Gender Identity

Table of Contents:

1. What is gender identity?
2. Biological sex, gender and gender identity
3. Types of gender identity
4. What is gender confirmation surgery?
5. Indications
6. Surgery procedures
7. Side effects

What is gender identity?

According to the World Health Organization (WHO), gender identity is “the internal, individual experience of gender as each person experiences it, which may or may not correspond to the sex assigned at birth, including the personal experience of the body and other experiences of gender such as speech, dress or mannerisms”.

Gender identity refers to each person’s individual and internal way of living with their gender, which may be independent of the sex they are born with and their sexual orientation. It is a concept that is related to how we live and feel our body and how we reflect it in the public sphere.

In this sense, gender identity is independent of sexual orientation and includes the ways in which a person self-identifies and presents him or herself to others. On the other hand, it also includes the freedom to modify bodily appearance or function through social gender roles, medical, surgical or other techniques.

What is the relationship between biological sex, gender and gender identity?

Gender identity is related to the concept of gender, in the sense that gender is the social role assigned to a person based on his or her birth sex. A person may or may not identify with the gender assigned at birth. It is essential to differentiate these concepts so as not to confuse them.

• Biological sex: refers to the biological and physical characteristics traditionally used to assign gender at birth (external and internal genitalia, hormone levels, reproductive organs, etc.).
• Gender: is the sociocultural construct that determines the concept of woman, man and other non-binary or normative categories, which refers to the way society believes we should look, think and act as such.
• Gender identity: refers to the way each person identifies him/herself independently of his/her biological sex.

What types of gender identities are there?

Within gender identity, there are different types:

• Cisgender people: are those who identify with their sex and gender assigned at birth.
• Transgender people: people who do not identify with their gender assigned at birth or with their own sex. Here we can find: transsexuals, transvestites, queer, gender fluid, non-binary gender, transvestites, among others.
• Agender people: are people who do not identify with any gender.

In this sense, there are transgender people who, not feeling identified with their gender, request a sex change or reassignment. The treatment in these cases consists of gender reassignment or gender confirmation surgery.

What is gender confirmation surgery?

Gender confirmation surgery is an intervention that aims to achieve harmony between gender and sex, adapting the genitals of birth to the desired sex through reconstructive surgery and hormone treatments. This allows to obtain improvements in the psychological and social health of some transgender patients.

In which cases is it indicated?

It is indicated in transgender people who meet the following requirements:

• Being of legal age.
• To have psychological support to certify that it is a real process of transsexuality.
• To have a certificate of diagnosis of transsexuality, accredited by a psychiatrist.
• To have received hormonal treatment for 9 months, as indicated by an endocrinologist.
• Sign an informed consent for the procedure.

What procedures are included in gender confirmation surgery?

There are different techniques and procedures in gender confirmation surgery. On the one hand, there are surgeries for female transsexuality, which are used to modify the male genitalia and to change the physical features for more feminine ones. On the other hand, male transsexuality surgeries are used to acquire masculine physical features.

Surgeries for female transsexuality:

• Vaginoplasty to construct the vagina: includes orchicectomy and penectomy, vaginoplasty, vulvoplasty, clitoroplasty and labiaplasty.
• Breast and buttock augmentation.
• Complementary aesthetic medicine: facial feminization, body feminization and voice feminization.

Surgeries for male transsexuality:

• Metaidoioplasty
• Phalloplasty
• Complementary surgeries: removal of the uterus (hysterectomy) and vagina (vaginectomy), reconstruction of the urethra and incorporation of the testicles with a special prosthesis.
• Additional procedures: mastectomy to remove the breasts, liposuction and lipofilling to remove fat.

What side effects can this surgery have?

In surgeries for female transsexuality, some side effects may develop, such as the following:

• Bruising
• Infections
• Stenosis
• Scarring in the urethra
• Fistulas
• Necrosis
• Difficulties in sexual intercourse

In male transsexuality surgeries, the side effects that may appear are the following:

• Hematomas
• Infections
• Reduced sensitivity
• Urinary fistulas
• Scarring
• Lack of blood flow in penile tissue