Sex reassignment surgery

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Sex reassignment surgery (initialized as SRS; also known as genital reconstruction surgery, sex affirmation surgery, sex realignment surgery or sex-change operation) is a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble that of the other sex. It is part of a treatment for gender identity disorder/gender dysphoria in transsexual and transgender people. It may also be performed on intersex people, often in infancy. Other terms for SRS include gender reassignment surgery, sex reconstruction surgery, genital reconstruction surgery, gender confirmation surgery, and more clinical terms, such as feminizing genitoplasty or penectomy, orchidectomy and vaginoplasty are used medically for trans women, with masculinizing genitoplasty often similarly used for trans men.

The best known of these surgeries are those that reshape the genitals, which are also known as genital reassignment surgery or genital reconstruction surgery (GRS). However, the meaning of "sex reassignment surgery" has been clarified by the medical subspecialty organization, the World Professional Association for Transgender Health (WPATH), to include any of a larger number of surgical procedures performed as part of a medical treatment for "gender dysphoria", "transsexualism" or "gender identity disorder". According to WPATH, medically necessary sex reassignment surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation [...] including breast prostheses if necessary, genital reconstruction (by various techniques which must be appropriate to each patient[...])[...] and certain facial plastic reconstruction."[1] In addition, other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial electrolysis.

The array of medically necessary surgeries differs for trans women (male to female) rather than trans men (female to male). For trans women, genital reconstruction usually involves the surgical construction of a vagina, whereas in the case of trans men, genital reconstruction may involve either construction of a penis or metoidioplasty/construction of a penis. In both cases, for trans women and trans men, genital surgery may also involve other medically necessary ancillary procedures, such as orchiectomy or vaginectomy. As underscored by WPATH, a medically-assisted transition from one sex to another may entail any of a variety of non-genital surgical procedures, any of which are considered "sex reassignment surgery" when performed as part of treatment for transsexualism. For trans men these may include mastectomy (removal of the female breasts) and chest reconstruction (the shaping of a male-contoured chest), or hysterectomy and bilateral salpingo-oophorectomy. For some trans women, facial feminization surgery and breast augmentation are also medically necessary components of their surgical treatment.

A growing number of public and commercial health insurance plans in the United States now contain defined benefits covering sex reassignment related procedures, usually including genital reconstruction surgery (MTF and FTM), chest reconstruction (FTM), breast augmentation (MTF), and hysterectomy (FTM).[2] In June 2008, the American Medical Association House of Delegates declared that discrimination [3], stating that the denial to patients with Gender Identity Disorder of otherwise covered benefits represents discrimination, and that the AMA supports "public and private health insurance coverage for treatment for gender identity disorder as recommended by the patient's physician." Other organizations have issued similar statements, including WPATH [4], the American Psychological Association [5], and the National Association of Social Workers [6].

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