Sex Changing Surgery by medicyatra

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Gender Reassignment Surgery



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Overview

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

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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



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Background Assumptions

   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.




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    Background Assumptions

   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



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



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             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.


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        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


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      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.


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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.


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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.



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            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)

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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


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Some transitions are finished
without surgery

            Expense
            Mutilation
            Irreversibility



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               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?




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         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


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  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.



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       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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