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Gender reassignment surgeries: When you're born with the wrong body

Abu Dhabi - Under the new law, if the sex of the individual is unclear, and if medical examinations indicate the person's physical features do not match with his or her characteristics, then he or she could be qualified to undergo a sex-change operation.

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In August, the UAE implemented changes in law governing healthcare and one of the new laws permitted sex-change operations for those who have gender dysphoria. 
This is the right step forward, explained UAE medical and healthcare experts. 
Under the new law, if the sex of the individual is unclear, and if medical examinations indicate the person's physical features do not match with his or her characteristics, then he or she could be qualified to undergo a sex-change operation. 
Dr Monika Chawla, reproductive endocrinologist and fertility specialist at Fakih IVF Fertility Centre spoke to Khaleej Times about gender dysphoria, and why it is crucial to raise awareness and overcome discrimination.
She said that neglecting the issue due to it being considered a taboo, could lead to depression and even suicide for those suffering with gender identity issues. 
"Gender dysphoria is a condition that happens when you are born feeling that your emotional, psychical and psychological identity is not the same as your biological identity." 
Those suffering from gender dysphoria often feel dissatisfaction, anxiety and restlessness, as well as discomfort within his or her body. The term is also referred to as gender identity disorder (GID), transgenderism or gender incongruence. 
"You feel completely opposite to your identity, you feel discomfort within your own skin and this greatly affects all your functions in life, from your emotions to your thoughts, to your work and personal life. 
"The first signs can appear at a young age. For example, a little boy may refuse to were a typical boy's clothing." 
She noted that although this behaviour is normal and will pass in time, in many cases it continues right into adulthood and the individual begins to face identity conflicts. 
"This can be a psycho-sexual problem, where it is just an emotional issue. But in many cases it is more than a psychological problem." 
Dr Pankaj Shrivastav, medical director of Conceive, gynaecology and fertility centre, said: "Gender dysphoria is a very unhappy situation in which the person thinks he or she is in the wrong body. The mind could be male or female, but the body that the mind is in could be just the opposite." 
"Unfortunately, people like this try to enact what their inner mind is telling them. For instance, a boy with gender dysphoria would behave in a very effeminate manner or dress in a manner inappropriate for his physical body." 
Dr Shrivastav pointed out that those suffering from gender dysphoria, also often suffer from the society. 
"This is an inherent condition. It is not something that the person has tried to become. For no fault of theirs, they suffer ridicule, are the butt of many jokes and their behaviour is mimicked and all this leads to them withdrawing from their families and society." 
Naser Al Riyami, Emirati psychologist and hypnotherapist, highlighted that it is not uncommon for patients dealing with gender identity to seek help. 
"Some patients often tell me: "I feel like a boy but I am a girl," or vice-versa, but some patients have a confusion between gender identity disorder and sexual identity disorder, which are two separate things." 
"Gender identity disorder is when the person is completely unhappy with his or her gender, whereas sexual identity disorder is when one is unhappy with the sexual preference." 
Nevertheless, he noted that patients often suffer from deeper issues. "A lot of times there is history of abuse, neglect and maltreatment and these need to be dealt with. 
"The individual often has a poor self-image. Patients often believe that all these negative feelings will magically disappear after surgery, but there are deeper issues. You don't magically grow to love yourself once your appearance changes." 
The Equality and Human Rights Commission conducted a survey of 10,000 people in 2012, which revealed that one per cent of the population in the survey was gender variant. 

What is gender dysphoria? Gender dysphoria is a condition that happens when you are born feeling that your emotional, psychical and psychological identity is not the same as your biological identity. Those suffering from gender dysphoria often feel dissatisfaction, anxiety and restlessness, as well as discomfort within his or her body. The term is also referred to as gender identity disorder (GID), transgenderism or gender incongruence

Gender dysphoria often caused inside mother's womb
There are often serious mismatches with hormones which may have been caused by various factors such as medications that may have been consumed by the mother during her pregnancy.
Unborn babies can also be exposed to hormones that are opposite to their physical gender.
Dr Monika highlighted that gender development is complex and there are many possible variations which can cause a mismatch between an individual's biological sex and their gender identity, thus making the exact cause of gender dysphoria unclear.
"The sex of the baby is identified through its characteristic features, and by looking at the genitalia. You don't perform chromosome testing when the baby is born to identify the gender."
Hormones that trigger development of biological sex may not always work sufficiently on the brain, genitals and reproductive organs causing an unbalance.
Other rare conditions can cause gender dysphoria, such as intersex conditions or ambiguous genitalia, which cause babies to be born with the genitalia of both sexes.
This is when parents are often recommended to wait until the child grows and chooses his or her own gender identity, prior to any surgical intervention.
Congenital adrenal hyperplasia (CAH), where a high level of male hormones are produced in a female foetus, causing the genitals to appear male in appearance, which means the baby may be thought to be biologically a male at birth, is also common.
"The person will grow up feeling a complete conflict that no one will understand because he looks like a male from the outside but is really a female on the inside," she said.
Adults with gender dysphoria can feel trapped inside a body that doesn't match their gender identity and are unable to conform societal expectations.
"They may have a strong desire to get rid of physical signs of their biological sex, such as facial hair or breasts.
"Men with gender dysphoria suffer more, whereas women who act and dress in a masculine fashion don't seem to face the same ridicule taunts," said Dr Pankaj.
"Several times these people start self-medicating themselves with hormones and there have even been instances of self-mutilation of genitalia - all because society and the medical world don't know how to react to them."
He said that it is crucial to raise awareness and shed light on the health issue.
"Only awareness can improve plight of these people."
jasmine@khaleejtimes.com