How a Kerala trans woman’s death highlighted need for urgent revamp of sex reassignment surgery

Thiruvananthapuram, Aug 04: The tragic death of 28-year old trans-woman Ananya Kumari Alex who was found hanging in the bedroom of her apartment. She had underwent tremendous suffering after an unsuccessful sex reassignment surgery (SRS), which must serve as a wake-up call to our society.

Her fellow transgenders alleged that Anannyah was suffering from severe physical pain for some time after undergoing a sex reassignment surgery at a private hospital Thiruvananthapuram last year and complained of medical negligence against the doctor who conducted the procedure.

Healthcare providers have no guidelines on gender affirmative care and sex reassignment surgeries, says the transgender community.

The incident raises concerns about the lack of quality gender and trans affirmative healthcare in India. Trans people are more vulnerable to medical neglect and are also stigmatized even in primary healthcare settings, which impacts the quality of healthcare they receive.

The Kerala government has decided to make its hospitals more "transgender friendly" and also frame guidelines with regard to performing sex reassignment surgeries and prevent exploitation of the third gender in the private sector.

Health Minister Veena George on Tuesday announced these proposed initiatives during the state legislative assembly proceedings. She said presently there are no guidelines in place for dealing with the problems faced by transgenders.

Therefore, the health department would be constituting a committee to frame guidelines with regard to the sex reassignment surgeries that transgenders often undergo.

The guidelines would also ensure that transgenders are not exploited in the private sector. The minister also said that when transgender persons visit hospitals, there is always a confusion as to where they should be accommodated -- in the ward for men or women.

Starting with the issue of a dedicated ward for them, the department would be taking other steps to make hospitals here more "transgender friendly", she added. The proposed initiatives come in the wake of the death of noted trans activist Anannyah Kumari Alex, Kerala's first radio jockey from the third gender community.

What is gender reassignment surgery?
ender reassignment surgery, sometimes called sex reassignment surgery, is performed to transition individuals with gender dysphoria to their desired gender.

People with gender dysphoria often feel that they were born in the wrong gender. A biological male may identify more as a female and vice versa.

Surgery is typically the last step in the physical transition process, but it is not a decision to be made lightly.

Many healthcare providers require patients to be formally diagnosed with gender dysphoria and undergo counseling to determine if they are truly ready to surgically transition.

Patients usually undergo hormone therapy first. Hormones can suppress the secondary sex characteristics of the biological gender and make them appear more like their desired sex. For instance, women take androgens and start developing facial hair. Men take estrogens and anti-androgens to look more feminine.

Surgeons may also require that patients live as their desired gender for at least one year. A man might dress as a woman traditionally does in the culture. Many men change their names and refer to themselves with female pronouns. Women transitioning to men would do the reverse.

Surgical transition may include several procedures. Males transitioning to females have their testicles and penis removed. The prostate gland may or may not be removed as well. Tissue from the penis is used to construct a vagina and clitoris. Labia - the "lips" surrounding the vagina - can be made from scrotal skin. The urethra (the tube from which urine leaves the body) is shortened.

Many biological men also have facial feminization surgery to change the appearance of their lips, eyes, nose, or Adam's apple.

After surgery, patients use vaginal dilators to keep the new vagina open and flexible.

Surgery for females transitioning to males is more complicated and expensive. The breasts, ovaries, and uterus are removed and the vagina is closed. A penis and scrotum may be made from other tissue. In some cases, a penile implant is used. The urethra is extended so that the patient can urinate while standing.

Continued psychotherapy is recommended for most patients as they adjust to their new bodies and lifestyles.

Not all people with gender dysphoria have surgery. Some feel comfortable living as the opposite gender without medical intervention. Others find that hormone therapy is sufficient for their personal needs.