Sex reassignment surgery in France: analysis of the legal framework and current procedures and its consequences for transsexuals.
OBJECTIVE
In France there is no specific law that recognizes either sex reassignment surgery (SRS) or changes in civil status. This practice is based on a set of rules that have been devised by those practitioners in the disciplines involved. This study has been directed to evaluate the perceptions of French surgeons regarding their own activity in the area of the SRS with the implications that these perceptions may have on the management of patients and to contribute to a useful international collection of material on this difficult topic in terms both of report and interpretation.


METHODS
Personal interviews with 10 surgeons representing almost all of teams involved in transsexualism in France. The data were collected during 1998.


RESULTS
Surgeons alone cannot evaluate the motivation of each patient's request. Their decision whether or not to operate is made in consultation with both a psychiatrist and an endocrinologist. They never urge patients to undergo SRS. An assessment lasting at least two years before making a recommendation for surgery is routine. The rate of postoperative suicides is very low. Among surgeons, postoperative regrets are minimal (postoperative regrets by patients were not directly evaluated in the framework of this study). The diagnosis seems to be made with satisfactory reliability, but at the cost of a tedious process for the patient. As a consequence some decide to be operated on abroad. However not all are true transsexuals.


CONCLUSIONS
SRS represents a good example of the collaboration of certain disciplines as surgery, medicine, psychiatry and law to reaffirm the meaning that society gives to the status of the individual while protecting the respect of some unusual situations.
Meningaud
J P
JP
Department of Medical Ethics and Public Health, Necker University Hospital Paris, France.
Descamps
M A
MA
Herve
C
C
D002961:Civil Rights; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D014189:Transsexualism / Q000523:psychology / Q000601:surgery*