What to do when non transsexuals seek sex reassignment surgery

A request for sex reassignment by a non-transsexual frequently leads to a serious confrontation between the patient and therapist. Therapists should explore and resolve the specific issues that have lead to such requests. As those issues are resolved, the non-transsexual usually drops his/her demands for sex reassignment.     

A law concerning sex reassignment of transsexuals in Sweden

In 1972, a law regulating surgical and legal measures required for sex reassignment came into force in Sweden. The law, its practical application, and the number of transsexual cases dealt with by the National Board of Health and Welfare during the first 2 years of enforcement are described.     

Long-term follow-up: psychosocial outcome of Belgian transsexuals after sex reassignment surgery

BackgroundTo establish the benefit of sex reassignment surgery (SRS) for persons with a gender identity disorder, follow-up studies comprising large numbers of operated transsexuals are still needed.AimsThe authors wanted to assess how the transsexuals who had been treated by the Ghent multidisciplinary gender team since 1985, were functioning psychologically, socially and professionally after a longer period. They also explored some prognostic factors with a view to refining the procedure.MethodFrom 107 Dutch-speaking transsexuals who had undergone SRS between 1986 and 2001, 62 (35 male-to-females and 27 female-to-males) completed various questionnaires and were personally interviewed by researchers, who had not been involved in the subjects' initial assessment or treatment.ResultsOn the GAF (DSM-IV) scale the female-to-male transsexuals scored significantly higher than the male-to-females (85.2 versus 76.2). While no difference in psychological functioning (SCL-90) was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors.ConclusionWhile sex reassignment treatment is an effective therapy for transsexuals, also in the long term, the postoperative transsexual remains a fragile person in some respects.     

Social work practice with transsexuals in Hong Kong who apply for sex reassignment surgery

There is a dearth of social work literature describing the comprehensive way of helping transsexuals who seek sex reassignment surgery. In view of this knowledge gap, this paper proposes a practice model to help transsexuals at different stages: assessment, surgery, and post-surgical follow-up. The characteristics of this practice model, its underlying theoretical framework, its focus of intervention, and the intervention at the multiple systems levels (namely individual, family and organization) are described. The roles of the social worker at different stages of helping are discussed.     

Social assessment of transsexuals who apply for sex reassignment therapy

A social worker member of the gender identity team of a Psychiatry Department is responsible for the social assessment of the transsexual who applies for sex reassignment surgery. This paper synthesizes the dynamics and processes in conducting the social assessment for eight male-to-female transsexuals from 1986 to April 1988. Role theory was used as the underlying theoretical framework for the assessment. Social criteria for the eligibility of the surgery are delineated. Three cases demonstrate how the social worker used these criteria for the assessment, the difficulties in the process and ways of resolving them.     

Sex reassignment surgery: A study of 141 dutch transsexuals

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.Supported by the NOAPR (Netherlands Organization for the Advancement of Pure Research) Grant No. 56-165.     

Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery

Objectives  

To determine the self-reported quality of life of male-to-female (MTF) transgendered individuals and how this quality of life is influenced by facial feminization and gender reassignment surgery.     

Psychiatric aspects of sex reassignment surgery

Sex reassignment surgery is perhaps the most controversial issue in psychiatry today. Clinicians involved in the treatment of transsexualism have been accused of "playing God" or colluding with the patient's psychopathology. This paper reviews the literature and argues for a systematic approach to the treatment of transsexualism.     

Determinants of global quality of life before and after major cancer surgery: an exploratory study

Objective  

To explore whether determinants of global quality of life (QOL) change before and after major cancer surgery.     

Transsexual healing: Medicaid funding of sex reassignment surgery

Federal requirements for state Medicaid programs are surveyed, and case law regarding Medicaid funding of sex reassignment surgery is reviewed. States have attempted to exclude sex reassignment surgery (SRS) from Medicaid coverage on various bases, concluding, for example, that the procedure constituted cosmetic surgery. Judicial scrutiny of such exclusions has usually resulted in the state action being found violative of the federal Medicaid statute and accompanying regulations. In those cases upholding the state exclusion, the primary judicial obstacle to funding has been a determination that SRS is not medically necessary or is experimental. The author explores the recent scientific literature concerning long-term outcomes following SRS and concludes that the procedure, for purposes of Medicaid funding, is neither unnecessary nor experimental, and that the categorical exclusion of SRS from Medicaid coverage is therefore inappropriate. The author recommends case-specific determinations of eligibility for Medicaid funding, utilizing the standards of care promulgated by The Harry Benjamin International Gender Dysphoria Association.     

Determinants of health-related quality of life after temporal lobe epilepsy surgery

Ternporal lobectomy appears to be an effective treatment for medically intractable epilepsy. However, the influences of pre-operative health status and post-operative reductions in seizure activity on post-surgical health-related quality of life (HRQOL) are not well understood. We used the Epilepsy Surgery Inventory 55 (ESI-55) to evaluate changes between pre- and post-operative HRQOL in 47 temporal lobectomy patients. Patients exhibited significantly improved scores in five HRQOL domains: health perceptions; energy fatigue; social function; cognitive function and role limitations due to physical problems. Although significant improvements in HRQOL were observed, this was not the case for all patients. Specifically, patients with low or medium pre-operative HRQOL scores were found to have the greatest degree of improvement post-operatively. Patients with high pre-operative scores did not exhibit these same improvements, although they continued to report high scores. The results indicate that the ESI-55 is a satisfactory instrument to measure change in HRQOL but also emphasizes that the magnitude of change in post-operative HRQOL scores tends to vary according to baseline scores. The outcome of temporal lobectomy is not entirely based upon the procedure's ability to reduce the frequency of seizures, but is also influenced by level of HRQOL prior to surgery.     

Physical activity and quality of life improvements before obesity surgery

OBJECTIVE: To examine quality of life (QOL), physical activity (PA), and physical activity readiness (PAR) among gastric-bypass surgery (GBS) candidates. METHODS: The SF-36v2, International Physical Activity Questionnaire, and a stages-of-change measure assessed QOL, PA, and PAR respectively across 2 presurgical visits. RESULTS: Increases in mental QOL, PA, and PAR were observed across visits. Sufficiently physically active participants reported significantly higher physical QOL than did insufficiently physically active participants. CONCLUSIONS: Findings demonstrating positive presurgical changes in PA and PA readiness as well as the association between PA and QOL warrant increased efforts to promote PA adoption and maintenance among GBS candidates.     

The outcome of sex reassignment surgery in Belgrade: 32 patients of both sexes

Several aspects of the quality of life after sex reassignment surgery in 32 transsexuals of both sexes (22 men, 10 women) were examined. The Belgrade Team for Gender Identity Disorders designed a standardized questionnaire for this purpose. The follow-up period after operation was from 6 months to 4 years, and four aspects of the quality of life were examined: attitude towards the patients' own body, relationships with other people, sexual activity, and occupational functioning. In most transsexuals, the quality of life was improved after surgery inasmuch as these four aspects are concerned. Only a few transsexuals were not satisfied with their life after surgery.     

Recurrent genital herpes and quality of life in France

Recurrent genital herpes is an incurable disease that may give rise to considerable psychological disturbance. This paper describes the impact of the disease on quality of life in a French population. The population study was also used to provide additional validation data for the French version of the RGHQoL (the Recurrent Genital Herpes Quality of Life) measure. The content of the RGHQoL was derived from patient interviews in the UK. The measure was then developed and tested simultaneously in several countries, including France. Statements in the measure were translated into French by a bilingual panel and then by a lay panel. Field-testing in France took place with 15 patients who judged the instrument to be relevant and easy to complete. The final version of the questionnaire was assessed for reliability and construct validity. The measure was found to have good test–retest reliability (0.94) and internal consistency (0.93) as assessed by Cronbach's alpha. The French RGHQoL was then used with 150 herpes patients obtained from a general population sample. A majority of the respondents completed all questions, indicating a high level of acceptability. Quality of life was found to be lowest in the under 25-year-olds and in those respondents who were most psychologically and sexually disturbed by their outbreaks and found it difficult to discuss the problem with their partner. It is concluded that the French version of the RGHQoL is an acceptable, reliable and valid instrument and that the measure provides valuable information about the impact of the disease.     

Determinants of quality of life in home parenteral nutrition

PURPOSE OF REVIEW: To highlight the most important and salient articles regarding home parenteral nutrition and quality of life published within the last 3 years. RECENT FINDINGS: In recent years, quality of life research in home parenteral nutrition has highlighted the need for a therapy-specific validated questionnaire. Several papers suggest a greater psychological input is required to better understand and evaluate this patient population. Issues surrounding the use of home parenteral nutrition in malignancy have arisen, prompting discussion on ideal timing and candidacy for home parenteral nutrition. Intestinal transplantation is evolving and improving, making it a possible alternative to home parenteral nutrition. Earlier referral is suggested as late referral can result in poorer outcome. SUMMARY: Home parenteral nutrition is a life-sustaining therapy for individuals with intestinal failure. There is now a relatively large amount of research into the quality of life in this population, but more focused measurements (in the form of validated therapy-specific questionnaires) are required to answer questions relating to cancer and intestinal transplantation.     

Confirmatory factor analysis of a Spanish version of the sex fantasy questionnaire: assessing gender differences

The objective of this study was to validate the factor structure of Wilson's Sex Fantasy Questionnaire (SFQ; Wilson, 1978; Wilson & Lang, 1981) using a Spanish version. In order to do this, we conducted confirmatory factor analysis on two nonclinical samples containing 195 men and 315 women. Both groups were tested for the structure proposed by Wilson and also for some alternative models. Confirmatory factor analysis showed that four factors were reasonably distinct, especially for the men. We proposed shortened version of the instrument that would have sufficient psychometric guarantees for assessing sexual fantasies in both genders. This abridged version improved the fit of the four-factor oblique factor equally for both the samples of men and women. In the light of the results of the validation hypothesis established with some criterion variables (dyadic sexual desire, unconventional sex, homophobia), we discuss discrepancies between both versions.