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HindustanTimes Sun,23 Nov 2014

Operating procedures
SV Kotwal
June 28, 2011
First Published: 23:15 IST(28/6/2011)
Last Updated: 23:18 IST(28/6/2011)

In a society where parents sometimes willingly kill their girl child, it is easy to believe news reports claiming that doctors in Indore are performing sex-change operations on ‘scores’ of girls as young as one to five years. But can sex really be changed at such a young age? To the best of my knowledge, no surgeon has performed sex-change surgery at infancy and I personally know the world leaders in the field. Changing sex involves many stages of surgery and anyone who claims to have changed a girl-child into a perfect little boy is either a charlatan or a godman (given that the distinction between the two is often blurred).

Among children, inter-sex surgeries are  done to correct birth defects or early injuries of the genitalia. These should not be confused with transsexualism or Gender Identity Dysphoria (GID). Each year, many children are born with ‘manufacturing defects’ in their sexual organs like undescended testes. Little boys with advanced forms of hypospadias are often mistaken for girls and are even brought up as girls.

Left untreated, they grow up into imperfect adults, and urologists, paediatric surgeons and reconstructive surgeons strive legitimately to correct such defects. The surgeon correcting it is not really changing sex, he is only correcting a congenital defect. Also, such surgeries must be performed before the age of three. Correction of ambiguous genitalia is a legal and validated procedure and it shouldn’t be confused with ‘sex change’.

Sex reassignment surgery is done only to cure GID. Some doctors too are unaware of this condition, as it is not part of their curriculum. It is a condition where a woman is ‘trapped’ inside a man’s body and vice-versa. Research tells us that there are structural differences in the brains of heterosexuals, homosexuals and transsexuals. So, an individual can’t do anything about it. Transsexualism, like homosexuality, is not a disease that can be cured by medication, counselling, reward or even punishment. It can even lead to death, for I know about one person committing suicide and another jumping off the fourth floor while awaiting surgery. Several of our patients have attempted suicide at least once.

It is essential to have highly-trained psychiatrists, endocrinologists and other specialists in the team performing a sex-change surgery. There are internationally recognised criteria for GID, which have been refined over the years. The most difficult part is doing a diagnosis, which is done by qualified psychiatrists through multiple interviews and tests. This is followed by hormonal treatment. The individual undergoes various cosmetic procedures during this process. To qualify for surgery, one must have a sound mind, be above the age of consent, be healthy, must have at least six months of hormones and must have lived in the gender of choosing for at least one year. Typically, the waiting period before the surgery ranges between 18-24 months. There are no shortcuts and the rejection rate is high. The ultimate aim should be to completely rehabilitate the individual in society, not to create a freak or a misfit.

The surgery is long and taxing, particularly the female-to-male one. One of our patients spent 25 hours on the operation table! Many secondary corrections are made and the final outcome may even take a couple of years. It is only then that the person can assume his pre-ordained sexual role, albeit a sterile one. Can you imagine this procedure being carried out on ‘scores’ of little children in one stage in places that lack proper facilities?

My take on what is happening in Indore is this: perhaps there was one (or more) talented surgeon who specialised in correcting congenital defects of the genitalia. The grateful parents believed that the surgeon ‘gave’ them a son. The surgeon did not deny it because it got him more patients! The news of the ‘miracle’ spread like wildfire and soon became ‘breaking news’. Quite possible, don’t you think?

SV Kotwal is a senior consultant urologist who has performed 32 sex-change surgeries at the Sitaram Bhartia Institute, Delhi. The views expressed by the author are personal.


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