Guest Blogger

"Sex Reassignment": What's in a Word?

Filed By Guest Blogger | July 13, 2010 5:00 PM | comments

Filed in: Living, Transgender & Intersex
Tags: gender reassignment surgery, GRS, sex, sex change, sex reassignment surgery, Shayna Schwach, SRS

Editors' Note: Shayna Schwach practiced accounting as a CPA for 22 years, and later transitioned at work as a paramedic. She has held public office, and lobbied in D.C. and Albany, NY for six years on education issues.Shayna Schwach.jpg

Before being terminated at work for being transgendered, my partner nicknamed me "Tree", stating I was as old as ... !

Born in 1950, I clearly remember when gays and blacks were commonly referred to using words that were pejorative, always used to demean and demoralize. I believe I am on firm ground if I state none of us would consider the use of such words proper today.

With a degree concentrating in biology/genetics and then medical training, I read through volumes attempting to learn all I could about this condition that plagued me throughout my life and with which I had finally been diagnosed. More and more, I was astounded as renowned researchers, medical doctors, WPATH [formerly HBIGDA], and even others with GID (Gender Identity Disorder) used terminology which made me cringe. Surely I thought, learned individuals should understand that the terminology they use can convey negative connotations.

I suggest it is society's schizophrenic attitude about "sex" and the vestiges of puritanical attitudes that drive much of the discrimination we face. Accordingly, any reference to "sex" becomes an impediment to changing societal attitudes.

To preface, let me put forth that "sex" and "gender" are not synonyms. Perhaps in the vernacular we do use them interchangeably at times, but can you imagine a group of early 20s young men sitting in their favorite bar with one exclaiming, "I had great gender with a girl I met last week"? If we define "sex" as an act of recreation and procreation," then it's really your gender, not sex, they're inquiring about on that application where you check the box for "male" or "female". Additionally, given I knew instinctively at age 4 that I was a girl, I've neither had a "sex change" nor "sex reassignment surgery" - I haven't even changed my gender!

For the record, I'm not one of those who ever felt "trapped in a man's body" but instead, as time progressed, simply began to feel discordant and deformed.

It also follows that I'm not "MtF" regardless of the convenience of the term, never mind what such conveys to the rest of society to reinforce it's visceral reaction to us. While I clearly understand that with XY chromosomes my brain should have differentiated to have a male physiology, it did not and the bottom line is that effectively I was born a female with a genital deformity.

And yet, even the WPATH Standards Of Care refer to GID patients undergoing a "change of sex". I have met few individuals who, even though somewhat compassionate, don't exhibit a slight "cringe" upon hearing such terms. As for "tranny", "shemale" and worse, aren't those the terms I hear from hostile males who seek to taunt me? Truly, I'm tired of hearing some with GID use those same terms as if they're a badge of honor.

And now, various television programs and documentaries have begun to flood the airwaves with programs on those who have had a "sex change". With only one exception, every single patient I have seen refers to their situation using what I consider less than desirable terminology. Only one corrected the host exclaiming "I didn't change my sex; I've been a girl since birth." Accordingly, the following question arises:

Desirous of bringing about a less discriminatory societal climate, why would those with GID and those professionals who seek to treat and/or enlighten others as to the true congenital nature of the condition, use and thus reinforce, the very terminology which reinforces myth?

We expend so much effort in an attempt to end bigotry and the denial of rights, yet, perhaps without much thought, reinforce the emotional discomfort of others with the words we choose. Even my surgeon agreed that "uro-genital reconstructive surgery" was more medically appropriate than "sex reassignment surgery". That said, would you care to guess which term is on his web site to this day?

Certainly, plastic surgeons refer to various procedures using proper medical terminology. In one's medical records, most doctors will refer to a myocardial infarct, not a heart attack, rhinoplasty and not a nose job, and breast augmentation vs. "boob job". But you can bet every one of my medical records says "sex change"!

Proper medical terminology should be the norm when discussing GID treatments anywhere. In fact, I recently noted that Dr. Marci Bowers' web site now refers to the vaginal surgery she performs as "GRS"- genital reassignment surgery. Kudos! That said, for me "reassignment" vs. "reconstruction" is odd and her site is still peppered with other terms I consider less than desirable (e.g. MtF), given the nature of the surgery and reality of what the condition is based on my research.

If I understand correctly, GLAAD considers "sex change" pejorative. However, it was suggested to me recently that "sex reassignment" is acceptable because one's genitals are referred to by some as one's "sex".

However, wouldn't we then in effect be saying one had their "sex changed"? We can't accept one term (i.e., SRS) and not the other ("sex change"); obviously, I reject both!

As for "reassigned", it generally refers to a transfer in job or duties which this is not.
Medically, it is the urinary and genital structures that are "reconstructed", i.e. rebuilt, and thus "uro-genital".

The point is, we do have alternatives which are not only more accurate but would help begin recasting current perceptions.


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Véronique | July 13, 2010 7:26 PM

One problem to start with here is your primary definition of the word sex. Sex refers to anatomical sex, the way one's body is formed -- male or female (or intersex). The first way in which you use the word sex is actually a colloquial term for "sexual intercourse." I realize that such a use of the term is common -- I use it myself -- but sex still means "anatomical sex." At birth, most are sexed male or female depending on visible genitalia. I was assigned male at birth, so the term MTF applies to me, even if someone inaccurately.

I say "inaccurately" because we know that sex isn't just a matter of genitalia or chromosomes. There is such a thing as core sex identity, meaning the sex we feel that we ought to be, sometimes referred to as "brain sex." We don't really know yet what is involved in brain sex, but we do know that sometimes it's out of sync with anatomical sex. Thus, whenever there is a need to refer to myself as something other than as a woman, I say "woman born transsexual." That was my state at birth.

No, it's not your gender that's being asked for on forms. It's your anatomical sex, the sex you were assigned, accurately or otherwise, at birth. Male and female are biological terms. I realize that gender is now commonly used as a synomym for anatomical sex, but gender is really about behaviour -- what a given society considers masculine or feminine. I dislike the use of gender as a synonym for sex, because it confuses rather than clarifies, but I fear that it's a losing battle.

Transsexualism isn't just a genital deformity. It's a complete body deformity, thanks to the actions of sex hormones -- in utero, at puberty, and throughout life. My transition wasn't just about reconstructing my external genitalia, however important that was to me (and it was). It was also about hormone therapy to give my body the hormonal balance that my body would not produce naturally but that my brain needed and now thrives on, and to change, to some extent, my morphology.

I realize that the term sex change is crude shorthand. Nonetheless, my anatomical sex was indeed changed from male to female, and with it my legal sex. Those are two rather important designations, at least to me. So I have no problem with the term sex reassignment surgery. SRS changed some vitally important aspects of my body. If I had been born looking like this down below, the obstetrician would have pronounced me female.

I understand your desire to change societal perceptions, but I don't think substituting genital reconstructive surgery (a term I used myself for a while) for SRS is helpful. If anything, it implies that the operation is cosmetic. It decidedly is not! SRS was life-changing for me in a way that is more profound than I can explain. Technically it was reconstructive surgery, but it was so much more than that. Along with hormone therapy, SRS brought my body in line with my brain, and I can now see in the mirror what I have wanted to see for my whole life. However imperfect my body is, it is now a female body, which it wasn't before.

That's why I also don't say that I was always a girl. Even though I think I should have been born a girl and I wish I had been, I wasn't. I wasn't reared as a girl and I didn't mature into a woman following the normal course. I was reared as a male, however untypical, and I had to learn to be a woman later in life rather than during my teens and 20s. No amount of verbal sleight-of-hand will change that, and neither do I think it furthers understanding.

I don't expect my use of SRS to be universal. I know people who use the term gender reassignment surgery, which to me it patently absurd. My gender was most definitely not reassigned! And like you, I detest terms like tranny and shemale. In the U.K., however, use of tranny by people who are transsexual is common, and it's not uncommon even in North America. It's hard for those who embrace the term to understand why I find it objectionable.

What it seems to come down to is that we all feel differently about terminology, what we prefer and what we feel is accurate.

Veronique –

Obviously, our views on many things are divergent (which is just fine)! To begin with, my point was that “sex” does not refer to one’s physical form though I realize this is contrary to your belief. What I assert is that society’s primary use of the word “sex”, and thus their immediate association with the word, is to mean “sexual intercourse”.

That the current state of medical science only permits the obstetrician to use one’s genitals to pronounce one’s gender does not mean it is an accurate assessment. Given my background in biology/genetics and my medical training, I find the research – first via postmortem dissection and then MRIs – that finds the transsexual brain physiology in certain ways to be virtually identical to natal females quite compelling given this is found in the limbic system/hippocampus. As Descartes said, “I think, therefore I am” and that a doctor “assigned male at birth” because it is the state of the art isn’t what I have to accept. So yes – as I stated, I agree that MtF is inaccurate.

As for a rather in depth discussion of gender, I find Dr. Carl Bushong’s analysis of the topic very enlightening and helpful: “What is Gender and Who is Transsexual / Transgendered?” [http://www.docbushong.com/pubs/what_is_gender.asp] Again, I respect your opinion that “No, its not your gender that’s being asked for …. it’s your anatomical sex.” I just strongly disagree. As Bushong explains, it is “brain sex” that relates to behavior, i.e. “how we relate to others on a social and interpersonal as well as sexual level.” Brain gender is quite something else and not a synonym at all.

Finally, I would agree that transition is far from just being about a genital deformity. At birth however, my gender has already been determined without the detrimental effects of puberty and “throughout life”. That said, genital reconstruction is just cosmetic. That this procedure has wonderful psychological effects is not debated. Surgical correction of a cleft palate, breast reconstruction after mastectomy, and many other procedures do the same but they are what they are!

I realize you don’t believe you were born a girl but the point I was trying to make was less about what you and I believe and more about the political realities, societal attitudes, and how one proceeds to alter culture. It’s all about “perception” – not yours and mine but society’s – and that is what controls. No matter what might penetrate on an intellectual level, for society this is all about “sex”. If we attempt to educate society at large and, perhaps more importantly, those with the power to bring about legislative change using language that only reinforces their phobia, we all might as well go home right now! I can tell you this from my years in public office and my lobbying efforts.

Véronique | July 14, 2010 10:11 AM

Thank you for replying to my comment, Shay. I have no problem with people disagreeing with me either. That's pretty common.

You wrote "I suggest it is society's schizophrenic attitude about 'sex' and the vestiges of puritanical attitudes that drive much of the discrimination we face." I don't think that's primarily why we face discrimination. So that means I disagree with your basic premise. No wonder we disagree after that! I think we face discrimination more because we violate some fundamental beliefs about the immutability of the sex of human beings. We are profoundly disturbing not because of any association with sexual intercourse but because we break what people think are rules, and some of them think are rules given by a deity.

Dr. Bushong's paper is interesting. Thank you for providing the link. He defines his terms for the purpose of the paper, which is as it should be, but they are non-standard terms, especially his use of the word "gender." I understand what he means. I am not sure that the terms can be easily applied outside of the paper. I could also take issue with some of his points and conclusions, but no one asked me to write a guest post, so I think I'll stop here. I think I've added enough words to this topic!

Thank you for bringing it up.

Veronique –

Obviously, our views on many things are divergent (which is just fine)! To begin with, my point was that “sex” does not refer to one’s physical form though I realize this is contrary to your belief. What I assert is that society’s primary use of the word “sex”, and thus their immediate association with the word, is to mean “sexual intercourse”.

That the current state of medical science only permits the obstetrician to use one’s genitals to pronounce one’s gender does not mean it is an accurate assessment. Given my background in biology/genetics and my medical training, I find the research – first via postmortem dissection and then MRIs – that finds the transsexual brain physiology in certain ways to be virtually identical to natal females quite compelling given this is found in the limbic system/hippocampus. As Descartes said, “I think, therefore I am” and that a doctor “assigned male at birth” because it is the state of the art isn’t what I have to accept. So yes – as I stated, I agree that MtF is inaccurate.

As for a rather in depth discussion of gender, I find Dr. Carl Bushong’s analysis of the topic very enlightening and helpful: “What is Gender and Who is Transsexual / Transgendered?” [http://www.docbushong.com/pubs/what_is_gender.asp] Again, I respect your opinion that “No, its not your gender that’s being asked for …. it’s your anatomical sex.” I just strongly disagree. As Bushong explains, it is “brain sex” that relates to behavior, i.e. “how we relate to others on a social and interpersonal as well as sexual level.” Brain gender is quite something else and not a synonym at all.

Finally, I would agree that transition is far from just being about a genital deformity. At birth however, my gender has already been determined without the detrimental effects of puberty and “throughout life”. That said, genital reconstruction is just cosmetic. That this procedure has wonderful psychological effects is not debated. Surgical correction of a cleft palate, breast reconstruction after mastectomy, and many other procedures do the same but they are what they are!

I realize you don’t believe you were born a girl but the point I was trying to make was less about what you and I believe and more about the political realities, societal attitudes, and how one proceeds to alter culture. You’re correct that it comes down to our different beliefs in terminology (though some terms are absolute). However, this is about “perception” – not yours and mine but society’s – and that is what controls. No matter what might penetrate on an intellectual level, for society this is all about “sex”. If we attempt to educate society at large and, perhaps more importantly, those with the power to bring about legislative change using language that only reinforces their phobia, we all might as well go home right now! I can tell you this from my years in public office and my lobbying efforts.

Since you both agree on having been born transsexual, why not use transsexual-to-female (T2F, T->F, or TtF) instead of MtF? And to bridge the disagreement over whether you were girls as children, why not agree on "transsexual girl", which seems appropriate for anyone young who understands their situation but hasn't completed transition.

That has the added value of countering the reparative therapists who maintain nobody can be transsexual until adult.

Personally I use "sex change" and "sex reassignment" without hesitation. The change is about far more than genitals and certainly doesn't change inborn gender, which doesn't need confirming either. I'm sure I'm not the only one for whom SRS also enabled sex. These are also widely understood and time honoured usages.

Sympathetic outsiders often say the biggest barrier they feel to assisting us, and especially children, is not knowing what to say because of the confusion of terms. So I would suggest that spawning new ones is unhelpful. Besides, there are many more serious issues to tackle.

Veronique,

FWIW, this is exactly how I see it, including the working through of terms I used for bottom surgery.

Carol :)

Shayna, I'm glad you posted this, because it shows the diversity of opinion in our community. Personally, I think that "sex" includes "gender," and I wrote a whole law review article about it here. Of course, other disagree with me, including yourself. My argument is based on a historical review of the changes in the meaning of the terms "gender" and "sex" from the 1500s to today. Although some people are nervous when they hear the word "sex", I think the better solution is to educate them, rather than to use "gender" less accurately.

But there is room for argument on that, and I think you have ably illustrated the other side.

Amy Hunter Amy Hunter | July 13, 2010 7:37 PM

Shayna, You bring up an on-going and troublesome topic.

There is little agreement in the intersex, transgender and transsexual communities about much of the terminology we use. What a large number of us will agree about is the slow pace of nomeclature development in the medical and psychiatric disiplines.

As a society, I agree, sex, is about an ACT, not a relevant descriptor of the physiological state of ones' body. Futhermore, nothing scares many american's more than sex... I once argued that transpeople could never acheive equality so long as we were part of the LGBT movement; LGB being about SEX and T being about a spiritual state with incongruent physical attributes. Sex simply has too high a fear factor for mainstream society.

I am absolutely guilty of using terminology to refer to myself that could be considered demeaning or lead to discriminatory actions on the part of others. My recent posts here-"Sex Reassignment Surgery: When Things Go Wrong"-could that title, seemingly harmless to me, conjour images of a disfigured being for a casual reader?

Often, I discover when writing for TBP or other blogs, that I have used contadictory terminology-or interchanged terms that must make for confusion to a non-transsexual (There you have it! Is it, NON-Transsexual, Non-transgender, non-trans or, cisgender?).

"Genital Reconstruction Surgery" makes sense to me. It is an accucate description of what the surgical procedure actually does, (IE deconstruct then reconstruct the genitals.)

It does NOT involve either "sex" or "gender", thus avoiding any possible conflation, confusion or arguement.

Works for me....:-)

I'd like to point out that we're only discussing sex change/sex reassignment in terms of "the urinary and genital structures that are 'reconstructed'."

This leaves the majority of the transmale spectrum out of the conversation, as genital surgery is relatively rare compared to chest surgery.

Chris –

Not at all! The intent wasn’t to keep you guys at bay. The issue was about the terms used to refer to all in our community. For example, I do believe society refers to you having a “sex change” and do you really think “FtM” is appropriate? Jump right in; the water’s f … well, there may be just a FEW piranha.

Chris –

Not at all! The intent wasn’t to keep you guys at bay. The issue was about the terms used to refer to all in our community. For example, I do believe society refers to you having a “sex change” and do you think “FtM” is appropriate? Jump right in; the water’s f … well, there may be just a FEW piranha.

I'll take my chance with the piranhas.

The thing that's funny is that for transwomen, transition isn't considered "complete" by society at large unless genital reconstruction occurs.

But for transmen, it gets convoluted: have you had chest surgery? Are you on hormones? Genital surgery? Depending on which state you live in, only one of the above might be required to change your sex marker on documents.

Medically speaking, there isn't one definition for sex. We have chromosomal sex/genetic sex, gonadal sex, morphological sex, and phenotypic sex. Each indicates something very specific: types of chromosomes, gonadal tissue, external genitalia, and endocrine influences.

So when we say someone has had a "sex change," what does that really mean? Diddly squat as far as I can tell.

I much prefer "Gender Confirmation Surgery," This is a more inclusive term, which may mean breast removal/construction or genital surgery options. The wording also suggests that it is a person's body and not their sex or gender that is changing. The surgery is merely confirming what the person already knows to be true of themselves.

Thank you for your clarification and for your thought-provoking post.

Why not just call it Penile Inversion Surgery. Of course PIS for short.

LOL .. maybe cause in Thailand (where I went) they don't use the penile inversion methodology?

Véronique wrote:
"I think we face discrimination more because we violate some fundamental beliefs about the immutability of the sex of human beings. We are profoundly disturbing not because of any association with sexual intercourse but because we break what people think are rules, and some of them think are rules given by a deity."

Whether the 'rules' come from a deity, or from the nature of human thought process, it's certain that Véronique has touched on a core issue for most humans. By nature we are organizing creatures, we say, 'animal, vegetable, mineral?', 'Black, white, brown, yellow?', 'Top or bottom?', 'Male or female?'

On the most immediate level, all sexual creatures, when meeting one of their own species during a mating cycle, must immediately ascertain 'competitor or mate?'. Genetic survival demands that these questions be answered quickly and correctly. For humans, which are fairly unique in our 'constantly-in-heat' physiology, that physiologic gender classification of concave or convex is probably the most primal classification we make of other humans. That classification is more primal than friend or enemy, tribemate or stranger, race, age, anything...

This then is the quandary faced by the transgendered, their bodies lie about their very identity, and that identity is the most important measure of one human to another. This is hateful, and I wish it weren't so, because it forces us to feel like the animals we are first, only thinking with compassion after the fact.

Chris' suggestion, 'confirmation', is certainly far more correct than '(re)assignment', or 'change'.

It's too bad so many folks continue to conflate gender, sex assignment, sexuality, and medical procedures. I'd really like to see all four made more distinct.

Sex reassignment is mostly a legal/social process often facilitated by making the body conform more closely to how one genders in the world. When considering reassignment it helps to understand how initial sex assignment has traditionally happened--cursory visual inspection of the genitals at birth... it's certainly understandable that "reassignment" is often contingent upon similar visual factors.

GRS is typically only one of a number of medical procedures that can be employed on the path taken by folks seeking sex reassignment. As one might expect folks seeking reassignment to male are likely to employ procedures that significantly differ from those seeking reassignment to female.

Gender is a slippery slope and can be argued ad nauseum within social boundries I've observed it to be fairly unique from individual to individual.. what defines gender changes over time and differs from society to society.

sexuality is easy... *chuckle*... most folks are either gyno or andro focused... some are unfocused...