This article originally written in Portuguese is by far the most popular. This isn't obviously an easy subject to write about. Do please leave your intelligent and helpful comments so that we can research further into this heartbreaking story.
"A transsexual's life is very hard. The difficulty is there from the moment we are born. When we start growing up and learning about things it starts to get tricky. Ever since I was a kid, I thought I was a girl. I had this sensation and it was a natural thing to have. Maybe there is a reason, because I am the youngest of three women. Some people used to believe that it was because of that. Thing is, when I grew up, and became a teenager, I started to notice my sexuality.” Vivian Proença
“It’s tough. Everyone goes through prejudice, the lessening of their condition. It was only through hard fights, even with myself, that I was able to find out who I really was. In the beginning, you are born and you get that doubt: who am I? What am I? What am I doing here? When you start to understand you begin the search. When I started to see myself as a transsexual, when I got the chance, I looked for the ideal treatment which was surgery. I had to wait for three years. Up until January 2002 when I underwent surgery…” Fernanda Rodrigues
“I am a post-op transsexual. Ever since I was a child I dreamed of becoming a woman, not only in essence but in body as well, to be one. I grew up with cravings and feelings of a woman, but with something that did not get in the way of my relationships… I had always been frustrated because of something that bothered me a lot. It was shameful to have something I did not like. I would never go to the swimming-pool. I was very repressed.” Roberta Sampaio
The statements above are the gist of the suffering those born with Gender Identity Disorder, also known as transsexualism, go through. People born with this condition will only find peace of mind only after undergoing a difficult, painful and risky surgery to reassign their gender. The biggest challenge is to turn a penis into a working vagina and one that looks like a real one.
According to Psychiatrist Maria Lobato, member of the multidisciplinary team of the Programa de Atendimento dos Transtornos de Identidade de Gênero (PROTIG) – Program for the Care of Gender Identity Disorders (PCGID)- at the Hospital de Clínicas in Porto Alegre, in the state of Rio Grande do Sul, Brazil: “The alteration of male genitalia, which is irrevocable, cannot be made under the slightest sign of discomfort. The patient's request for sex-reassignment surgery must be shown to be genuine and surgeons have to make sure they are not just dealing with the erotic imaginations of an immature personality, but with a long-thought-of conviction that this is a real gender disorder."
That’s why a psychiatric evaluation has to come before such surgeries to preclude the existence of a psychosis – which may be a contraindication to surgery, but also a reasonable degree of intelligence and emotional stability must be present if the person is to be illegible for surgery. “It’s the psychiatrist who has the final say and there is no other way of helping the patient to find acceptance," the psychiatrist says.
Science says that transsexualism is a gender identity disorder that begins in infancy and is characterized by non-acceptance and distress towards the gender individuals are born with, occurring more often in males than in females. Frequently, transsexuals wish to change their sex and live with a permanent search for games, clothing, and patterns of relationship and occupation with people of the opposite sex.
Transsexualism must be set apart from other disorders of sexual identity such as travestism or homosexuality: transvestites wear clothes of the opposite sex, associated with either bisexual or homosexual behavior without the wish to change their sex; however, homosexuality involves sexual attraction to same sex individuals, without the wish to dress or become the opposite sex.
Both transsexuals and their families experience great difficulties within their family as in society at large due to the prejudice and disinformation about transsexualism. “Patients usually find it difficult to adapt in the social milieu, schools and the workplace for example”, says psychologist Jaqueline Salvador also a member of the team at the Hospital de Clínicas in Porto Alegre.
“The transsexual person believes he or she is a victim of a biological accident, cruelly trapped in the wrong body, incompatible with their sexual orientation. Many ask for sex-reassignment surgery despite the difficulties these imply. Surgery will only be justified in very motivated individuals with a stable social and professional life,” continues the psychologist.
Jaqueline Salvador says that there is an ever increasing demand for sex-reassignment surgery due to a decision by the Federal Council of Medicine (CFM) from September 1997, in Brazil, which authorizes transgenitalization, or sex change, in transsexuals on an experimental basis. The Hospital de Clínicas of Porto Alegre is in charge of about 200 patients with gender identity disorder of both sexes.
According to the psychologist, “the requirement for the candidates for surgery is that the patients have to undergo a strict evaluation by the multidisciplinary team which includes behavioral, social, clinical and existential issues performed by psychiatrists, plastic surgeons, psychologist, endocrinologists, ear, nose and throat specialists, speech therapists and social workers".
Multidisciplinarity is especially necessary in the way surgery for sex-reassignment is performed. The main requirements are at least two years of therapy, and more: proof of age, older than 21, formal consent, absence of mental disorders and inappropriate physical features that may impact the surgery. The psychologist evaluates the transsexual candidate to make sure he or she is not just a homosexual or a transvestite.
Patients are expected to undergo therapy for two years and are made aware of the pre and post-op processes and resocialized within psychological, professional and sexual criteria. The diagnosis has to be precise, thus defining the interventions which are suitable to the patient’s personal characteristics with the sole aim of adapting the biological sex to the psychological one.
“The transsexual patient undergoes a great deal of distress before the sex-reassignment surgery. He or she will only get over their misery after the conversion and the taking on of either female or male identity, be that in name, behavior or social acceptance. It’s not only the frustrated sexuality, but the gnawing pain of being gender-discordant which makes, especially males, prone to self-mutilation, suicide attempt or outright suicide.
The false relief that comes from alcohol and drugs is a frequent complication”, writes Harry Benjamin in his book the The Transsexual Phenomenon, available on the internet: “Self-mutilations are not rare in at least four of my patients out of a 112 male transsexuals. Two of them tried to castrate themselves out of a total of 152 males. Two of them tried to castrate themselves but had to give up and call a doctor. One of them did with the help of a friend. One of them mutilated his penis and had several stitches to repair the damage.
"Many incidents like this may be out there,” Harry Benjamin writes. That, in the United States. It may be happening all over the world, as it did in Brazil, with the case of a young transsexual who mutilated himself in a hotel room in a small town then dying as a consequence.
Dr. Carlos Abib Cury, chief-coordinator of the Surgical Specialties Department at the São José do Rio Preto Medical School in São Paulo, writes in an-e-mail interview that there is nothing proven about the cause of transsexualism: “Just like other anxiety states, despite the great breakthroughs, medicine is still falling behind in many areas. There is a lot of controversy as to the real number of genes in the human body." he says, and then "It used to be thought they were around 1 million in the beginning, then they thought it would be around 30 thousand. Today it is speculated that it is around 21 thousand."
Further in the interview, he says that “when they find out the real number of genes, they will study the link each gene has for organic diseases and see whether there is a link with genetics." He mentions still that "Only then will they study behavioral diseases. Until that is clear, everything is a question of hypotheses, theories, suppositions without scientific evidence. Therefore for every 40 thousandth birth, one transsexual male is born and for every 1 millionth woman, one is born transsexual.”
In Transsexual..., Harry Benjamin writes that “the cause of transsexualism and the possible sources from which the wish to change one’s sexuality comes from are probably controversial” there is a trend in scientific investigation that takes into account more than merely psychological aspects.
The possible origin of transsexualism is not discussed in medical literature very frequently or in detail. Most times, it is affirmed that it has an unknown cause. Invariably, it is linked with travestism and sometimes to homosexuality, both opening doors to controversy. Both the main theories, to date, are concerned with organic causes, that is, biological - not necessarily inherited. Or more frequently, with the purely psychological ones.”
Obviously, transsexuals are not able to serve in the Church, Catholic that is, the Vatican demands the expulsion from their orders of those who have undergone sex change. Cardinal Eduardo Martinez Somalo, Prefect Emeritus of the Congregation for Institutes of Consecrated Life, has signed a document eliminating any possibility of transsexuals having religious jobs in ecclesiastical orders. Still, according to the text, priests are not allowed to alter Certificates of Baptism to accommodate them to the sex change.
The position of the Holy See about the subject means that the Church has already experienced cases of transsexuality amongst its ranks. “Due to the complexity of the matter, everyone is asked to keep this letter and the Note of the Congregation for the Doctrine of the Faith under strict secrecy and that it should be used exclusively within its institute or religious society, with the proper aim in mind", emphasizes the document which goes on with yet more instructions for the various societies of the Church.
Because the Brazilian Penal Code is from the 1940's and the studies and techniques used in medicine are very recent, there has not been a change in legislation. There is not a law or ruling for the legalization of the surgery from a legal view point, which is detrimental to the transsexual when trying to sort out their papers. There is, however, in the legal profession, people who are specialized in the matter and who have earned preliminary verdicts favorable to post-op transsexuals.
Once all the legal procedures are surpassed, society has the final say. Cases of transsexuals who are fully integrated are very rare. Most times, the contradiction of the physical appearance and the name registered officially closes doors professionally. That is why, for many men and women who have managed to change their appearance "stolen by nature", the only way out is prostitution or, in the best of cases, the entertainment world.
Only a minority will get a satisfactory job and have a love life. Dr. Carlos Abib Cury notices that “most of the post-op cases display euphoria, elation, which we consider harmful, once life’s difficulties go on despite the sex change. No Prince Charming will turn up and change the life of a transsexual. On the contrary, free from the shackles, he or she will have to work just as hard as the next person," he concludes.
What about the women from the beginning of the story?
“I was in hospital for 8 days when I got the operation. It was painful and the time to recuperate was slow. The sense of freedom you have after the surgery is difficult to explain. The dream of a female transsexual is to be operated on. Medicine and science are advanced and they managed to make a dream come true. I feel complete physically. I am proud of being a post-op transsexual because I know how much I struggled to bring awareness to people. The surgery was a great victory. I accept myself. Despite undergoing two other repair surgeries, I do not feel sad. I believe that when I get my papers in order I am going to be more complete and live life better and better." Vivian Proença
“After the surgery, I did not have to hide. The anticipation is better than before. Life changes. I was full of prejudice. There were things I would not do. Then I got that and everything gets easier. I got to change my life 360 degrees. Of course you will never reach perfection. I used to say that before the surgery I was on parole, after it, I got freedom. I used to live in a cocoon. Now I am a butterfly. Words cannot Express what I feel.” Fernanda Rodrigues
“Today, seven years after the surgery , I'm the happiest person in the world because I'm the body, the soul and the mind of a woman. My biggest pleasure was to feel orgasm and be penetrated. Reaching orgasm is very good. I can say I am very happy.” Amanda Sampaio
Update: Jaqueline Salvador, psychologist at the Hospital de Clinicas updates the numbers by saying "80 out of 243 patients have undergone sex-reassignment surgery." September 2009.