| Description |
Transsexuality is as old as humanity itself, but this syndrome was first described by H. Benjamin in 1953. The current optimal solution is a combination of hormonal treatment and surgical correction to change the anatomical sex. In the Czech Republic, rules and conditions for official gender reassignment are set. This is permissible on the basis of assessment of the diagnosis and prognosis by the Expert Commission for the implementation of gender reassignment of transgender patients of the Ministry of Health of the Czech Republic. The number of pending applications is constantly growing (125 in 2018, with a predominance of applications (70) for conversion from women to men (F-M). The transformation of a woman into a man takes place in several stages. Operational gender reassignment is preceded by a period of so-called RLE (real life experience) and RLT (real life test), when a person makes a new experience and tests the correctness of their decision. At least a year of hormonal treatment with testosterone will cause menstruation to stop, muscle structure to thicken, hair and beard to grow, and voice to change. At the time of the gynecologist's visit, F-M was already performing in a male role. Surgical gender reassignment in anatomical women begins with breast ablation performed by a plastic surgeon. This is followed by a hysterectomy with an adnexectomy, possibly a colectectomy performed by a gynecologist. Any phalloplasty and scrotal replacements are performed by a plastic surgeon. Surgical correction techniques in terms of uterine removal with adnexa have evolved from abdominal (until 2000), vaginal (until 2004), laparoscopically assisted vaginal (until 2011) to total laparoscopic hysterectomy (TLH). TLH is a mini-invasive method of removing the uterus by a laparoscopic approach with extraction of the uterus vaginally using a special uterine manipulator and supplementing the operation on the adnexa. It is especially advantageous for transsexual women with a narrow vagina, it is associated with lower blood loss, shorter hospital stays and convalescence. Deviation from performing collectectomies is due to the complexity of surgical technique. The surgeon limits the risk of injury to the surrounding organs of the vagina, ureters, bladder, urethra and rectum. Severe and difficult-to-adjust bleeding from paravaginal vascular plexuses can occur. Only a few workplaces in the Czech Republic deal with gender reassignment. In Brno, in 1975, the related change of name and documents was successfully enforced. In the Czech Republic, removal of the uterus is a condition for official gender reassignment. Our workplace has been dealing with this issue since the 1980s. Gender reassignment is a long, complex and costly process. The expert commission must carefully consider to whom the permission lasting several years will be allowed. The share of transsexuals F-M and M-F in the population is relatively balanced. At first, women who wanted to be men predominated, then it seemed to be the other way around. In the last 5 years, the share of F-M has been growing again. In the Czech Republic, the procedures are fully covered by the health insurance company. In the gynecological surgical solution of F-M transsexualism, laparoscopic techniques, especially TLH, displaced procedures with an abdominal or vaginal approach. Colpectomy is limited by experience and workplace equipment.
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