Factors Associated with Satisfaction or Regret Following Male-to-Female Sex Reassignment Surgery

Abstract

This study examined factors associated with satisfaction or regret following sex reassignment surgery (SRS) in 232 male-to-female transsexuals operated on between 1994 and 2000 by one surgeon using a consistent technique. Participants, all of whom were at least 1-year postoperative, completed a written questionnaire concerning their experiences and attitudes. Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery. Most indicators of transsexual typology, such as age at surgery, previous marriage or parenthood, and sexual orientation, were not significantly associated with subjective outcomes. Compliance with minimum eligibility requirements for SRS specified by the Harry Benjamin International Gender Dysphoria Association was not associated with more favorable subjective outcomes. The physical results of SRS may be more important than preoperative factors such as transsexual typology or compliance with established treatment regimens in predicting postoperative satisfaction or regret.

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

REFERENCES

  1. Abramowitz, S. I. (1986). Psychosocial outcomes of sex reassignment surgery. Journal of Consulting and Clinical Psychology, 54, 183–189.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  4. Blanchard, R. (1988). Nonhomosexual gender dysphoria. Journal of Sex Research, 24, 188–193.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  7. Blanchard, R., & Sheridan, P. M. (1992). Sibship size, sibling sex ratio, birth order, and parental age in homosexual and nonhomosexual gender dysphorics. Journal of Nervous and Mental Disease, 190, 40–47.

    Google Scholar 

  8. 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 

  9. 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.

    Google Scholar 

  10. Botzer, M., & Vehrs, B. (1995, October). Psychosocial and treatment factors contributing to favorable outcomes of gender reassignment. Paper presented at the XIV International Symposium on Gender Dysphoria, Kloster Irsee, Germany.

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

    Google Scholar 

  12. Carroll, R. A. (1999). Outcomes of treatment for gender dysphoria. Journal of Sex Education and Therapy, 24, 128–136.

    Google Scholar 

  13. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  14. Cohen-Kettenis, P. T., & Geooren, L. J. G. (1999). Transsexualism: A review of etiology, diagnosis and treatment. Journal of Psychosomatic Research, 46, 315–333.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  17. 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.

    Google Scholar 

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

    Google Scholar 

  19. Green, R., & Fleming, D. T. (1990). Transsexual surgery follow-up: Status in the 1990s. Annual Review of Sex Research, 1, 163–174.

    Google Scholar 

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

    Google Scholar 

  21. 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.

    Google Scholar 

  22. Kuiper, A. J., & Cohen-Kettenis, P. T. (1998). Gender role reversal among postoperative transsexuals. International Journal of Transgenderism, 2(3). Retrieved September 16, 2001, from http://www.symposion.com/ijt/ijtc0502.htm

  23. Kuiper, B., & Cohen-Kettenis, P. T. (1988). Sex reassignment surgery: A study of 141 Dutch transsexuals. Archives of Sexual Behavior, 17, 439–457.

    Google Scholar 

  24. Landén, M., Wålinder, J., Hambert, G., & Lundström, B. (1998). Factors predictive of regret in sex reassignment. Acta Psychiatrica Scandinavica, 97, 284–289.

    Google Scholar 

  25. Lawrence, A. (1997, June). Life after surgery: Questions and answers from the 1996 new women's conference. Paper presented at the Second International Congress on Sex and Gender Issues, Philadelphia, PA.

  26. Lawrence, A. (2001, November). Sex reassignment surgery without a one-year real-life experience: Still no regrets. Paper presented at the XVII Harry Benjamin International Symposium on Gender Dysphoria, Galveston, TX.

  27. Levine, S. B., Brown, G., Coleman, E., Cohen-Kettenis, P., Hage, J. J., Van Maasdam, J., et al. (1998). The standards of care for gender identity disorders, (5th version). Düsseldorf, Geormany, Symposion.

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  30. Lundström, B., Pauly, I., & Wålinder, J. (1984). Outcomes of sex reassignment surgery. Acta Psychiatrica Scandinavica, 70, 289–294.

    Google Scholar 

  31. Meyer, W., III, Bockting, W. O., Cohen-Kettenis, P., Coleman, E., DiCeglie, D, Devor H., et al. (2001). The standards of care for gender identity disorders, (6th version). Düsseldorf: Symposion.

    Google Scholar 

  32. Money, J., & Gaskin, R. J. (1970–1971) Sex reassignment. International Journal of Psychiatry, 9, 249–269.

    Google Scholar 

  33. Muirhead-Allwood, S. K. (1998). Questionnaire on results of gender reassignment surgery. Unpublished manuscript.

  34. Muirhead-Allwood, S. K., Royle, M. G., & Young, R. (1999a, August). Factor analysis of satisfaction with vaginal reconstructive surgery in male-to-female transsexuals. Poster session presented at the Harry Benjamin International Gender Dysphoria Association XVI Biennial Symposium, London.

  35. Muirhead-Allwood, S. K., Royle, M. G., & Young, R. (1999b, August). 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.

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

    Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  39. Pfäfflin, F., & Junge, A. (1998). Sex reassignment. Thirty years of international follow-up studies after sex reassignment surgery: A comprehensive review, 1961–1991 (R. B. Jacobson & A. B. Meier, Trans.). Retrieved September 16, 2001, from http://www.symposion.com/ijt/pfaefflin/1000.htm (Original work published 1992).

  40. 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.

    Google Scholar 

  41. 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.

    Google Scholar 

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

    Google Scholar 

  43. 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 

  44. Snaith, P., Tarsh, M. J., & Reid, R. (1993). Sex reassignment surgery: A study of 141 Dutch transsexuals. British Journal of Psychiatry, 162, 681–685.

    Google Scholar 

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

    Google Scholar 

  46. Wålinder, J., Lundström, B., & Thuwe, I. (1978). Prognostic factors in the assessment of male transsexuals for sex reassignment. British Journal of Psychiatry, 132, 16–20.

    Google Scholar 

  47. Walker, P. A., Berger, J. C., Green, R., Laub, D. A., Reynolds, C. L., & Wolman, L. (1990, January). Standards of care. Sonoma, CA: Harry Benjamin International Gender Dysphoria Association.

    Google Scholar 

  48. Walworth, J. R. (1997). Sex-reassignment surgery in male-to-female transsexuals: Client satisfaction in relation to selection criteria. In B. Bullough, V. L. Bullough, & J. Elias (Eds.), Gender blending (pp. 352–369). Amherst, NY: Prometheus Books.

    Google Scholar 

Download references

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lawrence, A.A. Factors Associated with Satisfaction or Regret Following Male-to-Female Sex Reassignment Surgery. Arch Sex Behav 32, 299–315 (2003). https://doi.org/10.1023/A:1024086814364

Download citation

  • transsexual
  • sex reassignment surgery
  • follow-up
  • typology
  • Standards of Care
  • autogynephilia