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Sexuality Before and After Male-to-Female Sex Reassignment Surgery

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Abstract

The sexual behaviors and attitudes of male-to-female (MtF) transsexuals have not been investigated systematically. This study presents information about sexuality before and after sex reassignment surgery (SRS), as reported by 232 MtF patients of one surgeon. Data were collected using self-administered questionnaires. The mean age of participants at time of SRS was 44 years (range, 18–70 years). Before SRS, 54% of participants had been predominantly attracted to women and 9% had been predominantly attracted to men. After SRS, these figures were 25% and 34%, respectively.Participants’ median numbers of sexual partners before SRS and in the last 12 months after SRS were 6 and 1, respectively. Participants’ reported number of sexual partners before SRS was similar to the number of partners reported by male participants in the National Health and Social Life Survey (NHSLS). After SRS, 32% of participants reported no sexual partners in the last 12 months, higher than reported by male or female participants in the NHSLS. Bisexual participants reported more partners before and after SRS than did other participants. 49% of participants reported hundreds of episodes or more of sexual arousal to cross-dressing or cross-gender fantasy (autogynephilia) before SRS; after SRS, only 3% so reported. More frequent autogynephilic arousal after SRS was correlated with more frequent masturbation, a larger number of sexual partners, and more frequent partnered sexual activity. 85% of participants experienced orgasm at least occasionally after SRS and 55% ejaculated with orgasm.

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References

  • Barr, R. F., Raphael, B., & Hennessey, N. (1974). Apparent heterosexuality in two male patients requesting change-of-sex operation. Archives of Sexual Behavior, 3, 325–330.

    PubMed  Google Scholar 

  • Baumeister, R. F., & Tice, D. M. (2001). The social dimension of sex. Boston: Allyn and Bacon.

    Google Scholar 

  • Bentler, P. M. (1976). A typology of transsexualism: Gender identity theory and data. Archives of Sexual Behavior, 5, 567–584.

    PubMed  Google Scholar 

  • Berk, R., Abramson, P. R., & Okami, P. (1995). Sexual activities as told in surveys. In P. R. Abramson & S. D. Pinkerton (Eds.) Sexual nature, sexual culture (pp. 371–386). Chicago: University of Chicago Press.

    Google Scholar 

  • Blanchard, R. (1985). Typology of male-to-female transsexualism. Archives of Sexual Behavior, 14, 247–261.

    PubMed  Google Scholar 

  • Blanchard, R. (1989a). The classification and labeling of nonhomosexual gender dysphorias. Archives of Sexual Behavior, 18, 315–334.

    Google Scholar 

  • Blanchard, R. (1989b). The concept of autogynephilia and the typology of male gender dysphoria. Journal of Nervous and Mental Disease, 177, 616–623.

    Article  Google Scholar 

  • Blanchard, R. (1991). Clinical observations and systematic studies of autogynephilia. Journal of Sex and Marital Therapy, 17, 235–251.

    PubMed  Google Scholar 

  • Blanchard, R. (1992). Nonmonotonic relation of autogynephilia and heterosexual attraction. Journal of Abnormal Psychology, 101, 271–276.

    PubMed  Google Scholar 

  • Blanchard, R., Clemmensen, L. H., & Steiner, B. W. (1985). Social desirability response set and systematic distortion in the self-report of adult male gender patients. Archives of Sexual Behavior, 14, 505–516.

    PubMed  Google Scholar 

  • Blanchard, R., Clemmensen, L. H., & Steiner, B. W. (1987). Heterosexual and homosexual gender dysphoria. Archives of Sexual Behavior, 16, 139–152.

    PubMed  Google Scholar 

  • Blanchard, R., Legault, S., & Lindsay, W. R. N. (1987). Vaginoplasty outcomes in male-to-female transsexuals. Journal of Sex and Marital Therapy, 13, 265–275.

    PubMed  Google Scholar 

  • Blanchard, R., Racansky, I. G., & Steiner, B. W. (1986). Phallometric detection of fetishistic arousal in heterosexual male cross-dressers. Journal of Sex Research, 22, 452–462.

    Google Scholar 

  • Blanchard, R., Steiner, B. W., Clemmensen, L., & Dickey, R. (1989). Prediction of regrets in postoperative transsexuals. Canadian Journal of Psychiatry, 34, 43–45.

    Google Scholar 

  • Bodlund, O., & Kullgren, G. (1996). Transsexualism–general outcome and prognostic factors: A five-year follow-up study of nineteen transsexuals in the process of changing sex. Archives of Sexual Behavior, 25, 303–316.

    PubMed  Google Scholar 

  • Buhrich, N., & McConaghy, N. (1978). Two clinically discrete syndromes of transsexualism. British Journal of Psychiatry, 133, 73–76.

    Article  PubMed  Google Scholar 

  • Chew, S., Tham, K. F., & Ratnam, S. S. (1997). Sexual behaviour and prevalence of HIV antibodies in transsexuals. Journal of Obstetrics and Gynaecology Research, 23, 33–36.

    PubMed  Google Scholar 

  • Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91, 915–921.

    PubMed  Google Scholar 

  • Daskalos, C. T. (1998). Changes in sexual orientation of six heterosexual male-to-female transsexuals. Archives of Sexual Behavior, 27, 605–613.

    PubMed  Google Scholar 

  • De Cuypere, G., Jannes, C., & Rubens, R. (1995). Psychosocial functioning of transsexuals in Belgium. Acta Psychiatrica Scandinavica, 91, 180–184.

    PubMed  Google Scholar 

  • Docter, R. F., & Fleming, J. S. (1992). Dimensions of transvestism and transsexualism: The validation and factorial structure of the Cross-Gender Questionnaire. Journal of Psychology and Human Sexuality, 5(4), 15–37.

    Google Scholar 

  • Docter, R. F., & Fleming, J. S. (2001). Measures of transgender behavior. Archives of Sexual Behavior, 30, 255–271.

    PubMed  Google Scholar 

  • Doorn, C. D., Poortinga, J., & Verschoor, A. M. (1994). Cross-gender identity in transvestites and male transsexuals. Archives of Sexual Behavior, 23, 185–201.

    PubMed  Google Scholar 

  • Eldh, J. (1993). Construction of a neovagina with preservation of the glans penis as a clitoris in male transsexuals. Plastic and Reconstructive Surgery, 91, 895–900.

    Article  PubMed  Google Scholar 

  • Eldh, J., Berg, A., & Gustafsson, M. (1997). Long-term follow up after sex reassignment surgery. Scandinavian Journal of Plastic and Reconstructive and Hand Surgery, 31, 39–45.

    Article  Google Scholar 

  • Fang, R.-H., Chen, C.-F., & Ma, S. (1992). A new method for clitoroplasty in male-to-female sex reassignment surgery. Plastic and Reconstructive Surgery, 89, 679–682.

    PubMed  Google Scholar 

  • Feinbloom, D. H., Fleming, M., Kijewski, V., & Schulter, M. P. (1976). Lesbian/feminist orientation among male-to-female transsexuals. Journal of Homosexuality, 2(1), 59–71.

    PubMed  Google Scholar 

  • Freund, K. (1985). Cross gender identity in a broader context. In B. W. Steiner (Ed.), Gender dysphoria: Development, research, management (pp. 259–324). New York: Plenum.

    Google Scholar 

  • Freund, K., & Blanchard, R. (1993). Erotic target location errors in male gender dysphorics, paedophiles, and fetishists. British Journal of Psychiatry, 162, 558–563.

    Article  PubMed  Google Scholar 

  • Freund, K., Steiner, B. W., & Chan, S. (1982). Two types of cross-gender identity. Archives of Sexual Behavior, 11, 47–63.

    Google Scholar 

  • Freundt, I., Toolenaar, T. A. M., Huikeshoven, F. J. M., Jeekel, H., & Drogendijk, A. C. (1993). Long-term psychosexual and psychosocial performance of patients with a sigmoid neovagina. American Journal of Obstetrics and Gynecology, 169, 1210–1214.

    PubMed  Google Scholar 

  • Gagnon, J., Giami, A., Michaels, S., & de Columby, P. (2001). A comparative study of the couple in the social organization of sexuality in France and the United States. Journal of Sex Research, 38, 24–34.

    Google Scholar 

  • Green, R. (1969). Psychiatric management of special problems in transsexualism. In R. Green & J. Money (Eds.), Transsexualism and sex reassignment (pp. 281–289). Baltimore: Johns Hopkins Press.

    Google Scholar 

  • Green, R. (1998). Sexual functioning in post-operative transsexuals: male-to-female and female-to-male. International Journal of Impotence Research, 10(Suppl. 1), S22–S24.

    PubMed  Google Scholar 

  • Hage, J. J., & Karim, R. B. (1996). Sensate pedicled neoclitoroplasty for male transsexuals: Amsterdam experience in the first 60 cases. Annals of Plastic Surgery, 36, 621–624.

    PubMed  Google Scholar 

  • Harry, J. (1984). Sexual orientation as destiny. Journal of Homosexuality, 10(3/4), 111–124.

    PubMed  Google Scholar 

  • Hellman, R. E., Green, R., Gray, J. L., & Williams, K. (1981). Childhood sexual identity, childhood religiosity, and ‘homophobia’ as influences in the development of transsexualism, homosexuality, and heterosexuality. Archives of General Psychiatry, 38, 910–915.

    PubMed  Google Scholar 

  • Hoenig, J., & Kenna, J. C. (1974). The nosological position of transsexualism. Archives of Sexual Behavior, 3, 273–287.

    PubMed  Google Scholar 

  • Hunt, D. D., & Hampson, J. L. (1980). Transsexualism: A standardized psychosocial rating format for the evaluation of results of sex reassignment surgery. Archives of Sexual Behavior, 9, 255–263.

    PubMed  Google Scholar 

  • Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia: Saunders.

    Google Scholar 

  • Kirk, S. (1997, September). A survey of post-operative male to female transsexuals from health care to sexual experience and points in between. Paper presented at the XV Harry Benjamin International Gender Dysphoria Association Symposium, Vancouver, BC, Canada.

  • Krege, S., Bex, A., Lümmen, G., & Rübben, H. (2001). Male-to-female transsexualism: A technique, results, and long-term follow-up in 66 patients. BJU International, 88, 396–402.

    PubMed  Google Scholar 

  • Kwan, M., Van Maasdam, J., & Davidson, J. M. (1985). Effects of estrogen treatment on sexual behavior in male-to-female transsexuals: Experimental and clinical observations. Archives of Sexual Behavior, 14, 29–40.

    PubMed  Google Scholar 

  • Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.

    Google Scholar 

  • Lawrence, A. A. (1999). Changes in sexual orientation in six male-to-female (MtF) transsexuals [Letter to the editor]. Archives of Sexual Behavior, 28, 581–583.

    PubMed  Google Scholar 

  • Lawrence, A. A. (2003). Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Archives of Sexual Behavior, 32, 299–315.

    PubMed  Google Scholar 

  • Lawrence, A. A., Latty, E. M., Chivers, M., & Bailey, J. M. (2005). Measurement of sexual arousal in postoperative male-to-female transsexuals using vaginal photoplethysmography. Archives of Sexual Behavior, 34, 135–145.

    PubMed  Google Scholar 

  • Leavitt, F., & Berger, J. C. (1990). Clinical patterns among male transsexual candidates with erotic interest in males. Archives of Sexual Behavior, 19, 491–505.

    PubMed  Google Scholar 

  • Lewins, F. (2002). Explaining stable partnerships among FTMs and MTFs: A significant difference? Journal of Sociology, 38, 76–88.

    Google Scholar 

  • Lief, H. I., & Hubschman, L. (1993). Orgasm in the postoperative transsexual. Archives of Sexual Behavior, 22, 145–155.

    PubMed  Google Scholar 

  • Lindemalm, G., Körlin, D., & Uddenberg, N. (1986). Long-term follow-up of “sex change” in 13 male-to-female transsexuals. Archives of Sexual Behavior, 15, 187–210.

    PubMed  Google Scholar 

  • Lindemalm, G., Körlin, D., & Uddenberg, N. (1987). Prognostic factors vs. outcome in male-to-female transsexualism. Acta Psychiatrica Scandinavica, 75, 268–274.

    PubMed  Google Scholar 

  • Martin, J. (1988). The incidence, frequency and rate of genital satisfaction of sixty-four post-operative male-to-female transsexuals reported to be experienced during various sexual behaviors: A descriptive study. Unpublished doctoral dissertation, Institute for Advanced Study of Human Sexuality, San Francisco, CA.

    Google Scholar 

  • McEwen, L., Ceber, S., & Daws, J. (1986). Male to female surgical genital reassignment. In W. A. W. Walters & M. W. Ross (Eds.), Transsexualism and sex reassignment (pp. 103–112). Oxford: Oxford University Press.

    Google Scholar 

  • Meston, C. M., Heiman, J. R., Trapnell, P. D., & Paulhus, D. L. (1998). Socially desirable responding and sexuality self-reports. Journal of Sex Research, 35, 148–157.

    Article  Google Scholar 

  • Muirhead-Allwood, S. K., Royle, M. G., & Young, R. (1999, September). Sexuality and satisfaction with surgical results in male-to-female transsexuals. Poster session presented at the Harry Benjamin International Gender Dysphoria Association XVI Biennial Symposium, London.

  • Perovic, S. V., Stanojevic, D. S., & Djordjevic, M. L. J. (2000). Vaginoplasty in male transsexuals using penile skin and a urethral flap. BJU International, 86, 843–850.

    PubMed  Google Scholar 

  • Person, E., & Ovesey, L. (1974a). The transsexual syndrome in males. I. Primary transsexualism. American Journal of Psychotherapy, 28, 4–20.

    Google Scholar 

  • Person, E., & Ovesey, L. (1974b). The transsexual syndrome in males. II. Secondary transsexualism. American Journal of Psychotherapy, 28, 174–193.

    Google Scholar 

  • Pfäfflin, F. (1992). Regrets after sex reassignment surgery. Journal of Psychology and Human Sexuality, 5(4), 69–85.

    Google Scholar 

  • Pillard, R. C., & Bailey, J. M. (1995). A biological perspective on sexual orientation. Psychiatric Clinics of North America, 18, 71–84.

    PubMed  Google Scholar 

  • Pomeroy, W.B. (1969). Transsexualism and sexuality: Sexual behavior of pre- and postoperative male transsexuals. In R. Green & J. Money (Eds.), Transsexualism and sex reassignment (pp. 183–188). Baltimore: Johns Hopkins Press.

    Google Scholar 

  • Rakic, Z., Starcevic, V., Maric, J., & Kellin, K. (1996). The outcome of sex reassignment surgery in Belgrade: 32 patients of both sexes. Archives of Sexual Behavior, 25, 515–525.

    PubMed  Google Scholar 

  • Rehman, J., Lazer, S., Benet, A., Schaefer, L., & Melman, A. (1999). The reported sex and surgery satisfactions of 28 postoperative male-to-female transsexual patients. Archives of Sexual Behavior, 28, 71–89.

    PubMed  Google Scholar 

  • Rehman, J., & Melman, A. (1999). Formation of neoclitoris from glans penis by reduction glansplasty with preservation of neurovascular bundle in male-to-female gender surgery: Functional and cosmetic outcome. Journal of Urology, 161, 200–206.

    PubMed  Google Scholar 

  • Ross, M. W., & Need, J. A. (1989). Effects of adequacy of gender reassignment surgery on psychological adjustment: A follow-up of fourteen male-to-female patients. Archives of Sexual Behavior, 18, 145–153.

    PubMed  Google Scholar 

  • Rubin, S. O. (1993). Sex reassignment surgery male to female. Scandinavian Journal of Urology and Nephrology, 154 (Suppl.), 1–28.

    PubMed  Google Scholar 

  • Schroder, M., & Carroll, R. (1999). New women: Sexological outcomes of male-to-female gender reassignment surgery. Journal of Sex Education and Therapy, 24, 137–146.

    Google Scholar 

  • Sheskin, D. J. (2004). Handbook of parametric and nonparametric statistical procedures (3rd ed.). Boca Raton, FL: Chapman & Hall/CRC

    Google Scholar 

  • Sørensen, T., & Hertoft, P. (1980). Transsexualism as a nosological unity in men and women. Acta Psychiatrica Scandinavica, 61, 135–151.

    PubMed  Google Scholar 

  • Stein, M., Tiefer, L., & Melman, A. (1990). Followup observations of operated male-to-female transsexuals. Journal of Urology, 143, 1188–1192.

    PubMed  Google Scholar 

  • Stokes, J. P., Vanable, P., & McKirnan, D. J. (1997). Comparing gay and bisexual men on sexual behavior, condom use, and psychosocial variables related to HIV/AIDS. Archives of Sexual Behavior, 26, 383–397.

    PubMed  Google Scholar 

  • van Noort, D. E., & Nicolai, J.-P. (1993). Comparison of two methods of vagina construction in transsexuals. Plastic and Reconstructive Surgery, 91, 1308–1315.

    PubMed  Google Scholar 

  • Verschoor, A. M., & Poortinga, J. (1988). Psychosocial differences between Dutch male and female transsexuals. Archives of Sexual Behavior, 17, 173–178.

    PubMed  Google Scholar 

  • Wiederman, M. W. (2002). Validity in research. In M. W. Wiederman & B. E. Whitley (Eds.) Handbook for conducting research on human sexuality (pp. 25–50). Mahwah, NJ: Erlbaum.

    Google Scholar 

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Correspondence to Anne A. Lawrence M.D., Ph.D..

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Lawrence, A.A. Sexuality Before and After Male-to-Female Sex Reassignment Surgery. Arch Sex Behav 34, 147–166 (2005). https://doi.org/10.1007/s10508-005-1793-y

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