Department of Obstetrics and Gynecology Saitama Medical Center Saitama Medical School
- 日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)
- vol.52, no.8, pp.1208-1214, 2000-08-01
Individuals pursuing sex reassignment have not been taken seriously in Japan, differing from in modern Western societies, where gender identity disorder (GID) has been officially adopted in ICD-10 or DSM-IV. Under these circumstances, we established multidisciplinary gender team in Saitama Medical Center, in which transsexuals are diagnosed and treated. The term GID han been used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, or a sense of inappropriateness in the gender role of that sex. The number of the GID in our gender clinic was 317 during 6 years from 1993 to 1999, among which 178 cases (56%) was female to male transsexuals (FTMTS), whereas 139 (44%) was male to female transsexuals (MTFTS). The cases desiring sex reassignment surgery in FTMTS was 102 (57%). Most of the transsexuals visiting our gender clinic became manifest during infant days or before puberty. The sex partners of 48% of FTMTS were female, and one fourth of the patients had the episode of failure to suicide. The origins of transsexualism are still largey unclear. A first indication of anatomic brain differences between transsexuals and no transsexuals have been found. There are two phases for the diagnosis of GID. In the first phase, a diagnosis in made based on formal psychiatric classification criteria, a "strong and persistent cross-gender identification". In the second phase, one's capability to live in the desired role and the strength of the wish for SRS, in the face of disappointments while living in the opposite gender role, is tested. Then the psychological intervention starts, followed by hormone therapy. Sex reassignment surgery for FTMTS is composed of mastoidectomy, a urethra lengthening, closure of vaginal wall and oophorotomy with hysterectomy. The point of operation technique is to make the anterior vaginal flap to lengthening the urethra to reach the tip of clitoris released upward, at hysterectomy. SRS for MTFTS is to dissect penis to make new clitoris and followed by vaginoplasty. SRS was first undertaken in Japan in 1998, and the attitude toward GID has become positive. It seems likely that GID would be accepted in medical, legal social field soon in Japan.