History, Societal Attitudes, and Contexts

Abstract

Gender confirmation surgery as we know it today originated in western Europe in the early twentieth century. This chapter introduces the social context and the scientific theories and surgical experience that brought forth “transsexualism” and ultimately led to the contemporary efforts to alleviate the stress and anxiety that can often accompany a given individual’s disconnect between their gender identity and their body. Today, this condition may be called gender dysphoria (DSM-5) or gender incongruence (ICD-11), depending on what system of nomenlature is operative in one’s healthcare delivery/payment system. In any case, people who require gender confirmation surgery are often judged according to criteria established by persons who cannot imagine what it would feel like to experience this dissonance. As we enter the twenty-first century, “trans” people have become much more articulate and better equipped to self-advocate, and the surgeon’s role has become even more challenging and yet rewarding as the surgical results improve and the medical necessity of treatment becomes more self-evident.