Sex Change Operations: The Science, Sociology and Psychology

Chaz Bono, as Sonny and Cher's former daughter is now known, began a surgical process to become a man earlier this year, and in doing so, joined the increasing numbers of people who now undergo gender-reassignment surgery annually.

It's difficult to gauge the size of the transgender population in the United States. The U.S. Census doesn't record this data, and neither does any other organization — at least, officially. The National Center for Transgender Equality in Washington, D.C., estimates the number as between .0025 percent and 1 percent of the general population.

There are limited statistics regarding the prevalence of these types of surgery. Male-to-female (MTF) surgery is more common than female-to-male (FTM), such as Bono is undergoing. Because there are significantly fewer FTM transgender people, such research subjects are more difficult to find.

Regardless of direction, how does a sex change … change sex? Gender-reassignment surgery addresses larger issues of gender, sexuality and sexual orientation.

"Chaz Bono's decision to live his life authentically represents an important step forward, both for him personally and for all who are committed to advancing discussions about fairness and equality for transgender people," Neil G. Giuliano, the president of the Gay & Lesbian Alliance Against Defamation (GLAAD), said in a statement to the media. "Coming out as transgender is an extremely personal decision and one that is never made lightly."

Sex, gender and sexuality

The issue of gender can be misunderstood because of the terminology that surrounds it, says C. Lynn Carr, a professor at Seton Hall University in New Jersey who studies the relationship between sex, gender and sexuality.

"Sex is the biological (e.g., male/female); gender is the social (e.g., masculine, feminine, androgynous); sexuality is the erotic (e.g., heterosexual, bisexual, homosexual, autosexual, celibate)," Carr tells LiveScience. "In Western culture, both scholars and lay persons commonly fuse and confuse [the three]."

Being unhappy with gender roles doesn't mean that a person is unhappy with that gender specifically. Rather, Carr says, many people — regardless of their sexuality — resent having to conform to the stereotypes of their gender.

"For a long time, girls were commonly dissatisfied with narrow gender roles," Carr says. "They were so often dissatisfied that a majority of adult women in research studies in the late 20th century recalled gender nonconformity in childhood. When the girls acted on those dissatisfactions, they were called 'tomboys.'

Because athleticism in girls today is more accepted, the label of 'tomboy' is used less frequently, and may even disappear."

Transgender: what it means

For transgender people, however, the problems of gender go much further than dissatisfaction with stereotypes. According to GLAAD, the term "transgender" is used to describe people whose gender identity is different from the one they were assigned at birth. Many transgender people say their bodies have always felt "wrong," and that they have been uncomfortable in their skin since they were children. This is especially true in the case of intersex children, who are born with both male and female sex organs; doctors will often assign a sex for the child through surgery.

Transgender individuals might change their bodies hormonally or surgically to alter their gender — or not. Gender-reassignment hormone therapy or surgery is available for both men looking to become women, and women looking to become men.

A study in the September 2007 issue of the journal BJU International found that the majority of patients who undergo MTF gender-reassignment surgery are happy with the results, despite complications such as vaginal hair growth (29 percent), urinary problems (27 percent), vaginal prolapse (6 percent) and vaginal tissue death (3 percent).

"Despite these problems, which were mainly minor and easily corrected by secondary surgery, 76 percent of the patients who provided detailed feedback were happy with the cosmetic result of their surgery and 80 percent said the surgery had met their expectations," wrote Jonathan C. Goddard, the head of the study.

A drastic change

This happiness doesn't imply an easy decision, or an easy life. Ilene Donin, a New York City-based psychologist, says it takes more than bodily discomfort to lead a person, and his or her doctor, to investigate such a "drastic change." Among the reasons:

  • A strong and persistent desire to be or an insistence that they are the other sex.
  • A persistent discomfort about their sex and the belief that they were born the wrong sex.
  • Significant distress or problems functioning caused by these feelings.
  • A frequent pronouncement of wishing to be the other sex, trying to pass as the other sex, wanting to live or be treated as the other sex, and belief that they feel and act like the other sex.

For those who feel they fit the criteria, or who are ready to out themselves as transgender, one final concern — and perhaps the most important — is support.

"One would have to evaluate the emotional and psychological stamina in coping with the reactions of those who would be affected and the potential reactions of others, and the impact on their lives, their work and their relationships," Donin said. "Very importantly, they would need to identify who comprises their support system and how much support there would be once this outing were to occur."

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Sally Law has written about health and sexuality for the Cleveland Clinic, and has appeared regularly as a guest host on Sirius Radio. Her column, The Science of Sex, appears weekly on LiveScience.