas de sangue pré e pós-CRS foi medido. Resultados: Não houve diferença significativa nos níveis de BDNF pré e pós-CRS ou em relação ao tempo decorrido entre a CRS e a coleta. Conclusão: O alívio do sofrimento relacionado à incongruência de gênero pós-CRS não pode ser avaliado apenas pelo BDNF. Soluções cirúrgicas podem não fornecer uma solução rápida para o sofrimento associado ao transexualismo, e a CRS pode servir como um passo em direção à, em vez de conclusão da, construção da identidade de gênero de uma pessoa.

[Legal recognition of transsexuality in Chile through the judicial procedure for name change]. / El reconocimiento legal de la transexualidad en Chile mediante el procedimiento judicial de cambio de nombre: Un caso de complementariedad epistemológica entre medicina y derecho.

Do transsexual people in Chile have a right to have their gender identity or their sex reassignment legally recognized? The absence of any legislation on gender identity or transsexualism could lead us to believe that it is not the case. However, a quantitative review of decisions issued by Chilean courts during the last years on name-and sex-change requests filed by transsexual people reveals that most of these courts have accepted these requests. From the perspective of the well-being of transsexual people, this is a positive result. However, the fact that a few rejections exist reminds us of the need to enact an explicit legislation in this issue. Lastly, a qualitative analysis of those decisions suggests that the traditional reluctance of courts to interpret the law in a creative way has been overcome in these cases by the use of knowledge and discourses belonging to healthcare sciences. This is an example of an epistemological complementariness between medicine and law.

El reconocimiento legal de la transexualidad en Chile mediante el procedimiento judicial de cambio de nombre: Un caso de complementariedad epistemológica entre medicina y derecho / Legal recognition of transsexuality in Chile through the judicial procedure for name change

Do transsexual people in Chile have a right to have their gender identity or their sex reassignment legally recognized? The absence of any legislation on gender identity or transsexualism could lead us to believe that it is not the case. However, a quantitative review of decisions issued by Chilean courts during the last years on name-and sex-change requests filed by transsexual people reveals that most of these courts have accepted these requests. From the perspective of the well-being of transsexual people, this is a positive result. However, the fact that a few rejections exist reminds us of the need to enact an explicit legislation in this issue. Lastly, a qualitative analysis of those decisions suggests that the traditional reluctance of courts to interpret the law in a creative way has been overcome in these cases by the use of knowledge and discourses belonging to healthcare sciences. This is an example of an epistemological complementariness between medicine and law.

Transexualidade: aspectos psicológicos e novas demandas ao setor saúde / Transsexuality: psychological characteristics and new demands on the healthcare sector / Transexualidad: aspectos psicológicos y nuevas demandas para el sector de la salud

Os(as) transexuais exibem uma discordância entre sexo biológico e gênero. Em busca de uma adequação, optam por cirurgias, como: neocolpovulvoplastia (mudança do sexo masculino para o feminino), faloplastia (mudança inversa), mastectomia, histerectomia, e hormonioterapia. Este trabalho investigou as situações vividas por essas pessoas na busca de uma harmonia com seus corpos, incluindo os períodos pré e pós-cirúrgicos. Foram entrevistados quatro transexuais que já haviam realizado a cirurgia ou estavam em vias de realizá-la. Observou-se a importância das intervenções cirúrgicas e hormonais, assim como a mudança do nome civil, como condição para uma vida melhor. Constatou-se que a fila de espera no Sistema Único de Saúde (SUS), o protocolo pré-operatório de dois anos, o custo das cirurgias nas clínicas particulares e a falta de regulamentação jurídica para a mudança de documentação são algumas das maiores dificuldades encontradas para a realização do processo transexualizador.

Transsexual people show a discrepancy between biological sex and gender. In seeking to resolve this, they choose surgery such as neocolpovulvoplasty (change from male to female), phalloplasty (inverse change), mastectomy, hysterectomy and hormone therapy. This study investigated the situations experienced by these people in their search for harmony with their bodies, including before and after surgery. Four transsexuals who had undergone surgery or were on track to achieve it were interviewed. The importance of hormonal and surgical interventions was observed, as well as a change in legal name, as conditions for a better life. It was noted, however, that the waiting list in the Brazilian National Health System (SUS), the preoperative protocol of two years, the cost of surgery in private clinics and the lack of legal regulation for changes in documentation are some of the greatest difficulties encountered in achieving the sex change process.

Los(las) transexuales muestran una discrepancia entre sexo biológico y género. En busca de um ajuste, optan por cirugías, como neocolpovulvoplastia (cambio de hombre a mujer), faloplastia (cambio inverso), mastectomía, histerectomía y terapia hormonal. Este estudio ha investigado las situaciones vividas por estas personas en busca de la armonía con sus cuerpos, incluyendo el pre y post-operatorio. Fueron entrevistados cuatro transexuales que ya habían realizado la cirugía o estaban por hacerlo. Se observó la importancia de las intervenciones hormonales y quirúrgicas, así como cambiar el nombre legal, como condición para una vida mejor. Se observó que la lista de espera en el Sistema Único de Salud (SUS), los dos años del protocolo pre-operatorio, el coste de las cirugías en clínicas privadas y la falta de regulación legal para el cambio de la documentación son algunas de las mayores dificultades en su aplicación.

Gender reassignment surgery--a 13 year review of surgical outcomes.

PURPOSE: The aim of this study is to thoroughly report on surgical outcomes from 332 patients who underwent male to female gender reassignment surgery (GRS). MATERIAL AND METHODS: Records from 332 patients who underwent GRS from 1995 to 2008 were reviewed. All patients were submitted to penile inversion vaginoplasty with glans-derived sensate clitoroplasty. Mean age was 36.7 years (range 19-68 years). Surgical complications were stratified in 5 main groups: genital region, urinary tract, gastrointestinal events, wound healing disorders and unspecific events. RESULTS: Progressive obstructive voiding disorder due to meatal stenosis was the main complication observed in 40% of the patients, feasibly corrected during the second setting. Stricture recurrence was found in 15%. Stricture of vaginal introitus was observed in 15% of the cases followed by 12% and 8% of vaginal stenosis and lost of vaginal depth, respectively. Rectal injury was seen in 3% and minor wound healing disorders in 33% of the subjects. CONCLUSION: Regarding male to female GRS, a review of the current literature demonstrated scarce description of complications and their treatment options. These findings motivated a review of our surgical outcomes. Results showed a great number of adverse events, although functionality preserved. Comparision of our outcomes with recent publications additionally showed that treatment options provide satisfying results. Moreover, outcomes reaffirm penile inversion vaginoplasty in combination with glans-derived sensate clitoroplasty as a safe technique. Nevertheless, discussing and improving surgical techniques in order to reduce complications and their influence on patient's quality of life is still strongly necessary and theme of our future reports.

Gender reassignment surgery - a 13 year review of surgical outcomes

PURPOSE: The aim of this study is to thoroughly report on surgical outcomes from 332 patients who underwent male to female gender reassignment surgery (GRS). MATERIAL AND METHODS: Records from 332 patients who underwent GRS from 1995 to 2008 were reviewed. All patients were submitted to penile inversion vaginoplasty with glans-derived sensate clitoroplasty. Mean age was 36.7 years (range 19-68 years). Surgical complications were stratified in 6 main groups: genital region, urinary tract, gastrointestinal events, wound healing disorders and unspecific events. RESULTS: Progressive obstructive voiding disorder due to meatal stenosis was the main complication observed in 40% of the patients, feasibly corrected during the second setting. Stricture recurrence was found in 15%. Stricture of vaginal introitus was observed in 15% of the cases followed by 12% and 8% of vaginal stenosis and lost of vaginal depth, respectively. Rectal injury was seen in 3% and minor wound healing disorders in 33% of the subjects. CONCLUSION: Regarding male to female GRS, a review of the current literature demonstrated scarce description of complications and their treatment options. These findings motivated a review of our surgical outcomes. Results showed a great number of adverse events, although functionality preserved. Comparision of our outcomes with recent publications additionally showed that treatment options provide satisfying results. Moreover, outcomes reaffirm penile inversion vaginoplasty in combination with glans-derived sensate clitoroplasty as a safe technique. Nevertheless, discussing and improving surgical techniques in order to reduce complications and their influence on patient's quality of life is still strongly necessary and theme of our future reports.

Diversidade sexual e direito homoafetivo / Sexual diversity and right homoafetivo

Dar visibilidade e impor respeito às diferenças de caráter sexual, bem como inserir os direitos das pessoas lésbicas, gays, bissexuais, transexuais, travestis e transgêneros no sistema jurídico é um projeto antigo da coordenadora desta obra. Escrita por juristas que se notabilizaram na abordagem dos diversos aspectos relacionados ao tema, a presente obra é um passo decisivo para a sistematização do direito homoafetivo. São apresentados, inicialmente, os possíveis modelos de enquadramento jurídico das uniões homoafetivas. Seguem-se temas: A proteção dos direitos humanos e a vedação à discriminação por orientação sexual Da união homoafetiva como uma família constitucionalmente protegida.Afetividade como norteador das relações familiares. O reconhecimento da homoparentalidade O cabimento dos alimentos nas uniões homoafetiva.Dano moral e o direito à livre orientação sexual Homoparentalidade e filiação.Da partilha de bens Uso do nome social e a adequação do prenome antes da realização de cirurgia genital Seguro DPVAT ao beneficiário homossexualPlanos de saúde Criminalização da discriminação por orientação sexual sob o enfoque do direito fundamental à tolerância Licença paternidade e a adoção. Trata-se, assim, de obra que, acima de tudo, contribui decisivamente para desconstruir o preconceito ainda tão forte em nossa sociedade.

Transgenitalização masculino / feminino: experiência do Hospital Universitário da UFRJ / Male-to-female transsexual surgery: experience at the UFRJ University Hospital

OBJETIVO: Mostrar a experiência do tratamento cirúrgico do transgenitalismo (masculino/feminino) realizado no Programa de Transgenitalização do Hospital Universitário Clementino Fraga Filho, - UFRJ. MÉTODOS: A seleção dos pacientes para operação de transgenitalismo obedeceu à avaliação de equipe multidisciplinar, atendendo aos critérios definidos, após dois anos de acompanhamento conjunto: diagnóstico médico de transexualismo; paciente maior de 21 anos; ausência de características físicas inapropriadas para a mudança; apoio de pelo menos um familiar próximo. RESULTADOS: De 1997 a 2004 foram atendidas dezessete, pessoas quinze confirmaram a condição transexual, uma foi afastada por ter trazido exames falsos. Do total de dezesseis transexuais, foram realizadas seis operações. As pacientes operadas situavam-se na faixa de 25 a 40 anos com média de 31 anos. O procedimento cirúrgico foi concluído sem dificuldades técnicas em todas as pacientes . Uma paciente apresentou estenose do neo meato e em outra foi necessário encurtar um pouco mais a uretra. CONCLUSÃO: A técnica operatória não oferece maiores dificuldades em sua execução, mas pode depender das condições locais e da criatividade do cirurgião. A dificuldade maior está em preparar estes pacientes para que não haja frustrações ou expectativas demasiadas.

OBJECTIVE: To describe the experience of male-to-female sex reassignment surgery conducted at the Transgenitalization Program of the Clementino Fraga Filho University Hospital -UFRJ. METHODS: The selection of patients for operation followed the evaluation of a multidisciplinary team, meeting the criteria after two years of follow-up: medical diagnosis of transsexualism, patient over 21 years, no physical characteristics unsuitable for change, support at least one close relative. RESULTS: From 1997 to 2004 seventeen patients were followed, fifteen of which had confirmed transsexual condition, one was dismissed for bringing false examinations. Of the total of sixteen transsexuals, six operations were performed. The operated patients were in the age range of 25 to 40 years with an average of 31. The surgical procedure was completed without any technical difficulties in all patients. One patient had stenosis of the neo meatus and in another it was necessary to shorten the urethra. CONCLUSION: The technique provides no major difficulties in implementation, but may depend on local conditions and surgeon's creativity. The greatest difficulty is to prepare these patients so that there are neither frustrations, nor too many expectations.