Few bodies consistently portray natural or unaltered forms. Instead, humans inhabit bodies imbued with sociocultural meanings about what is attractive, appropriate, functional, and presentable. As such, embodiment is always gendered. The social, extra-corporeal body is a central locus for expressing gender. Surgical body modifications represent inherently gendered technologies of the body. But psychomedical institutions subject people who seek gender-crossing surgeries to increased surveillance, managing and regulating cross-gender embodiment as disorderly. Using mixed research methods, this research systematically compared transgender and cisgender (non-transgender) people’s experiences before, during, and after surgical body modification. I conducted a content analysis of 445 threads on a message board for an online cisgender surgery community, an analysis of 15 international protocols for transgender-specific surgeries, and 40 in-depth interviews with cisgender and transgender people who had surgery. The content analysis of the online community revealed similar themes among cisgender and transgender surgery users. However, detailed protocols existed only for transgender consumers of surgery. Interview findings showed that transgender and cisgender people reported similar presurgical feelings toward their bodies, similar cosmetic and psychological motivations for surgery, and similar benefits of surgery. For both cisgender and transgender people, surgery enhanced the inner self through improving the outer gendered body. Despite these similar embodied experiences, having a cisgender gender status determined respondents’ abilities to pursue surgery autonomously and with institutional support. Ultimately, this research highlights inequalities that result from gender status and manifest in psychomedical institutions by identifying the psychosocial impacts of provider/consumer or doctor/patient interactions, relating gendered embodiment to regulatory systems of authority, and illuminating policy implications for clinical practice and legal classifications of sex and gender.

Den här studien handlar om olika diskurser kring genitala ingrepp på personer som upplever att de har en annan könsidentitet än den juridiska könstillhörigheten, och vill genomföra en juridisk könsändring. Syftet med uppsatsen var att genom analyser av dessa diskurser försöka förstå hur genitalierna är kopplade till den sociala konstruktionen av kön och genus. Intervjuer har gjorts med personer som finns med i utrednings- och beslutsprocess eller har verkställighetsfunktion som berör de genitala ingreppen. Det har inneburit psykiatriker, kirurger och jurister. Intervjuer har även gjorts med föreningsrepresentanter för transsexuella, före detta transsexuella och transpersoner. Flertalet inom professionen uttrycker att genitalierna har en avgörande betydelse för bestämmande av kön och genus. Även om de har en uppfattning om att könet ”sitter i huvudet” måste detta överensstämma med känslan för genitalierna. Det finns en skillnad i resonemanget för KtM (Kvinna-till-man-transsexuella) och MtK (Man-till-Kvinna-transsexuella). Penis ses som den mest avgörande könsmarkören och flertalet av de intervjuade inom professionen hade svårt att förstå att en person som vill behålla sin penis kan ha en könsidentitet som kvinna. Vaginan uttrycktes inte ha samma status som könsmarkör men livmoder och äggstockar och dess reproduktiva funktion uttrycktes nästan ha samma betydelse som könsmarkör som penis. De inom professionen hade därmed svårt att förstå hur en gravid person skulle kunna ha en könsidentitet som man.De som representerade transsexuella, före detta transsexuella och transpersoner uttryckte olika syn på kön och definition av kön. Det gavs både uttryck för att hela kroppen inklusive genitalierna skulle ha stor betydelse för kön men det gavs även uttryck för att kroppen och genitalierna inte i sig skulle ha betydelse för kön utan att ”könet i huvudet” var det viktigaste för bestämmande av kön. / The aim of this thesis was to, through the analyses of different discourses surrounding sex reassignment try to understand how the genitals are linked to the social construction of sex and gender. I have interviewed psychiatrists, surgeons and people dealing with the laws surrounding sex reassignment surgery. I also interviewed people from organizations who represent transgender persons, transsexuals and former transsexuals. Most of the professionals indicate in the interviews that the genitals have an essential meaning in the decision-making regarding sex and gender. Even if they have an idea that the gender is “in the head”, it has to match the feelings for the genitals. There is a difference between the reasoning for FtM (Female-to-male-transsexual) and MtF (Male-to-female-transsexual). The penis is seen as the most essential sex marker and most of the professionals that were interviewed had difficulties in understanding how a person who wanted to keep the penis could have a gender identity as a woman. The vagina did not have the same status as a sex marker but instead the reproductive function from the ovaries and the uterus had almost the same status as a sex marker as the penis. For this reason the professionals that where interviewed had difficulties in understanding that a pregnant person could have a gender identity as a man. People from organizations who represented transgender persons, transsexuals and former transsexuals had some differing views. One considered that the whole body including the genitals was important for the feeling about ones gender while the other person expressed that the gender “in the head” was more vital for the decision and feelings of sex and gender.

A presente dissertação tem o escopo analisar o transexualismo em seus aspectos históricos, culturais, científicos, médicos, jurídicos e bioéticos, em especial quanto à submissão à cirúrgica da transgenitalização, como manifestação do princípio da dignidade da pessoa humana, do direito de isonomina e do direito à saúde, garantias fundamentais previstas na Constituição Federal. O progresso da medicina permite, há décadas, a mudança de sexo, adequando a genitália do transexual ao seu sexo psicológico, inconciliáveis e antagônicos. Entretanto, o transexual se depara com a falta de dispositivo legal que regulamente o ato cirúrgico de mudança de sexo e a retificação do registro civil, adequando o nome e o sexo do transexual operado à nova situação. O percurso dos interessados na mudança de sexo é difícil, repleto de obstáculos de diversas ordens, onde muitas vezes, o judiciário representa a consolidação do sofrimento e da exclusão social. O exercício pleno da cidadania exige o reconhecimento do direito à redesignação sexual e retificação do nome e do sexo no registro civil, além do direito à família, especificamente, ao casamento e à filiação. O presente estudo tem como objetivo demonstrar que a cirurgia de transgenitalização, bem como a correspondente alteração do registro civil do transexual são formas de concretização de direitos fundamentais, do direito à saúde e meios de proteção à dignidade da pessoa humana. / This thesis has as its main objective to analyze transsexualism in its historical, cultural, scientific , medical, legal and bioethical aspect, especially regarding the performance of the Sex Reassignment Surgery (RSR) as a manifestation of the human dignity principle, the right to isonomy and the right to health, and to fundamental guarantees provided for in the Federal Constitution . Medical advances have made the Sex Reassignment Surgery (SRS) possible for decades, thus adapting the genitalia of the transsexual to his/her psychological gender, which is irreconcilable and antagonistic. However, the transsexual is faced with the lack of legal provisions to regulate sex change operations and to ratify civil registry records, adjusting the name and the gender of the operated transsexual to the new situation. The ones interested in sex change operations have a long way to go; they will have to overcome all sorts of obstacles, where quite often the judiciary is the consolidation of suffering and social exclusion. The full and effective exercise of citizenship requires a recognition of the right to the Sexual Reassignment Surgery (SRS) and to name and gender rectification in civil registries, besides the right to family, more specifically, the right to marriage and to affiliation. This study has as its main objective to demonstrate that the Sex Reassignment Surgery (SRS) as well as the corresponding modification of the transgender civil registry are embodiments of fundamental rights, and of health rights and they also are safeguards of human dignity.

Transexualismo é definido como o desejo de viver e ser aceito como pertencente ao sexo oposto. É usualmente acompanhado por sentimento de desconforto ou inadequação em relação ao sexo anatômico, associado a desejo de se transformar cirúrgica e hormonalmente para tornar o corpo o mais congruente possível com o sexo pretendido. Com essa alteração, surge ainda a necessidade de adequação jurídica da pessoa física por meio de processo cível para mudança do nome e do sexo jurídicos, adequando-se, assim, o status civil/social. O objetivo deste trabalho foi observar como os laudos psicológicos poderiam ou não colaborar nas decisões judiciais, de acordo com a análise de sentenças judiciais para mudança de prenome em transexuais masculinos e femininos, submetidos ou não a cirurgia de transgenitalização. Realizamos levantamento por amostragem, que inicialmente caracterizou as variáveis sociais e demográficas dessa população e, posteriormente, sistematizamos os dados encontrados. A população estudada, que pleiteia a mudança do registro civil, foi mapeada a partir de dados de sentenças e processos para mudança de prenome, traçando-se um perfil nacional segundo os critérios definidos pelo SUS. Buscamos a amostra nos quatro centros credenciados para o processo transexualizador (Portaria no 457, de 19 de agosto de 2008). Encontramos 55 sujeitos que entraram com processo de mudança de prenome e/ou prenome e sexo, matriculados/acompanhados nos referidos hospitais. Observamos uma proporção de de 9:2 entre homem para mulher (MTF) e mulher para homem (FTM), semelhante ao que se relata na literatura internacional (4:1). Quanto às sentenças, apenas 5,50% (três) dos processos foram indeferidos, correspondentes a sujeitos do sexo biologico masculino que ainda não haviam sido submetidos à cirurgia. Observamos uma associação entre cirurgia e deferimento da mudança de prenome (p = 0,001). Em apenas 10,90% (seis) sentenças analisadas, havia menção ao laudo psicológico, que, portanto, foi omitido nas demais, 82,10% (49). Quando presentes, os laudos não foram elaborados por profissionais dos centros credenciados para o processo transexualizador, descaracterizandose como objetos deste estudo. Os resultados sugerem que os laudos psicológicos não influem na decisão judicial nos processos de mudança de prenome entre pacientes transexuais e que a realização prévia da cirurgia de readequação sexual está associada a um maior índice de êxito no pleito dos pacientes / Transsexualism is defined as a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort (or inappropriateness) with one\'s anatomic sex, and a wish to have surgical and hormonal treatment to make one\'s body as congruent as possible with one\'s preferred sex. This change triggers the need for legal adjustment of the individual through civil proceedings for change the legal name and sex/gender. This study\'s objective was to observe whether psychological appraisals may or may not influence the judicial decision, by the analysis of the judges\' sentences for the change of forename in transsexual men and women, whether or not they underwent reassignment surgery. We performed a sample study where we initially characterized the social and demographic variables of this population, and then we systematized the data found. The population studied, who presented a plea to change theirs forename at the civil register, was mapped from data of trial sentences. From this data we present a national profile of patients according to criteria for the processo transexualizador, the treatment as laid down by the Brazilian National Health Care System. We seeked our sample at the four centers licensed for the \"processo transexualizador\" (Ordinance 457 of the Brazilian Health Care Ministry, dated August 19, 2008). We have found 55 subjects which entered pleas for changes of forename and / or pleas for changes of forename and sex. This subjects should be registered patients or be monitored at these hospitals. We found a proportion of 9:2 male to female (MTF) and female to male (FTM) patients, this finding is similar to reports from the international literature (4:1). When we analyzed for outcome of the judgments, we found that 5.50% (three) cases were rejected. This three cases belonged to biological male gender and had not yet been submitted to surgery. We observed a association between surgery and plea for first name\'s change (p = 0.001). Only 10.90% (six) of the sentences analyzed mentioned the psychological appraisal, which was omitted in 82.10% (49) of the sentences. We also found that when the psychological appraisals were present they were not issued by professionals working at licensed centers, therefore these did not meet the criteria for the study. Our findings suggest that the psychological appraisals do not affect the judicial decision over the pleas for forename changes among transsexual patients and the prior execution of the reassignment surgery is associated to a higher success rate in the patients\' litigations

Transexualismo é definido como o desejo de viver e ser aceito como pertencente ao sexo oposto. É usualmente acompanhado por sentimento de desconforto ou inadequação em relação ao sexo anatômico, associado a desejo de se transformar cirúrgica e hormonalmente para tornar o corpo o mais congruente possível com o sexo pretendido. Com essa alteração, surge ainda a necessidade de adequação jurídica da pessoa física por meio de processo cível para mudança do nome e do sexo jurídicos, adequando-se, assim, o status civil/social. O objetivo deste trabalho foi observar como os laudos psicológicos poderiam ou não colaborar nas decisões judiciais, de acordo com a análise de sentenças judiciais para mudança de prenome em transexuais masculinos e femininos, submetidos ou não a cirurgia de transgenitalização. Realizamos levantamento por amostragem, que inicialmente caracterizou as variáveis sociais e demográficas dessa população e, posteriormente, sistematizamos os dados encontrados. A população estudada, que pleiteia a mudança do registro civil, foi mapeada a partir de dados de sentenças e processos para mudança de prenome, traçando-se um perfil nacional segundo os critérios definidos pelo SUS. Buscamos a amostra nos quatro centros credenciados para o processo transexualizador (Portaria no 457, de 19 de agosto de 2008). Encontramos 55 sujeitos que entraram com processo de mudança de prenome e/ou prenome e sexo, matriculados/acompanhados nos referidos hospitais. Observamos uma proporção de de 9:2 entre homem para mulher (MTF) e mulher para homem (FTM), semelhante ao que se relata na literatura internacional (4:1). Quanto às sentenças, apenas 5,50% (três) dos processos foram indeferidos, correspondentes a sujeitos do sexo biologico masculino que ainda não haviam sido submetidos à cirurgia. Observamos uma associação entre cirurgia e deferimento da mudança de prenome (p = 0,001). Em apenas 10,90% (seis) sentenças analisadas, havia menção ao laudo psicológico, que, portanto, foi omitido nas demais, 82,10% (49). Quando presentes, os laudos não foram elaborados por profissionais dos centros credenciados para o processo transexualizador, descaracterizandose como objetos deste estudo. Os resultados sugerem que os laudos psicológicos não influem na decisão judicial nos processos de mudança de prenome entre pacientes transexuais e que a realização prévia da cirurgia de readequação sexual está associada a um maior índice de êxito no pleito dos pacientes / Transsexualism is defined as a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort (or inappropriateness) with one\'s anatomic sex, and a wish to have surgical and hormonal treatment to make one\'s body as congruent as possible with one\'s preferred sex. This change triggers the need for legal adjustment of the individual through civil proceedings for change the legal name and sex/gender. This study\'s objective was to observe whether psychological appraisals may or may not influence the judicial decision, by the analysis of the judges\' sentences for the change of forename in transsexual men and women, whether or not they underwent reassignment surgery. We performed a sample study where we initially characterized the social and demographic variables of this population, and then we systematized the data found. The population studied, who presented a plea to change theirs forename at the civil register, was mapped from data of trial sentences. From this data we present a national profile of patients according to criteria for the processo transexualizador, the treatment as laid down by the Brazilian National Health Care System. We seeked our sample at the four centers licensed for the \"processo transexualizador\" (Ordinance 457 of the Brazilian Health Care Ministry, dated August 19, 2008). We have found 55 subjects which entered pleas for changes of forename and / or pleas for changes of forename and sex. This subjects should be registered patients or be monitored at these hospitals. We found a proportion of 9:2 male to female (MTF) and female to male (FTM) patients, this finding is similar to reports from the international literature (4:1). When we analyzed for outcome of the judgments, we found that 5.50% (three) cases were rejected. This three cases belonged to biological male gender and had not yet been submitted to surgery. We observed a association between surgery and plea for first name\'s change (p = 0.001). Only 10.90% (six) of the sentences analyzed mentioned the psychological appraisal, which was omitted in 82.10% (49) of the sentences. We also found that when the psychological appraisals were present they were not issued by professionals working at licensed centers, therefore these did not meet the criteria for the study. Our findings suggest that the psychological appraisals do not affect the judicial decision over the pleas for forename changes among transsexual patients and the prior execution of the reassignment surgery is associated to a higher success rate in the patients\' litigations