gender reassignment surgery vertaling nederlands

How Gender Reassignment Surgery Works

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gender reassignment surgery vertaling nederlands

In 1952 a 27-year-old, former WWII-era GI from New York named George Jorgensen traveled to Denmark, and returned to the U.S. as Christine Jorgensen. Jorgensen, who had described herself as a woman trapped in a man's body, was one of the first to transition from the male to female gender through a process involving hormone therapy and surgical procedures [source: Hadjimatheou ]. In time, she became a trailblazer in seeking those gender reassignment surgeries as these procedures, now known as gender realignment (reconstruction, affirmation or confirmation) surgeries, wouldn't begin in the U.S. until 1966 [source: Wexler ].

Gender identity struggles usually begin in early childhood but descriptions of feeling like a man trapped inside a woman's body, or vice versa, have been identified in and reported by people of all ages. A person living with this an internal conflict may develop anxiety and depression, and go on to be diagnosed with gender dysphoria, formally known as gender identity disorder (GID). Gender dysphoria is a mental health condition that can arise when a person lives with ongoing feelings of being physically incongruous with his or her birth sex — and medical intervention may be beneficial. Identifying as transgender, itself, is considered by scientists to be, at least in part, biological and not a mental illness [source: HRF ].

Being transgender also isn't about anatomy or sexual orientation; it's about internally identifying with a gender status — which could be masculine, feminine, agender or gender fluid — that is different than the one culturally assigned to you based upon your physical characteristics. While some people may never publicly acknowledge their transgender status, others may decide to live as their desired gender — and that could mean changing how they express their gender through transitioning.

Transitioning is often two-fold: a social transition, such as new clothing, a new name and new pronouns; and a medical transition, with treatments such as hormone therapy and surgical procedures. Depending on the needs and wants of each individual, transitioning may include both social and medical transitions; just one of the two; or for those who eschew gender completely, neither.

Diagnosing Gender Dysphoria

Gender affirmation surgery.

Gender transition is a process unique to each individual, and for those who do choose to affirm their gender with a medical transition, the path often consists of counseling and a diagnosis of gender dysphoria, hormone therapy and real-life experience before genital-changing surgeries are performed. Not all transgender people need — or want — these therapies; and, not all transgender people undergo surgery. Those who do choose to medically transition may select a number of procedures, or focus on just "top," "bottom" or cosmetic surgeries. The collection of procedures are also commonly called gender reassignment or — and the process begins long before the procedures do.

It begins with psychotherapy; in addition to providing counsel, mental health professionals assess a person's readiness for hormone therapy and surgery. To become a candidate for gender reassignment surgery, a person must first be diagnosed with gender dysphoria, as defined by the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a common language and standards protocol manual for the classification of mental disorders. Gender dysphoria was previously known as gender identity disorder (GID) and broken into a handful of classifications (such as childhood and adulthood) in the DSM-4. The revision was made not only to help ensure access to care while attempting to reduce the stigma associated with gender identity struggles, but it also removed the concomitance between transgender feelings and mental illness.

Having persistent feelings — for at least six months — that a person's birth sex doesn't align with his or her gender identity isn't considered a behavioral health issue. To be diagnosed with gender dysphoria, adults and adolescents must also exhibit at least two other conditions, including [source: APA ]:

An outward expression of gender that differs from what society expects
The desire to be a different gender
The wish to be treated as a different gender
The desire to get rid of the primary and secondary sex characteristics of the "wrong" gender
The wish to have the sexual characteristics of a different gender
The belief their gender reactions are of a different gender

The desire for gender change cannot be a symptom of another disorder or a chromosomal abnormality. Additionally, these gender identity issues must cause distress, personally, socially, professionally or in any other manner [source: APA ].

After counseling, evaluation and diagnosis, patients don't immediately schedule a vaginectomy (removal of the vagina), or penectomy (removal of the penis). Those who choose gender affirmation surgery will need letters of recommendation from counselors, psychiatrists, psychologists, sexologists and/or therapists prior to major gender reconstructive surgery.

Doctors normally recommend hormone therapy to alter secondary sex characteristics to the desired gender before surgery. Other than surgeries to reconstruct internal and external genitalia (and not counting anything considered a cosmetic procedure), most physical changes are managed with hormone therapy prescribed by an endocrinologist to suppress certain characteristics (such as distribution of body hair) or enhance certain others (such as breast growth). Hormone therapy may continue for a few years (it takes at least two years to achieve maximum results), and may be concurrent with what's known as the Real-Life Experience (RLE), a year dedicated to living openly as one's desired gender, and intended to help adjust — socially, physically and emotionally — to making these significant changes in gender expression [source: WPATH ].

It's difficult to know for certain what the actual numbers are, but the Williams Institute estimates that that about 0.3 percent of the general U.S. population identifies as transgender, although not all of those 1.5 million people will desire or undergo gender affirmation surgery [sources: Gates , Steinmetz ]. Each year between 100 and 500 gender reconstruction surgical procedures are done in the U.S. to treat gender dysphoria. The United States is not a major player in gender dysphoria treatment; estimates range that up to 2,500 people worldwide affirm their gender through surgery every year — and Thailand has long been considered the premiere destination for gender surgeries [sources: Toro , Encyclopedia of Surgery ].

Gender affirmation surgery is performed under the guidelines of World Professional Association for Transgender Health's (WPATH) globally accepted Standards of Care for Gender Identity Disorders (SOC). The types of surgeries to be conducted are decided by the patient's desire and comfort level, as well as finances. Not every patient will want or need the same surgeries, and the process is tailored for each individual. Certain procedures are considered medically necessary to treat gender dysphoria, while other common gender confirmation surgeries such as rhinoplasty and brow lifts are considered cosmetic; for some this new outward appearance may hold more significance than the reconstruction of internal and external genitalia.

Surgeries for trans men (or those assigned female at birth (AFAB)) include:

Bilateral mastectomy;
Complete hysterectomy
Reconstruction of the genitalia with a metoidioplasty (a procedure that allows a surgeon to construct a phallus from the clitoris)
Ring metoidioplasty (to lengthen the urethra)
Scrotoplasty (the construction of a scrotum)
Vaginectomy (to close of the vaginal canal)
Phalloplasty (the construction of the penis)

A penile implant (a prosthetic otherwise used to treat erectile dysfunction) and testicular implants may also be added to the reconstructed penis and testes. Although the mean length of a reconstructed penis is roughly 2 inches (5 centimeters), 80 percent of trans men in one study reported they were able to engage in sexual intercourse, and most experienced orgasms [source: Harrison ].

Trans women, or those assigned male at birth (AMAB), a group larger in number than trans men, may begin their physical transformation with breast augmentation (implants), as well as with cosmetic surgeries to feminize the face and body, such as facial feminization surgery (FFS) , and gluteal, hip and thigh implants before undergoing genital reconstruction. Surgeries to create female genitalia include:

Clitoroplasty (the construction of a clitoris)
Labiaplasty (the creation of a labia from scrotum skin)
Orchiectomy (testicle removal)
Prostatectomy (the removal of prostate)
Urethroplasty (the reconstruction of the urethra)
Vaginoplasty (the creation of the vaginal canal, made from penile tissue or a colon graft)
Penectomy (removal of the penis) is usually done concurrently with vaginoplasty, and a clitoral hood is typically constructed from the glans penis.

In the U.S. surgical costs in 2015 may run anywhere from about $25,000 for male-to-female transitions and upwards of $100,000 or more for female-to-male transitions, although typical costs fall between $7,000 and $50,000 [sources: Leitsinger , AP ]. Transgender Brits pay about 10,000 pounds ($15,000) [source: Telegraph ]. And for an extra $8,000, patients transitioning from female to male in Thailand can, for example, upgrade from a 1 inch (2.5 centimeter) penis to one with a few more inches [source: Ehrlich ].

Transgender people who have undergone gender affirmation surgeries are, in almost all cases, happy they did so. In the U.K., for instance, only 2 percent of people who've undergone gender reconstructive surgeries report regretting their physical transformation, compared to 65 percent of cisgender (non-transgender) people who report regretting their plastic surgery choices [source: Tannehill ]. And in the U.S. less than 1 percent of trans women regret their genital reconstruction, a percentage that's been decreasing alongside the risk of developing long-term complications [source: Tannehill ]. More than 80 percent of patients report long-term satisfaction despite (treatable) complications such as vaginal hair growth (a 29 percent prevalence among trans females) and urinary problems (almost the same, at 27 percent) [source: Goddard ]. The rate of regret for trans men is difficult to estimate, as they are smaller in number than trans women [sources: Jarolím , Tannehill ].

Sure, there's the case of Charles Kane, who famously transitioned from a man to a woman in 1997, and then back again. After living as Samantha Kane for seven years, Charles decided he would never pass as a "real woman," neither to himself or to the public, and felt hormone therapy altered his brain into making the original decision [source: Scutti ]. But, Kane is a rarity.

Lots More Information

Author's note: how gender reassignment works.

The terminology surrounding gender identity, expression and affirmation has changed a lot since I first wrote about gender dysphoria, then called gender identity disorder, and the ins and outs of, what was then called gender reassignment surgery. The first thing I noticed 8 years later is that there is a lot more labeling. For instance: A biologically born man who identifies as a woman may be known as an 'affirmed' or 'confirmed' woman, 'transgender' woman, or you may also hear the term 'trans woman' — all in reference to the same woman. For some, 'transsexual' continues to be used. And then there's also the acronyms, such as MTF (or M2F), which stands for male-to-female, and AMAB (or DMAB), indicating 'assigned male at birth' (and 'designated male at birth'). I'm sure I'm overlooking some, too. And it's a similar list for someone assigned female at birth who identifies as a man (AFAB). What seems to be left out, though is the most obvious: male and female, just as those who are cisgender (a term used for non-trans people). (Unless, of course, we're talking about a person whose identity lies somewhere along a spectrum of gender, who may prefer to describe themselves as neither male nor female, but gender fluid.)

Sex reassignment surgery (SRS)

Wat is srs of een geslachtsaanpassende operatie.

Sex reassignment surgery (SRS) of een geslachtsaanpassende operatie , ook bekend in het Engels als ‘gender reassignment surgery’ of ‘bottom surgery’, omvat een aantal plastische en reconstructieve chirurgische ingrepen met als doel de genitaliën van de patiënt overeenstemmend te maken met hun geslachtsidentiteit.

In het geval van MtF (‘Male to Female’ of van man naar vrouw) betekent dit dat de mannelijke genitaliën waarmee de patiënt is geboren, worden omgevormd in een esthetisch nauwkeurige en functionele vagina. Onder de zorg van een deskundige chirurg kan normaal urineren, minimale littekenvorming en het behoud van de erogene gevoeligheid worden bereikt.

Man-naar-vrouw-operaties zijn een reeks complexe ingrepen zoals de orchiectomie (= het verwijderen van de testikels), clitorisreconstructie, reconstructie van de grote en kleine schaamlippen, creatie van de venusheuvek en een vaginoplastiek. Deze ingrepen worden vaak gebundeld en staan bekend als een primaire vaginoplastiek . In sommige gevallen kan de orchiectomie enkele maanden van te voren worden uitgevoerd.

Welke methode gebruiken we?

Wij bevelen de methode aan van:

Dr. Hendrik Schöll & Dr. Susanne Morath "De Gecombineerde Methode"

Gevestigd in München in hun eigen praktijk en daarnaast hoofd van de afdeling plastische chirurgie in het Rode Kruis Ziekenhuis in München, beide esthetische plastische en reconstructieve chirurgen, gespecialiseerd op het gebied van SRS, FFS, borstchirurgie en op het hele gebied van body contouring. Meer dan 10 jaar geleden werd hier de "Gecombineerde Methode" voor geslachtsaanpassende chirurgie (MtF) bedacht en voortdurend verfijnd om een nog optimaler functioneel en esthetisch resultaat te kunnen bereiken. Sindsdien wordt deze chirurgische methode meermaals per week met veel succes als standaardprocedure uitgevoerd. In tegenstelling tot de andere technieken, zoals de penisinversie, wordt bij deze techniek naast de penishuid ook altijd de scrotale huid en een deel van het urethrale slijmvlies gebruikt om de neovagina te bekleden. Dit maakt niet alleen een aanzienlijke penetratiediepte mogelijk, maar schept ook de mogelijkheid van een zelfsmerende vaginale holte. Uit de eikel wordt een gevoelige clitoris gevormd, die tot een orgasme in staat is. De clitoris zelf wordt beschermd door een clitoraal kapje en kleine schaamlippen, die gevormd worden uit een deel van de voorhuid. Zelfs na de besnijdenis is er een mogelijkheid om deze te vormen. Natuurlijk worden ook de grote schaamlippen esthetisch aantrekkelijk gemaakt.

Wie kan SRS ondergaan?

Hieronder vindt u de voorwaarden voor wie een primaire vaginoplastiek kan en mag ondergaan. Deze zijn vastgelegd in de publicatie ‘Standards of Care’ (7de editie) van de World Professional Association for Transgender Care (WPATH).

Mensen die:

een consistente en goed gedocumenteerde diagnose van geslachtsdysforie hebben;
helder zijn en in staat zijn om een volledig geïnformeerde beslissing te nemen en toestemming te geven voor de behandeling;
van meerderjarige leeftijd zijn die geldt in een bepaald land.
geen absolute medische contra-indicaties hebben (medische aandoeningen die het te riskant zouden maken om de operatie uit te voeren);
minstens 12 maanden onafgebroken feminiserende hormoonvervangingstherapie volgen;
minstens 12 maanden aaneengesloten leven in de genderrol die in overeenstemming is met hun genderidentiteit.
Dit criterium is gebaseerd op de klinische consensus van deskundigen dat deze ervaring de patiënten ruimschoots de gelegenheid biedt om de gewenste genderrol te ervaren en zich sociaal aan te passen, alvorens deze onomkeerbare operatie te ondergaan.

Praktisch gezien heeft een patiënt:

een verwijsbrief nodig van de behandelaar (psycholoog, psychiater, seksuoloog...);
moet hij volwassen zijn;
in staat om beslissingen te nemen;
en moet hij/zij minstens 12 maanden lang transversale hormonen hebben genomen (oestrogenen, Androcur is niet voldoende).

Bij het intakegesprek wordt de procedure bekeken en toegelicht. Vragen worden beantwoord. De eerdere medische en persoonlijke voorgeschiedenis wordt genoteerd en er wordt bepaald of de patiënt een goede kandidaat is. Het klinisch onderzoek zal de procedure bepalen (hoeveelheid huid, noodzaak tot epilatie, specifieke procedure-elementen...).

Als aan alle voorwaarden voor de operatie is voldaan, wordt uw operatiedatum gepland. De operatie vereist een verblijf van 14 dagen in het ziekenhuis. De nacht voor de operatie wordt de darm gereinigd (door vocht te drinken).

Chirurgische wonden worden dagelijks gereinigd en moeten droog en schoon worden gehouden tot ze volledig zijn genezen. Het vaginakanaal moet dagelijks worden gereinigd om complicaties en infecties te voorkomen.

4 tot 6 weken na de operatie is het over het algemeen mogelijk om weer aan het werk te gaan (afhankelijk van het type werk).

Dilatatie (= het geleidelijk vergroten en verbreden van de vagina aan de hand van staafjes of dilatatoren) wordt meestal aanbevolen voor de eerste 6 maanden na de operatie .

Totdat de transplantatie van de vrouwelijke voortplantingsorganen mogelijk wordt door medische vooruitgang, is zwangerschap niet mogelijk voor transgender vrouwen.

Wanneer revisieoperaties worden aangevraagd, is dat meestal om de esthetiek van het resultaat te verbeteren, maar soms zijn correctieve ingrepen nodig om de functionaliteit van de neovagina te verbeteren. Ze worden meestal 6 maanden na de eerste ingreep uitgevoerd.

Wat kunt u verwachten na SRS met de "gecombineerde methode"?

Een neovagina met aanzienlijke penetratiediepte en mogelijkheid tot zelfsmering of autobevochtiging
Clitoris met sensatie, in staat tot orgasme
Normaal urineren
Grote en kleine schaamlippen en een clitoriskap

Wat kunt u niet verwachten na SRS?

De mogelijkheid om zwanger te worden

Mogelijke complicaties

Risico's en complicaties van chirurgische ingrepen voor de geslachtsverandering van man naar vrouw omvatten algemene risico's die niet specifiek zijn voor deze operatie, maar gelden algemeen voor alle operaties. Dit gaat om risico's in verband met algemene anesthesie, intra-operatieve en postoperatieve bloedingen, infecties, littekens, vertraagde genezing, accidentele schade aan de omliggende weefsels.

Onder de specifieke risico's in verband met SRS zijn er urethrale vernauwingen, vernauwing van de neovagina, vleesvernauwing van de nieuwe plasbuis, rectovaginale fistels, necrose of afstoting van een huidtransplantaat, verlies van gevoeligheid, ongewenste afmetingen van de neovagina enz.

Preoperatief traject:

Deze operatie is onomkeerbaar . Daarom moet u er zeker van zijn. U moet het traject met inbegrip van psychologische begeleiding, hormoontherapie en een levensechte testperiode doorstaan. Daarnaast moet u toestemming krijgen van een gediplomeerd psychiater en endocrinoloog. Dit is wettelijk verplicht.

Bepaalde aanpassingen van de behandeling, medische tests, bloedonderzoeken of bloeddonaties zijn verplicht:

Stop hormoonvervangingstherapie met oestrogenen 4 tot 6 weken voor de operatie (in overleg met uw behandelende endocrinoloog).

Permanente epilatie van de scrotale huid vóór de operatie is niet verplicht. Deze haren kunnen door de chirurg tijdens de operatie definitief worden verwijderd, met als doel een haarvrije vagina.

Als voor de operatie permanente ontharing gewenst is, is elektrolyse een zeer geschikte methode. Dit kan onder plaatselijke verdoving worden uitgevoerd. De kans bestaat dat bepaalde haarzakjes op het moment van de operatie onzichtbaar zijn omdat ze nog niet in hun groeifase zijn. Houdt u er rekening mee dat wij geen haren inwendig kunnen verwijderen nadat u geopereerd bent.

Tijdens een preoperatieve consultatie beslissen we samen waar we de huidtransplantatie kunnen verkrijgen om de binnenkant van de vagina te vervolledigen. Dit kan nodig zijn als de bestaande penishuid en scrotale huid onvoldoende is om de neovagina te bekleden vanwege de grootte.

Boek uw operatie bij Dr. Hendrik Schöll (DE)

Kijk voor meer informatie op www.morath-schoell.de of @morath.schoell op Instagram.

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Access to sex reassignment surgery

Key aspects.

In thirteen out of twenty-eight Member States, general surgery rules apply as regards the age at which children can request a sex reassignment surgery. In this context, the age requirement for access to medical treatment without the consent of the parents or of a public authority is 18 years in Bulgaria, Cyprus, Greece, France, Hungary, Romania and Slovakia , and 15 years in Slovenia . In the United Kingdom the age requirement ranges from 16 in Scotland to 17 in England and 18 in Wales . In Belgium, Estonia, Germany and Luxembourg the child’s maturity is assessed.
In Austria , Czechia, Croatia, Denmark, Finland, Italy, Latvia, Lithuania , the Netherlands , Poland, Portugal, Spain and Sweden the minimum age requirement to request sex reassignment surgery is explicitly set at the age of 18.
Overall, twenty Member States (and Wales ) only allow sex reassignment surgeries in individuals over the age of 18. Out of these, twelve Member States also set 18 as the age requirement for transgender hormone therapy, while in the case of sex reassignment surgery, eight countries ( Czechia, Denmark, Finland , the Netherlands, Latvia, Poland, Spain and Sweden ) ask for a higher age than for transgender hormone therapy.
In Ireland and Malta , the age requirement for sex reassignment surgery is 16 years.
Croatia allows children to have sex reassignment surgery before the age of 18 if they have parental consent, without laying down any specific minimum age requirement.

Language English

gender reassignment

View content in:, description.

Set of medical measures that can, but do not have to, include psychological, endocrinological and surgical treatments aimed at aligning a person’s physical appearance with their gender identity.

Additional notes and information

It might include psychological consultation, cross-hormonal treatment, sex or gender reassignment surgery (GRS) (such as facial surgery, chest/breast surgery, different kinds of genital surgery, or a hysterectomy), sterilisation (leading to infertility), hair removal and voice training. Not every transgender person wishes for, or is able to undergo, all or any of these measures.

European Commission (2012). Trans and Intersex People: Discrimination on the Grounds of Sex, Gender Identity and Gender Expression. European Network of Legal Experts in the Field of Gender Equality.

sexual health
gender identity

http://eige.europa.eu/taxonomy/term/1336?language_content_entity=en

The concepts and definitions found in this glossary were published in 2016, and some may be out-of-date. EIGE is currently looking into which terms may need to be updated in the future.

Sex reassignment surgery: a study of 141 Dutch transsexuals

Affiliation.

1 Medical Psychology Department, Free University Hospital, Amsterdam, The Netherlands.
PMID: 3219066
DOI: 10.1007/BF01542484

This is an evaluation of the therapeutic effect of sex reassignment surgery on 36 female-to-male transsexuals and 105 male-to-female transsexuals in the Netherlands. Data were collected by means of structured interviews. The evaluation was made on the basis of subjective data only, that is on what the persons themselves reported on their gender identity, gender role, and physical condition. Allowing for the restrictive methodology of the (ex post facto) study, it is concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery. No specific differences were found between those who were still in medical treatment and those who had completed treatment. The findings obtained in the female-to-male transsexuals compare favorably with those obtained in male-to-female transsexuals. Finally, the conclusion is drawn that more attention ought to be paid to psychosocial guidance in addition to medical guidance.

Publication types

Research Support, Non-U.S. Gov't
Consumer Behavior
Follow-Up Studies
Gender Identity
Middle Aged
Netherlands
Personal Satisfaction
Transsexualism / psychology
Transsexualism / surgery*

IMAGES

How Gender Reassignment Surgery Works (Infographic)
Document Your Gender Reassignment Surgery
Male To Female Gender Reassignment Surgery
What is gender reassignment surgery? Does the NHS offer it, what does
How Gender Reassignment Surgery Works
This is how gender reassignment actually works

VIDEO

Do I regret gender reassignment surgery. A question from a Patreon subscriber
Facial Feminization Surgery Review
Gender Reassignment Surgery
What Gender-Affirming Surgery Can Look Like
When cisgender people also get gender affirming surgery
3 Years Post-Op

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Sex reassignment surgery (SRS)
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gender confirmation surgery
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gender confirmation surgery
Letterlijke vertaling wordt ook gebruikt: - geslachtsbevestigende ... surgery apart from sex reassignment surgery and gender reassignment surgery.
Gender Surgery Amsterdam
If you wish to transition by having surgery, expert care is needed. Accessing health care can however be challenging for transgender people.
Access to sex reassignment surgery
Sex reassignment surgery (also called gender confirmation surgery) is a surgical procedure ... Nederlands · Polski · Português · Română
gender reassignment
It might include psychological consultation, cross-hormonal treatment, sex or gender reassignment surgery (GRS) (such as facial surgery, chest/breast
Sex reassignment surgery: a study of 141 Dutch transsexuals
Follow-Up Studies; Gender Identity; Happiness; Humans; Male; Middle Aged; Netherlands; Personal Satisfaction; Transsexualism / psychology; Transsexualism /