Free sex-change operation gives hope to transgenders

CHENNAI: A four-hour-long surgery at the Government General Hospital has remarkably transformed Ambika (name changed). Doctors removed the male genitals and reconstructed a vagina to enable the transgender to perform the sexual functions of a female.

“It is the first time we are doing this based on a request from the welfare board for transgenders under the government scheme that offers free sex-reassignment surgeries for transgenders,” said plastic surgeon Dr V Jayaraman of the Government General Hospital. GH and the Aravani Welfare Board will now independently place a proposal before the state health department urging it to form a team of specialists comprising urologists, endocrinologists, sexologists and psychologists
for sex reassignment surgery.

In the first phase, the hospital wants to focus on feminisation (male to female) surgeries. The social welfare department in a government order dated December 21, 2006 had stated that aravanis (the transgender community) were born biologically male, who sought to define themselves as a woman trapped in a man’s body’. While in early 2008, they were offered ration cards with T’ marked against the gender column, a board was constituted in September to help them with access to health care, education and housing.

“We need to counsel them and put them through a programme that will make their gender transition smooth. It is a complex process that needs physiological and medical therapy at least four months ahead of surgery. They need to put on hormonal pills to avoid any imbalance after surgery. And post-surgery, they need to be monitored and counseled about various things, including anatomy and physiology of the new gender. This will require a special team of doctors,” Dr Jayaraman said.

In Ambika’s case, a vagina has been constructed to resemble a normal woman’s vagina. But there is no uterus or ovary. The patient is likely to have silicon implants for breast construction. She’ will be on hormone replacement therapy and require counseling.

Aravani Welfare Board members said they were delighted. “We are sure the number of deaths due to crude surgeries will now come down. Those who can afford scientific surgeries go abroad but the rest have no other option but to visit quacks. We will be urging government to increase the strength of the surgical team to make it on par with international standards,” said Noorie, a transgender, also a member of the board.

Presently, there are no medical guidelines for sex reassignment surgeries in India. Most transgenders go to quacks or dhai ammas (leaders in the transgender community) for castration. “They are done in a bizarre environment. The transgender is prepared for the crude surgery days ahead with special poojas and diet. There is a six-foot deep pit dug before the dhai amma cuts the penis. Hot oil is poured to stop the bleeding. If the transgender dies, he is buried in the pit. Else, a function is held after the wound heals to celebrate her’ puberty,” says Dr Lakshmi Bai, project director, Tamil AIDS Initiative.

In the US, people are put through a rigorous screening process before sex reassignment surgeries. After three months of psychiatric counseling, the person has to undergo a real life test for two years, dressing and living like a woman, while undergoing hormone therapy. “Only after the team of doctors is satisfied that the person is fit to undergo genital reassignment is the surgery done,” says sexologist Dr Narayana Reddy.

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