Revisión del estado actual de la cirugía de reasignación genital en pacientes con disforia de género enfocada en el contexto colombiano

Resumen

La disforia de género o transexualismo es una condición que comprende a las personas que padecen profundo malestar o rechazo hacia el sexo biológico por cuanto se identifican con el sexo opuesto. Por lo tanto, se asocia a disfunción biopsicosocial y compromiso severo de la calidad de vida. En Colombia se han producido notables avances de índole constitucional y legislativa en las dos últimas décadas, los cuales son discutidos en la presente revisión. En el tratamiento multidisciplinario de los pacientes transexuales, el último paso corresponde a la cirugía de reasignación genital. El propósito de esta revisión es investigar el estado actual de la cirugía de reasignación genital enfocada en el contexto nacional.

Abstract

Gender dysphoria or transsexualism is a condition that includes people who suffer from deep discomfort or rejection of biological sex because they identify with the opposite sex. Therefore, it is associated with biopsychosocial dysfunction and severe compromise of their quality of life. In Colombia there have been notable advances of a constitutional and legislative nature in the last two decades, which are discussed in the present review. In the multidisciplinary treatment of transgender patients, the last step corresponds to genital reassignment surgery. The purpose of this review is to investigate the current status of genital reassignment surgery within the national context.

Palabras Clave

disforia de género - cirugía de reasignación genital - transexualismo - legislación - calidad de vida - Colombia

Keywords

gender dysphoria - genital reassignment surgery - transsexualism - legislation - quality of life - Colombia

Financiación

Este artículo de revisión no contó con ningún tipo de financiación.

• Referencias

• 1 World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People - 7th Version. www.wpath.org . 2001:1–132
• 2 Meyer III W. , et al. The Harry Benjamin International Gender Dysphoria Association's standards of care for gender identity disorders, sixth version. World Prof Assoc Transgender Heal [online]. 2001
• 3 Bakker A, van Kesteren PJ, Gooren LJ, Bezemer PD. The prevalence of transsexualism in The Netherlands. Acta Psychiatr Scand 1993; 87 (04) 237-238
• 4 Silva Herrera JM, Chavarriaga Soto J, Feijoo Monroy S. , et al. Calidad de vida, función del tracto urinario y salud sexual en cirugía de reasignación de sexo hombre a mujer. Urol Colomb 2016; 25 (02) 81-87 . Doi: 10.1016/j.uroco.2015.12.003
• 5 Tosh J. Psychology and Gender Dysphoria: Feminist and Transgender Perspectives. 1st ed. New York: 2016
• 6 American Psychiatric Association. Gender Dysphoria. Dsm 2013; 5: 2
• 7 Atkinson SR, Russell D. Gender dysphoria. Aust Fam Physician 2015; 44 (11) 792-796
• 8 Zhou JN, Hofman MA, Gooren LJ, Swaab DF. A sex difference in the human brain and its relation to transsexuality. Nature 1995; 378 (6552): 68-70
• 9 Kruijver FP, Zhou JN, Pool CW, Hofman MA, Gooren LJ, Swaab DF. Male-to-female transsexuals have female neuron numbers in a limbic nucleus. J Clin Endocrinol Metab 2000; 85 (05) 2034-2041
• 10 Swaab DF, Chung WC, Kruijver FP, Hofman MA, Ishunina TA. Sexual differentiation of the human hypothalamus. Adv Exp Med Biol 2002; 511: 75-100 , discussion 100–105
• 11 Garcia-Falgueras A, Swaab DF. A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. Brain 2008; 131 (Pt 12): 3132-3146
• 12 Corte Constitucional. Sentencia T-622/14. http://www.corteconstitucional.gov.co/relatoria/2014/t-622-14.htm ; 2014
• 13 Corte Constitucional. Norma Que Regula El Servicio Militar Obligatorio . http://www.corteconstitucional.gov.co/relatoria/SENTENCIAS%20DE%20CONSTITUCIONALIDAD%20DE%20INTERES16.php ; 2016
• 14 Corte Constitucional. Tratamiento de Población Reclusa Que Pertenece a Minorias de Identidad Sexual . http://www.corteconstitucional.gov.co/relatoria/2011/t-062-11.htm ; 2011
• 15 Ministerio de Justicia y del Derecho. Decreto 1227. https://www.minjusticia.gov.co/Portals/0/Ministerio/decreto%20unico/%23%20decretos/1.%20DECRETO%202015-1227%20sexo%20c%C3%A9dula.pdf ; 2015
• 16 Amend B, Seibold J, Toomey P, Stenzl A, Sievert KD. Surgical reconstruction for male-to-female sex reassignment. Eur Urol 2013; 64 (01) 141-149 . Doi: 10.1016/j.eururo.2012.12.030
• 17 Selvaggi G, Bellringer J. Gender reassignment surgery: an overview. Nat Rev Urol 2011; 8 (05) 274-282 . Doi: 10.1038/nrurol.2011.46
• 18 De Cuypere G, Van Hemelrijck M, Michel A. , et al. Prevalence and demography of transsexualism in Belgium. Eur Psychiatry 2007; 22 (03) 137-141 . Doi: 10.1016/j.eurpsy.2006.10.002
• 19 Wroblewski P, Gustafsson J, Selvaggi G. Sex reassignment surgery for transsexuals. Curr Opin Endocrinol Diabetes Obes 2013; 20 (06) 570-574
• 20 Selvaggi G, Ceulemans P, De Cuypere G. , et al. Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals. Plast Reconstr Surg 2005; 116 (06) 135e-145e
• 21 Trombetta C, Liguori G, Benvenuto S. , et al. [Neo-urethroclitoroplasty according to Petrovic]. Urologia 2011; 78 (04) 267-273
• 22 Selvaggi G, Elander A. Penile reconstruction/formation. Curr Opin Urol 2008; 18 (06) 589-597
• 23 Monstrey S, Hoebeke P, Selvaggi G. , et al. Penile reconstruction: is the radial forearm flap really the standard technique?. Plast Reconstr Surg 2009; 124 (02) 510-518
• 24 Lumen N, Monstrey S, Goessaert AS, Oosterlinck W, Hoebeke P. Urethroplasty for strictures after phallic reconstruction: a single-institution experience. Eur Urol 2011; 60 (01) 150-158
• 25 Falcone M, Garaffa G, Gillo A, Dente D, Christopher AN, Ralph DJ. Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery. BJU Int 2018; 121 (01) 139-144
• 26 Plemons ED. It is as it does: genital form and function in sex reassignment surgery. J Med Humanit 2014; 35 (01) 37-55
• 27 Sigurjonsson H, Rinder J, Möllermark C, Farnebo F, Lundgren T. Male to female gender reassignment surgery: Surgical outcomes of consecutive patients during 14 years. JPRAS Open 2015; 6: 69-73
• 28 Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BP, Mullender MG. Aesthetic and Functional Outcomes of Neovaginoplasty Using Penile Skin in Male-to-Female Transsexuals. J Sex Med 2015; 12 (07) 1626-1634
• 29 Hess J, Neto R, Panic L, Rübben H, Senf W. Satisfaction with male-to-female gender reassignment surgery. Dtsch Arztebl Int 2014; 111 (47) 795-801
• 30 Eldh J. Construction of a neovagina with preservation of the glans penis as a clitoris in male transsexuals. Plast Reconstr Surg 1993; 91 (05) 895-900 , discussion 901–903
• 31 Wesser DR. A single stage operative technique for castration, vaginal construction and perineoplasty in transsexuals. Arch Sex Behav 1978; 7 (04) 309-323 . Doi: 10.1007/BF01542040
• 32 von Szalay L. [Construction of a neo-clitoris in male-to-female transsexuals]. Handchir Mikrochir Plast Chir 1990; 22 (05) 277-278
• 33 Fang RH, Chen CF, Ma S. A new method for clitoroplasty in male-to-female sex reassignment surgery. Plast Reconstr Surg 1992; 89 (04) 679-682 , discussion 683
• 34 Sigurjónsson H, Möllermark C, Rinder J, Farnebo F, Lundgren TK. Long-Term Sensitivity and Patient-Reported Functionality of the Neoclitoris After Gender Reassignment Surgery. J Sex Med 2017; 14 (02) 269-273
• 35 Khouri RK, Young VL, Casoli VM. Long-term results of total penile reconstruction with a prefabricated lateral arm free flap. J Urol 1998; 160 (02) 383-388
• 36 Bettocchi C, Ralph DJ, Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int 2005; 95 (01) 120-124
• 37 Kuhn A, Hiltebrand R, Birkhäuser M. Do transsexuals have micturition disorders?. Eur J Obstet Gynecol Reprod Biol 2007; 131 (02) 226-230
• 38 Morgan J. Trans* health: “diversity, not pathology”. Lancet Psychiatry 2015; 2 (02) 124-125 . Doi: 10.1016/S2215-0366(15)00022-X
• 39 Drescher J, Cohen-Kettenis PT, Reed GM. Gender incongruence of childhood in the ICD-11: controversies, proposal, and rationale. Lancet Psychiatry 2016; 3 (03) 297-304 . Doi: 10.1016/S2215-0366(15)00586-6
• 40 Robles R, Fresán A, Vega-Ramírez H. , et al. Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11. Lancet Psychiatry 2016; 3 (09) 850-859 . Doi: 10.1016/S2215-0366(16)30165-1
• 41 Mcneil J, Bailey L, Ellis S, Morton J, Regan M. Trans Mental Health Study 2012. 2012. https://www.gires.org.uk/wp-content/uploads/2014/08/trans_mh_study.pdf . Accessed November 25, 2017
• 42 Grant JM, Mottet LA, Justin Tanis J. with Jack Harrison Jody Herman DmL, Keisling M. Injustice at Every Turn. http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf . Accessed November 25, 2017
• 43 Heylens G, Verroken C, De Cock S, T'Sjoen G, De Cuypere G. Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with a gender identity disorder. J Sex Med 2014; 11 (01) 119-126
• 44 Mate-Kole C, Freschi M, Robin A. A controlled study of psychological and social change after surgical gender reassignment in selected male transsexuals. Br J Psychiatry 1990; 157: 261-264 http://www.ncbi.nlm.nih.gov/pubmed/2224377 AccessedOctober212017
• 45 Smith YL, Van Goozen SH, Kuiper AJ, Cohen-Kettenis PT. Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals. Psychol Med 2005; 35 (01) 89-99
• 46 de Vries AL, McGuire JK, Steensma TD, Wagenaar EC, Doreleijers TA, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics 2014; 134 (04) 696-704
• 47 Coleman E, Bockting W, Botzer M. , et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgenderism 2012; 13 (04) 165-232 . Doi: 10.1080/15532739.2011.700873