Sexual and Physical Health After Sex Reassignment Surgery

Abstract

A long-term follow-up study of 55 transsexual patients (32 male-to-female and 23 female-to-male) post-sex reassignment surgery (SRS) was carried out to evaluate sexual and general health outcome. Relatively few and minor morbidities were observed in our group of patients, and they were mostly reversible with appropriate treatment. A trend toward more general health problems in male-to-females was seen, possibly explained by older age and smoking habits. Although all male-to-females, treated with estrogens continuously, had total testosterone levels within the normal female range because of estrogen effects on sex hormone binding globulin, only 32.1% reached normal free testosterone levels. After SRS, the transsexual person's expectations were met at an emotional and social level, but less so at the physical and sexual level even though a large number of transsexuals (80%) reported improvement of their sexuality. The female-to-males masturbated significantly more frequently than the male-to-females, and a trend to more sexual satisfaction, more sexual excitement, and more easily reaching orgasm was seen in the female-to-male group. The majority of participants reported a change in orgasmic feeling, toward more powerful and shorter for female-to-males and more intense, smoother, and longer in male-to-females. Over two-thirds of male-to-females reported the secretion of a vaginal fluid during sexual excitation, originating from the Cowper's glands, left in place during surgery. In female-to-males with erection prosthesis, sexual expectations were more realized (compared to those without), but pain during intercourse was more often reported.

This is a preview of subscription content, log in to check access.

References

  1. Asscheman, H., & Gooren, L. (1992). Hormone treatment in transsexuals. Journal of Psychology and Human Sexuality, 5, 39–54.

    Google Scholar 

  2. Asscheman, H., Gooren, L., & Eklund, P. (1989). Mortality and morbidity in transsexual patients with cross-gender hormone treatment. Metabolism, 38, 869–873.

    PubMed  ISI  Article  Google Scholar 

  3. Blanchard, R., Legault, S., & Lindsay, W. (1987). Vaginoplasty outcome in male-to-female transsexuals. Journal of Sex and Marital Therapy, 13, 256–276.

    Google Scholar 

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

    Google Scholar 

  5. 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  ISI  Google Scholar 

  6. Chivers, M. L., & Bailey, J. M. (2000). Sexual orientation of female-to-male transsexuals: A comparison of homosexual and nonhomosexual types. Archives of Sexual Behavior, 29, 259–278.

    PubMed  ISI  Article  Google Scholar 

  7. Coleman, E., Bockting, W. O., & Gooren, L. (1993). Homosexual and bisexual identity in sex-reassigned female-to-male transsexuals. Archives of Sexual Behavior, 22, 37–50.

    PubMed  ISI  Article  Google Scholar 

  8. Daskalos, C. (1998). Changes in the sexual orientation of six heterosexual male-to-female transsexuals. Archives of Sexual Behavior, 27, 605–614.

    PubMed  ISI  Article  Google Scholar 

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

    PubMed  Google Scholar 

  10. Deslypere, J. P., Kaufman, J. M., Vermeulen, T., Vogelaers, D., Vandalen, J. L., & Vermeulen, A. (1987). Influence of age on pulsatile luteinizing hormone release and responsiveness of the gonadotrophs to sex hormone feedback in men. Journal of Clinical Endocrinology and Metabolism, 64, 68–73.

    PubMed  ISI  Article  Google Scholar 

  11. 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  ISI  Article  Google Scholar 

  12. Eicher, W., Schmitt, B., & Berger, C. M. (1991). Transfomationsoperation bei Mann-zu-Frau-Transsexuellen. Darstellung der Methode und Nachuntersuchung von 50 Operierten. Zeitschrift für Sexualforschung, 4, 119–132.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  15. Hoebeke, P., De Cuypere, G., Ceulemans, P., & Monstrey, S. (2003). Obtaining rigidity in total phalloplasty: Experience with 35 patients. Journal of Urology, 169, 221–223.

    PubMed  ISI  Google Scholar 

  16. Köckott, G., & Fahrner, E. M. (1988). Male-to-female and female-to-male transsexuals: A comparison. Archives of Sexual Behavior, 17, 539–546.

    PubMed  Google Scholar 

  17. Kuiper, A. J. (1991). Transseksualiteit: Evaluatie van de geslachtsaanpassende behandeling [Transsexualism: An evaluation of sex reassignment]. Unpublished doctoral dissertation, Utrecht, The Netherlands.

  18. Laughlin, G. A., Barrett-Connor, E., Kritz-Silverstein, D., & von Muhlen, D. (2000). Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: The Rancho Bernardo Study. Journal of Clinical Endocrinology and Metabolism, 85, 645–651.

    PubMed  ISI  Google Scholar 

  19. 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  ISI  Google Scholar 

  20. 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  ISI  Google Scholar 

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

    PubMed  ISI  Article  Google Scholar 

  22. Lindemalm, G., Korlin, 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  ISI  Article  Google Scholar 

  23. Lindgren, T. W., & Pauly, I. B. (1975). A Body Image Scale for evaluating transsexuals. Archives of Sexual Behavior, 4, 639–656.

    PubMed  ISI  Article  Google Scholar 

  24. Meyer, W., Bockting, W. O., Cohen-Kettenis, P., Coleman, E., DiCeglie, D., Devor, H., et al. (2001). The Harry Benjamin Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, Sixth Version. Journal of Psychology and Human Sexuality, 13(1), 1–30.

    Google Scholar 

  25. Monstrey, S., Hoebeke, P., Dhont, M., De Cuypere, G., Rubens, R., Moerman, M., et al. (2001). Surgical therapy in transsexual patients: A multi-disciplinary approach. Acta Chirurgica Belgica, 101, 200–209.

    PubMed  ISI  Google Scholar 

  26. Mooradian, A., Morley, J., & Korenman, S. (1987). Biological actions of androgens. Endocrine Reviews, 8, 1–28.

    PubMed  ISI  Article  Google Scholar 

  27. Moore, E., Wisniewski, A., & Dobs, A. (2003). Endocrine treatment of transsexual people: A review of treatment regimens, outcomes, and adverse effects. Journal of Clinical Endocrinology and Metabolism, 88, 3467–3473.

    PubMed  ISI  Article  Google Scholar 

  28. Pfäfflin, F., & Junge, A. (1990). Nachuntersuchung von 85 operierten Transsexuellen. Zeitschrift für Sexualforschung, 3, 331–348.

    Google Scholar 

  29. Pfäfflin, F., & Junge, A. (1998). Sex reassignment. Thirty years of international follow-up studies after sex reassignment surgery: A comprehensive review, 1961–1991 (English ed.). Retrieved from http://www.symposion.com/ijt.pfaefflin/1000.htm

  30. Prior, J., Vigna, Y., & Watson, D. (1989). Spironolactone with physiological female steroids for presurgical therapy of male-to-female transsexualism. Archives of Sexual Behavior, 18, 49–57.

    PubMed  ISI  Article  Google Scholar 

  31. Raeside, J., Christie, H., & Renaud, R. (1999). Metabolism of oestrone and oestradiol-17beta to conjugated steroids by the accessory sex glands of the male pig. Journal of Endocrinology, 163, 49–53.

    PubMed  ISI  Article  Google Scholar 

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

    PubMed  ISI  Article  Google Scholar 

  33. Smith, Y. S. L. (2002). Sex reassignment: Predictors and outcomes of treatment for transsexuals. Unpublished doctoral dissertation, University of Utrecht, The Netherlands.

  34. Sorensen, T. (1981a). A follow-up study of operated transsexual males. Acta Psychiatrica Scandinavica, 63, 486–503.

    ISI  Google Scholar 

  35. Sorensen, T. (1981b). A follow-up study of operated transsexual females. Acta Psychiatrica Scandinavica, 64, 50–64.

    ISI  Google Scholar 

  36. Steiner, B. W., & Bernstein, S. M. (1981). Female-to-male transsexuals and their partners. Canadian Journal of Psychiatry, 26, 178–182.

    ISI  Google Scholar 

  37. T'Sjoen, G., Rubens, R., De Sutter, P., & Gooren, L. (2004). Author's response: The endocrine care of transsexual people. Journal of Clinical Endocrinology and Metabolism, 89, 1014–1015.

    PubMed  ISI  Article  Google Scholar 

  38. van Kesteren, P., Asscheman, H., Megens, J., & Gooren, L. (1997). Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clinical Endocrinology, 47, 337–342.

    PubMed  Article  Google Scholar 

  39. Vermeulen, A., Verdonck, L., & Kaufman, J. M.(1999). A critical evaluation of simple methods for the estimation of free testosterone in serum. Journal of Clinical Endocrinology and Metabolism, 84, 3666–3672.

    PubMed  ISI  Article  Google Scholar 

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

    PubMed  ISI  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Griet De Cuypere.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

De Cuypere, G., TSjoen, G., Beerten, R. et al. Sexual and Physical Health After Sex Reassignment Surgery. Arch Sex Behav 34, 679–690 (2005). https://doi.org/10.1007/s10508-005-7926-5

Download citation

Key Words

  • transsexualism
  • gender identity disorder
  • sexual functioning
  • orgasm
  • sex reassignment surgery