A sex change operation, the so-called SRS (Sex Reassignment Surgery) is a series of medical procedures dedicated to changing not only the appearance of transsexual person's genitals, but their entire life. In the past, finding a clinic performing this type of surgeries was very difficult, however nowadays, there are a few internationally renown specialists in Poland who carry out SRS procedures. According to world statistics, transsexualism is diagnosed in one in 30 thousand genetically male people and one in 100 thousand genetically female people. In Poland, as well as other Central European countries, there are 4 to 7 times more trans men than trans women. However in other parts of the world the number of trans women is on average 3 to 4 times larger than the number of trans men.
Today, only patients with diagnosed transsexualism or hermaphroditismm (intersexualism) can undergo a gender changing procedure in Poland. By the gender changing procedure we understand a series of operations leading to the "birth" of a new person - having different sex, looks and personal data. Surgical intervention occurs at the last stage of this long process of changing a transsexual person' life. Upon the completion of all the procedures, the person will no longer be legally considered transsexual, but a representative of the opposite sex. Gender change can only be performed on adult people, although some doctors accept starting the hormone replacement therapy with 17 year old patients.Transsexual people start the process of sex alteration by seeing specialists. They can undergo the required tests on their own or ask a sexologist for referrals. Doctors decides on the course of proceedings based on their interviews with the patients as well as on the results of psychological tests. Other necessary lab test include EEG, CT scanning as well as blood and hormonal tests. One of the essential elements in the process is the psychologists opinion and sometimes the patients are referred to a psychiatrist. Upon reaching a diagnosis, a specialist can prescribe hormone replacement therapy. During this process the trans man takes testosterone hormone and trans woman takes estrogens and antiandrogens preventing the production of testosterone. Sometimes a patient is referred to an endocrinologist, who will select the appropriate hormone doses for individual patients. In this period, trans men can undergo their first surgery - mastectomy, i.e. breast tissue removal.
The next step is to make an application to the court for a change in gender. This action is indispensable, otherwise, the operation on genitals is a crime in the light of the Polish law (as you deprive a citizen from their reproductive abilities). The court summons parents of the transsexual person and the proceedings last approximately half a year if there are no complications such as objection on the part of the family. After the final judgement comes into force, the person can replace their documents, birth certificate is amended, a new id card is issued, new passport and driving license and other documents such as vehicle registration papers, etc. The last stage of the process is the SRS (Sex Reassignment Surgery). The aim of the treatment is to perform a series of operations altering patient's genitals.
SRS - Sex reassignment surgery
SRS are very difficult medical procedures requiring general anaesthesia or epidural and a long convalescence period.. When the SRS is performed on a trans woman the operation consists of forming a vagina from the scrotum and penile skin. It lasts about 7 hours. The procedure includes the surgical removal of testicles as well as almost entire vasa deferentia. The surgeon also removes corpus spongiosum and scrotum during the operation. Then, s/he uses the top part of the glans to form a clitoris, fully supplied with nerve endings. This procedure allows the patient to achieve sexual satisfaction during an intercourse (clitoral orgasm). Vagina is produced from the foreskin and penile skin - its depth depends on the size of penis. If there is not enough material, the doctor obtains a piece of intestine. The membranous part becomes reduced by diminishing its circumference with the use of sutures (it is not surgically eliminated due to its increased blood flow, which can significantly affect sexual experiences). Then the surgeon sutures the new vagina to peritoneum - there is only a small scar on lower abdomen left after the surgery. It is important not to remove the prostate gland as the lack of it could cause the incontinence problem. After the operation the patient stays at the hospital for several days. One must wear a catheter for about a week, and after approximately 4 days you can take a short walk. Some women also decide to undergo the FFS, i.e. facial feminization surgeries. The procedure may include nose reduction, scalp advance or grinding down the superorbital arches.
In the event of trans man sex reassignment surgery is divided into stages (I, II, and III). After procedure I, i.e. mastectomy, patients undergo the entire surgical removal of uterus – both cervix and corpus uteri. Fallopian tubes as well as ovaries are also removed and this surgery is called panhysterectomy (radical hysteroctomy). There are two methods of performing the operation: traditionally through abdominal walls, or laparoscopically. Should the former one be selected, the surgeon makes a 7 cm horizontal incision in abdominal walls, and in laparoscopy (Total Laparoscopic Hysterectomy, TLH) they make 2-3 entry spots for leading the laser fibre, a source of light and gas. The removed organs are then taken out through the openings in the abdominal wall.
The last and at the same time most complicated surgery for trans men is the neophalloplasty i.e. the production of scrotum and penis. The procedure is performed in epidural (the patient is administered anaesthesia into the backbone). Penis is most frequently formed from the subcutaneous tissue obtained from the groin together with the femoral artery. The operating surgeon tries to obtain the artery together with the nerve (thus allowing the patients to experience penile sensation). The length of the penis depends on the length of the artery and its general condition. The thickness depends on the fat tissue of the patient. After the procedure a patient cannot straighten his body for approximately 2 weeks, and must sleep on the back with the legs tucked under. The sutures are removed after 2-3 weeks. After the wounds have healed a silicone prosthesis is placed in the artificially produced penis. A patient can also obtain a hydraulic penile prosthesis, however the procedure is extremely expensive as this type of prosthesis can even cost a few hundred thousand zlotys.
Sex reassignment in Poland – what is the cost?
In Poland SRS operations are much cheaper than abroad. For instance, on the British Isles, the treatment co-funded by the NHS costs approximately £10000 (55 thousand zlotys). Dr. A. Sankowski's Plastic Surgery Clinic in Warsaw offers an operation involving the recontstruction of scrotum from the labia minora and majora. The cost of the procedure starts at 7 thousand zlotys. The patients of this centre can also undergo the female-to-male sex reassignment surgery - the cost of the operation starts with 20 thousand zlotys. The Klinika Chirurgii Plastycznej, Medycyny Estetycznej i Flebologii Solumed in Poznań offers the female-to-male gender correction procedure for the cost of 32.5 thousand zlotys. The male-to-female operation costs 27 thousand zlotys.
The medical team of the Medical University in Gdańsk can boast the most extensive professional experience in performing male-to-female procedures. The SRS operations are performed by Prof. Kazimierz Krajka, M. D., PhD, highly recommended on the transseksualizm.pl forum. Patients determined to have the procedure performed by Prof. Krajka must be aware that he only accepts cases with referrals from Dr Stanisław Dulka, a sexologist from Warsaw. Male-to-female SRS treatment costs approximately 14 thousand zlotys at the clinic. The Barlicki hospital in Łódź can present some impressive achievements in reference to genital reassignment surgeries. The operations are performed by Dr Bogusław Antoszewski, M. D., PhD, the head of the Plastic Surgery Clinic at the Hospital. The medical team of the clinic performs a complete sex change of a transgendered person, starting with the removal of Adam's apple and finishing on the phallic reconstruction. The cost of the sex change operation is 50 thousand zlotys.
Prices of SRS in clinics outside Poland
According to data presented on surgeryencyclopedia.com, the operation in the USA on average costs from $7,000 to $24,000 and the female-to-male sex reassignment can even reach the price of $50,000. The costs are lower in the south of the North American continent. Dr Marci L. Bowers from The San Mateo Surgery Center (Trinidad) performs the male-to-female surgery at $23,000, i.e. approx. 76.5 thousand zlotys. The orchiectomy procedure (removal of testicles and spermatic cord) costs about $4.300, and a trans woman must pay around $2,500 to undergo a skin graft necessary to form the vagina properly.
Thailand is much cheaper. It is at present the world leader of sex reassignment surgeries. Patients from all over the world flock to Thai surgeons. The reason are not only the low prices, which really are considerably lower than in the USA or Great Britain, but also the professionalism of doctors specialized in SRS. According to the transgendersurgerythailand.com metoidioplasty (a surgery transforming the clitoris into a small penis) costs approximately $10,450 at Thai clinics. Vaginoplasty surgery costs $11,000. The price includes a procedure under general anaesthesia and 18 days at the clinic. Foreign medical tourists who will decide on a procedure performed by Dr Suporn Watanyusakul, the head of the Suporn Clinic in Chonburi will need to pay an equivalent of circa 45 thousand zlotys. The cost of male to female sex reassignment surgery at the Destination Beauty clinic in Bangkok starts from THB 240,000, or about 25.6 thousand zlotys. Patients who wish to surgically reduce the size of their Adam's apple will pay THB 24,000, which is the equivalent of 2.6 thousand zlotys, and the voice pitch altering surgery will cost THB 90,000 (approx. 9.6 thousand zlotys). Dr Rodchareon Pichet from the Bangkok Plastic Surgery Clinic performs vaginoplasty for the fee of $8,500.
In response to the growing needs of patients more and more surgeons gain the necessary knowledge and skills to be able to perform sex change operations. The fact that the University of Illinois in Chicago has been covering sex reassignment surgeries of its students since the fall of 2013 (source: dziennikzwiazkowy.com) signifies the rapid change in the society's awareness of the SRS procedures. There is more evidence in Great Britain: the number of SRS tripled ever since the procedure has been funded by the NHS (since the year 2000). Despite these facts the demand for surgeries is still greater than the possible supply. Thus transsexuals, who do not want to wait or, for some reason, cannot use the NHS opportunity for covered operations, leave to undergo the procedure abroad. A similar tendency can be observed in the countries where the cost of SRS is extremely high - such as the USA, Germany and Sweden. More and more patients from these places come to Poland enjoying the low prices and the expertise of our surgeons. As the sex reassignment surgery takes quite a considerable amount of time, they spend a long holiday with us and then return to their home countries as completely different people.
Comments (1) for entry Sex reassignment surgeries in Poland
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