著者

木下 勝之 Katsuyuki KINOSHITA 埼玉医科大学総合医療センター産婦人科 Department of Obstetrics and Gynecology Saitama Medical Center Saitama Medical School

雑誌

日本産科婦人科學會雜誌 = Acta obstetrica et gynaecologica Japonica (ISSN:03009165)

巻号頁・発行日

vol.52, no.8, pp.1208-1214, 2000-08-01

参考文献数

12

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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.

著者

Satoru Takeda Jun Takeda Taro Koshiishi Shintaro Makino Katsuyuki Kinoshita

出版者

日本妊娠高血圧学会

雑誌

Hypertension Research in Pregnancy (ISSN:21875987)

巻号頁・発行日

vol.2, no.2, pp.65-71, 2014 (Released:2015-02-06)

参考文献数

17

被引用文献数

9

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The precise reporting of fetal station is important in the decision-making regarding whether instrumental vaginal delivery or cesarean section should be performed. However, accurate evaluation of fetal station is difficult because it is defined on the basis of a hypothetical vertical midline to the ischial spines. Moreover, during delivery, the fetal head descends anteriorly into the pelvis along the pelvic axis and not in the vertical direction. DeLee’s concept of fetal station, first reported in 1924, has been revised by taking into account the fetal head descent along the pelvic axis, and this concept has been in clinical use at the University of Tokyo Hospital since the 1970s.In this review, we assess the problems associated with conventional fetal station and explain the new concept of fetal station based on the trapezoidal plane and assessment of head descent upon instrumental delivery.