Dispute puts first sex change on hold

URAWA, Saitama Pref. (Kyodo) Saitama Medical College has decided to postpone Japan's first sex-change operation following news reports about the facility's unauthorized womb-ovary removal in 1993, college officials said.

The college, located north of Tokyo, had planned to conduct the surgery Friday as the first stage in a sex change that would take about six months to complete.

According to news reports Sunday, in October 1993 the college removed the womb and ovaries from a woman in her 30s who wanted a sex change, without approval from the facility's ethics committee.

The officials said an in-house check has found that the 1993 operation was not to alter the woman's gender but to treat endometriosis.

But the planned operation must be postponed to give the school time to explain the outcome to its ethics committee and faculty, the officials said.

In May, the college's ethics committee gave approval for a 30-year-old woman with transsexualism, a gender-identity disorder, in north-eastern Japan to undergo a sex change on condition that complete mental support measures be provided afterward.

The Japanese Society of Psychiatry and Neurology said last year that sex-change operations should be permitted under certain conditions, including that the patient undergo psychoanalysis and hormone therapy following the procedure.

Some 2,200 to 7,000 people in Japan want to live as a member of the opposite sex, according to one estimate.

copyright ｩ1998 The Japan Times

(The Japan Times, Sept. 7, 1998, page2)

Unapproved sex change revealed

Woman sought switch but surgery was to halt pain: doctors

URAWA, Saitama Pref. (Kyodo) A woman in her 30s who wanted a sex change had her uterus and ovaries removed in an operation at Saitama Medical University Hospital in 1993 without the approval of the university's ethics committee, it was learned Sunday.

The hospital is scheduled to conduct Japan's first officially approved sex-reassignment surgery later this week.

Hospital sources said the patient in the 1993 surgery felt uncomfortable as a woman and wanted to become a man.

"Looking back, the surgery could be seen as part of a sex-change operation, but at the time, we carried out the operation as an emergency medical procedure to relieve the patient of the pain she was suffering," said Takao Harashina, a Saitama MedicalUniversity professor who was involved in the 1993 surgery.

The operation is expected to generate controversy because what can be viewed as the first step in the sex-change process was conducted without deliberation by any type of medical ethics committee.

According to the professor, the woman, a resident of Tokushima Prefecture, visited the hospital with her mother in October 1993 and repeatedly asked that her uterus be removed, complaining of terrible menstrual pain.

She was diagnosed as having endometriosis, Harashina said.

Later in the same month, Katsuyuki Kinoshita, a professor of obstetrics and gynecology at the hospital, and his team operated on the woman, he said.

Harashina said the patient had already undergone breast reduction at another hospital and he recognized to a certain extent that she was suffering from a condition known as gender identity disorder.

However, Harashina said that the university's ethics committee was not informed of the surgery because it was intended to relieve the patient's physical suffering and that he had not considered it to be sex-reassignment surgery.

Kinoshita said the operation was carried out as treatment for endometriosis and there was no problem at all as the hospital received written consent from both the patient and her mother that the operation would make it impossible for the patient to have babies in the future.

Toshio Yamauchi, chairman of the Saitama Medical University Hospital's Ethics Committee, said: "It can be seen as not a problem if the uterotomy and ovariotomy were conducted as purely medical treatment, even if the patient had gender identity disorder.

But it is a problem if the operation was held with awareness of it being a sex conversion.

"Revelation of the case may affect the sex-reassignment surgery that is scheduled to be conducted Friday for the first time as appropriate medical practice," he said.

Delayed progress regarding sex-change operations in Japan stems in part from a 1969 case in which a doctor was found guilty of violating the Eugenic Protection Law by performing such a sex-change on three men without taking the proper legal steps and procedures.

In May, the university's ethics committee gave approval for a 30-year-old woman who lives in northeastern Japan to undergo a sex-change operation on condition that complete mental support be provided afterward.

Harashina, among others, is scheduled to oversee the procedure.

The Japanese Society of Psychiatry and Neurology said last year that a sex- change operation should be permitted on certain conditions, including that the patient undergo psychoanalysis and hormone therapy following the procedure.

Some 2,200 to 7,000 people in Japan want to live as members of the opposite sex, according to one estimate.

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