Beginnings of sex reassignment surgery in Japan

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The first sex reassignment surgery (SRS) performed officially in Japan - for a female-to-male (FtM) person in 1998 and for a male-to-female (MtF) person in 1999 - are reported. For the FtM, two-stage conversion was applied. In the first operation, salpingo-oophorectomy, hysterectomy, colpectomy, metoidioplasty, and mastectomy were performed. A free flap phalloplasty with the deltoid flap is planned as the second stage. For the MtF, one-stage neovaginoplasty was performed by penile skin inversion technique with sensate pedicled neoclitoplasty.

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... Torai comments that it was this 'one patient who opened the door' for legal SRS in Japan (Harima 2004: 127). The ethics committee commissioned a report on GID and SRS from its medical team, which acknowledged that the disorder existed and that SRS was a medically justifiable activity (Takamatsu et al. 2001). The ethics committee requested guidelines for diagnosis, and physicians at the hospital drew these directly from guidelines by The Harry Benjamin International Gender Dysphoria Association (now named the World Professional Association for Transgender Health), publishing them in 1997. ...
... The first legal SRS in Japan was female-to-male and took place at Saitama Medical School in October 1998. There was no public criticism and the surgery was positively reported in mainstream Japanese media (Takamatsu et al. 2001). ...
... However, an alternative view is that Japan is still largely a homophobic and transphobic society and there are major issues with discrimination on a daily basis (Amnesty International, 2017;Kaleidoscope Human Rights Foundation, 2015). The first GAS in Japan was completed in 1998 (Ako et al., 2001). In Japan, 'Gender Identity Disorder' is still considered a mental illness according to Mental Health and Welfare Law (Masumori, 2012). ...
Around the globe, trans and gender diverse people have a wide range of access to health care, psychological as well as physical, that is unique to their home country’s context. Some of the contributing factors are nations’ health care systems, laws and policies surrounding discrimination, adequate resources, and under-trained health care professionals. Unfortunately, inability or difficulty in accessing transition related health care and support leads to negative impacts on mental health. In this article, the authors describe the unique contexts related to transgender health care in Canada, Japan, South Africa, and the United States. We focus specifically on the financial cost of transition for trans and gender diverse people, including gender affirming surgeries as well as mental and health care more broadly. We discuss the role of mental health professionals as advocates for gender affirming care and the fundamental human right to health care. We include discussions of therapy, assessment, medical care such as hormone replacement therapy (HRT) and surgeries, and additional invisible costs. We highlight the importance for all mental health professionals to be aware of the impacts to trans and gender diverse people’s mental health when their fundamental health care needs are not met. Furthermore, we provide recommendations for how mental health professionals can advocate for their clients’ access to transition related care.
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Transgenderism and Intersexuality in Childhood and Adolescence: Making Choices presents an overview of the research, clinical insights, and ethical dilemmas relevant to clinicians who treat intersex youth and their families. Exploring gender development from a cross-cultural perspective, esteemed scholar Peggy T. Cohen-Kettenis and experienced practitioner Friedemann Pfäfflin focus on assessment, diagnosis, and treatment issues. To bridge research and practical application, they include numerous case studies, definitions of relevant terminology, and salient chapter summaries.
The gender reassignment process has ethical, social and legal dimensions. However, European Union countries have recommended certain principles for such reassignment. The lack of special legislation regulating legal conditions and effects of gender reassignment creates a difficult situation for transsexuals. A new civil law was implemented in 2001 in Turkey recognising gender identity reassignment which has set new standards for procedures. According to the law, court permission is compulsory for gender reassignment surgery. Courts require expert analyses in a health council report which must include a psychiatric examination of the individual, who must also be permanently unreproductive as defined by the law. Although the new Civil Law arranges new standards for gender reassignment surgery procedures, there are several problems in reassigning the civil status of transsexuals in Turkey.
To describe the technical details of our experience in performing metaidoioplasty. After the first officially approved sex-reassignment surgery on a patient with transsexualism was performed in Japan, we performed metaidoioplasties on 69 female-to-male transsexuals between 1998 and 2007. Oophorohysterectomy and metaidoioplasty were performed by a one-stage procedure. Hage's technique was used on the first 26 cases. The labial ring flap technique was performed on 43 patients (aged 18-33 years) after 2005. This new technique uses all the labia minora skin incorporated with the anterior vaginal flap for urethral lengthening. The clitoral chordee is also released by this procedure. Using this method, we obtained a neo-urethra of a good diameter and a more male-like appearance for external genitalia along with a minipenis. The postoperative course was uneventful in 28 of 43 cases. Urethral fistula occurred in 12 cases, which was spontaneously closed in eight cases. Four other cases required secondary repair. Three cases with neo-urethral stenosis were treated by urethral dilation. Of the 43 cases, 28 can void in a standing position. For five patients who desired a larger phallus, various phalloplasty techniques were performed subsequently. Satisfactory urine stream and appearance were achieved. Metaidoioplasty with minimal scarring can be selected independently or as the first step followed by phalloplasty if the patient requires such an operation.
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