Vaginal prolapse, pelvic floor function, and related symptoms 16 years after sex reassignment surgery in transsexuals

To evaluate the prevalence of prolapse and related bladder, bowel, and sexual problems in transsexual patients (TS) after sex reassignment surgery.

Quality of life 15 years after sex reassignment surgery for transsexualism

OBJECTIVE: To evaluate quality of life and patients' satisfaction in transsexual patients (TS) after sex reassignment operation compared with healthy controls. DESIGN: A case-control study. SETTING: A tertiary referral center. PATIENT(S): Patients after sex reassignment operation were compared with a similar group of healthy controls in respect to quality of life and general satisfaction. INTERVENTION(S): For quality of life we used the King's Health Questionnaire, which was distributed to the patients and to the control group. Visual analogue scale was used for the determination of satisfaction. MAIN OUTCOME MEASURE(S): Main outcome measures were quality of life and satisfaction. RESULT(S): Fifty-five transsexuals participated in this study. Fifty-two were male-to-female and 3 female-to-male. Quality of life as determined by the King's Health Questionnaire was significantly lower in general health, personal, physical and role limitations. Patients' satisfaction was significantly lower compared with controls. Emotions, sleep, and incontinence impact as well as symptom severity is similar to controls. Overall satisfaction was statistically significant lower in TS compared with controls. CONCLUSION(S): Fifteen years after sex reassignment operation quality of life is lower in the domains general health, role limitation, physical limitation, and personal limitation.

Ethical Conflicts over the Management of Transsexual Adolescents-Report of Two Cases

Introduction. The diagnosis and the treatment of transsexualism, particularly during adolescence, generate considerable discussion among specialists. Many health and legal professionals have not yet reached a strong consensus on medical treatment for juvenile transsexuals. Hormonal therapy cannot only represent a medical procedure to adjust the somatic sex to the psychological gender, but can also be a reasonable means of preventing some juvenile transsexuals from engaging in undesirable and risky behavior. Aim. To report the cases of two transsexual adolescents who resorted to prostitution to afford hormonal medications when treatment was denied because of age criteria. Results. Hormonal medications were not recommended by the endocrinology staff because specific laws regulating this medical procedure for juvenile transsexuals in Brazil are lacking. In response, these adolescents chose to use illegally obtained sex hormones to treat themselves. Conclusions. We propose ""harm reduction"" as a means of coping with this dilemma in some cases. Baltieri DA, Cortez FCP, and de Andrade AG. Ethical conflicts over the management of transsexual adolescents-report of two cases. J Sex Med 2009;6:3214-3220.

Schizophrenia Modifying the Expression of Gender Identity Disorder

According to the Brazilian Federal Medical Association, transsexualism is recognized as a gender identity disorder if a long-term diagnostic therapeutic process has demonstrated that the transposition of gender roles is irreversible, and if only hormonal and surgical procedures are appropriate to relieve the stress associated with the gender identity. Although such treatment will only be initiated with caution and after a long phase of intense diagnostic screening, the differentiation between pure identity disorders and transsexual feelings secondary to an ongoing psychopathologic process, such as schizophrenia, can be arduous for many health professionals. To report a case of a female patient with schizophrenia and transsexualism and the risks of a potential diagnostic confusion. A 19-year-old black woman, with an 8-year history of undifferentiated schizophrenia and intense gender dysphoria, was referred for sex reassignment surgery evaluation in the Ambulatory for the Treatment of Sexual Disorders of the ABC Medical School. After a more adequate antipsychotic treatment, her masculine behavior has persisted, but her desire to change her own genital organs has decreased. A better acceptance of the multiplicity of possible genders should neither contribute to inadequate interpretations of the signs and symptoms of our patients nor facilitate dangerous clinical or surgical recommendations. Baltieri DA, and De Andrade AG. Schizophrenia Modifying the expression of gender identity disorder. J Sex Med **;**:**-**.

Do transsexuals have micturition disorders?

OBJECTIVE: Transsexualism occurs with an estimated prevalence of 2.4:100,000 male-to-female (MTF) and 1:100,000 female-to-male (FTM) transsexuals. As sex reassignment surgery involves surgery of the urethra and transsexuals are substituted life-long with the cross gender hormones there could possibly arise micturition disorders. Aim of the study was to determine if transsexuals have an increased risk of micturition disorders and if so which. STUDY DESIGN: Between January and July 2003 we examined 25 transsexuals whereof 18 were MTF and 7 were FTM transsexuals using King's Health Questionnaire, visual analogue scale for patient's well being, perineal and transabdominal ultrasound, urine dipstick and uroflow measurement. RESULTS: 17 out of 25 patients considered themselves very happy. In MTF transsexuals, a diverted stream, overactive bladder and stress urinary incontinence was a common problem. Prostate volume was small with 20 g and palpation did not confirm and solid or suspicious lesions. None of the patients had significant residual urine but MTF transsexuals had a reduced urinary flow. We could not detect a current urinary tract infections in any of the patients. CONCLUSION: Transsexuals have an increased risk for the development of micturition disorders including stress urinary incontinence and overactive bladder compared to age-matched control groups and should be counselled preoperatively. Reasons for the development of incontinence might be surgery including pudendal nerve damage, hormonal reasons and ageing.

Paternalism and Competent Patient Choice in the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People

In 2016 physicians in Ontario will be granted the authority to refer patients with gender dysphoria for sex reassignment surgery. In order to be granted this authority physicians must be trained in the World Professional Association for Transgender Health’s Standards of Care, which outlines healthcare procedures for the treatment of gender dysphoria and provides background information concerning transgender health. The Standards of Care require that patients undergo a process of 12 months of continuous living in a gender role that is congruent with their gender identity prior to being given access to sex reassignment surgery. While this requirement can sometimes be helpful it can also cause more harm than benefit. This paper argues that the requirement is strongly paternalistic in its current form and should no longer be mandatory in most cases.

Unilateral hypoplastic breast in a male-to-female transsexual with Poland syndrome after gender reassignment--reconstructive considerations

Gender reassignment procedures are performed more frequently nowadays due to a multidisciplinary approach and improved techniques and selection process. Many male-to-female patients require bilateral breast augmentation as part of the transformation following the gender reassignment if they fail to develop female breast features after hormonal treatment. We report on a very rare incidence of male-to-female gender reassignment in a patient with Poland syndrome. A male-to-female transsexual on hormonal therapy for gender reassignment developed one normal female-shaped breast whereas the other breast remained hypoplastic. As a male, he was not aware of his chest wall deformity but it became a major issue after successful gender reassignment surgery. Our experience with the specific reconstructive considerations and recommendations regarding our surgical approach to this complex reconstructive problem are discussed.

Orifice diseases project - experience of the "Hospital das Clínicas" University of São Paulo Medical Center in day-hospital of anorectal disease

The treatment of malignant or benign colorectal pathologies that require more complex management are priorities in tertiary hospitals such as "Hospital das Clínicas" University of São Paulo Medical Center (HCFMUSP). Therefore, benign, uncomplicated orifice conditions are relegated to second place. The number of patients with hemorrhoids, perianal fistulas, fissures, condylomas and pilonidal cysts who seek treatment at the HFMUSP is very great, resulting in over-crowding in the outpatient clinics and a long waiting list for recommended surgical treatment (at times over 18 months). The authors describe the experience of the HCFMUSP over an eight-day period with day-hospital surgery in which 140 patients underwent surgery. Data was prospectively taken on the patients undergoing surgery for benign orifice pathologies including age, sex, diagnosis, surgery performed, immediate and late postoperative complications, and follow-up. 140 patients operated on over eight days were studied. 68 were males (48.75%) with ages ranging from 25 to 62 (mean 35.2 yrs.). Hemorrhoids was the most frequent condition encountered (82 hemorrhoidectomies, 58.6%), followed by perineal fistula (28 fistula repairs, 20.0%). The most common complication was headache secondary to rachianesthesia occurring in 9 patients (6.4%). One patient (0.7%) developed bleeding immediately PO that required reoperation. Mean follow-up was 104 days. Day-surgery characterized by quality care and low morbidity is feasible in tertiary public hospitals, permitting surgery for benign orifice pathologies on many patients within a short period of time.

Transexualismo: as decisões do Poder Judiciário no tocante à alteração do prenome a partir da Carta Cidadã de 1988

À luz do instituído pela Constituição Federal de 1988, os direitos fundamentais passaram a ser vistos sob um novo olhar. Todavia, temas considerados complexos, como o transexualismo, segundo a Classificação Internacional das Doenças (CID 10) considerado “Transtorno de Identidade Sexual”, ainda suscitam maior aprofundamento por parte da sociedade, do poder judiciário e do poderes executivo e legislativo. O Sistema Único de Saúde – SUS passou a permitir a cirurgia de transgenitalização no Brasil, na qual se opera a redesignação de sexo, tendo sido estipulados por lei critérios para a sua realização. Após a cirurgia, surge um problema: o da identidade civil, uma vez que o novo gênero da pessoa operada não se coaduna com o seu registro civil, causando-lhe constrangimento. Não há lei que regule a matéria. A partir desta constatação, o presente estudo se propõe a explorar as decisões judiciais de todos os estados da Federação, por intermédio de pesquisa nos sites dos seus respectivos tribunais, bem como das cortes superiores, buscando os termos “transexual” e “prenome” e utilizando o filtro temporal a partir de 1988, ano da promulgação da Carta Cidadã, até final de 2010. Tendo em vista a falta de lei que normatize a matéria, o escopo primordial consiste na obtenção de uma narrativa de como vêm sendo decididas as demandas na temática ora proposta. A conclusão do trabalho sugere que apesar de não haver um marco normativo estabelecido, o discurso do poder judiciário se utiliza de diversos argumentos de ordem social, psicológica e jurídica, devidamente sistematizados e apreciados, bem como de princípios jurídicos, sendo, nesse caso, o princípio da dignidade da pessoa humana, previsto na Carta Magna, o mais utilizado.

Para além do que se vê: das transexualidades às singularidades na busca pela alteração corporal

Pós-graduação em Psicologia - FCLAS

Psychological Perspectives on the Civil Liberties of Transgendered Inmates in a Prison Setting

As society becomes increasingly less binary, and moves towards a more spectrum based approach to mental illness, medical illness, and personality, it becomes necessary to address this shift within formerly rigid institutions. This paper explores this shift as it is occurring within correctional settings around the United States concerning the medical care, housing, and safety of transgendered inmates. As there is no legal standard for the housing or access to gender-affirming medical care (i.e., hormone therapy, sexual reassignment surgery), these issues are addressed on an institutional level, with very little consistency throughout the country. Currently, most institutions follow a genitalia-based system of classification. Within the system, core beliefs are held, some adaptive and some no longer adaptive, that drive the system's behavior and outcomes. With regard to transgendered inmates, several underlying beliefs within the system serve to maintain the status quo; however, the most basic underpinning is the system's reliance on a binary gender system. As views of humane treatment of the incarcerated expand and modernize, the role of mental health within corrections has also expanded. Psychologists, social workers, counselors, and psychiatrists are found in almost all correctional facilities, and have become a voice of advocacy for an often underserved population.

Metamorfoses: identidades e papéis de género. Um estudo com Transhomens

Este estudo, de carácter exploratório, tem o objetivo de perceber como se processam as (re)aprendizagens dos vários papéis de género em transhomens, atendendo aos processos de adaptação ao nível social, comportamental e da perceção de si na (re)construção da identidade. Para a concretização deste trabalho, recorreu-se à recolha de informação, através de uma estratégia metodológica qualitativa e utilizou-se um questionário analisado através do método de análise de conteúdo, segundo Laurence Bardin (1979). Participaram neste estudo 20 transhomens (pessoas cujo sexo designado no registo de nascimento foi feminino, mas que se identificam com o género masculino). As principais conclusões sugerem que existem mudanças ao nível dos sentimentos, perceção de si, comportamentos, identidade de género e relação com o corpo que resultam do processo de redesignação sexual. Verifica-se que as aprendizagens e pressões para a conformidade aos estereótipos de género resultam por vezes em comportamentos intencionais na construção das feminilidades e masculinidades. Verifica-se também a consciencialização destas intencionalidades, bem como uma progressiva libertação desses comportamentos e dos constrangimentos a eles associados, o que resulta numa apropriação e autoidentificação de si mais liberta, consequentemente de uma vida mais feliz. Esperamos com este trabalho contribuir para o conhecimento e visibilidade das identidades trans, em específico dos transhomens, na tentativa de desconstrução de estereótipos sociais; Metamorphoses: Identity and Gender Roles. A Study with Transmen Abstract: This study of exploratory nature aims to understand the process of (re)learning the various gender roles in transmen, in relation to the social and behavioural processes of adaptation and self-perception in the (re)construction of identity.To do this work, we gathered information, outlined a qualitative methodological strategy and used a survey using the content analysis method according to Laurence Bardin (1979). 20 transmen participated in this study (people whose sex assigned at birth registration was female but identify with the masculine gender). The main findings suggest that there are changes in the level of feelings, self-perception, behaviour and relation with the body that result from sex reassignment process. It appears that the learning and pressures for conformity to gender stereotypes sometimes result in intentional conduct compliance in the construction of femininity and masculinity before and after the sex reassignment process. You can also verify the awareness of these intentions, as well as a gradual release of these behaviours and constraints associated with them, which results an appropriation and self-identification of himself more free, thus a happier life. We expect this work to contribute to the knowledge and visibility of the trans people, in particular the transmen in an attempt to deconstruct social stereotypes.

Transsexualisme: enjeux et spécificités liés à la prise en charge d'une demande de réassignation sexuelle [Gender identity disorder: challenges and specificity in the treatment of requests for sexual reassignment].

Gender identity disorder is defined as a permanent desire to relieve one's own sexual features to acquire the sexual features and line to life of the opposite sex. The diagnosis is based on the psychiatric evaluation and treatment on an interdisciplinary approach by endocrinologists, surgeons and psychiatrists, and can be conceptualized into distinct phases: diagnostic evaluation, real life experience, hormonal treatment and surgery. Multiples challenges have to be faced, especially by the psychiatrist who follows the patient during the whole process.

Observations in surgery : being a collection of one hundred and twenty eight different cases : with particular remarks on each, for the improvement of young students : wherein not only the method of practice in difficult labours, but other distempers incident to the female sex are copiuosly enlarged on : among others that of the descent of the womb, clearly proving the reality of such a disease in opposition to Mr. Veduc : to which are added the particular receipts of such remedies as were used by the author in each case /

Mode of access: Internet.

Five-year follow-up of angiographic disease progression after medicine, angioplasty, or surgery

Background: Progression of atherosclerosis in coronary artery disease is observed through consecutive angiograms. Prognosis of this progression in patients randomized to different treatments has not been established. This study compared progression of coronary artery disease in native coronary arteries in patients undergoing surgery, angioplasty, or medical treatment. Methods: Patients (611) with stable multivessel coronary artery disease and preserved ventricular function were randomly assigned to CABG, PCI, or medical treatment alone (MT). After 5-year follow-up, 392 patients (64%) underwent new angiography. Progression was considered a new stenosis of >= 50% in an arterial segment previously considered normal or an increased grade of previous stenosis > 20% in nontreated vessels. Results: Of the 392 patients, 136 underwent CABG, 146 PCI, and 110 MT. Baseline characteristics were similar among treatment groups, except for more smokers and statin users in the MT group, more hypertensives and lower LDL-cholesterol levels in the CABG group, and more angina in the PCI group at study entry. Analysis showed greater progression in at least one native vessel in PCI patients (84%) compared with CABG (57%) and MT (74%) patients (p < 0.001). LAD coronary territory had higher progression compared with LCX and RCA (P < 0.001). PCI treatment, hypertension, male sex, and previous MI were independent risk factors for progression. No statistical difference existed between coronary events and the development of progression. Conclusion: The angioplasty treatment conferred greater progression in native coronary arteries, especially in the left anterior descending territories and treated vessels. The progression was independently associated with hypertension, male sex, and previous myocardial infarction.