Treatment Issues

There are a number of different sexual dysfunctions one could address with this information.

The first is sexual role adjustment, either adjusting to the sex of ones birth or adjusting to the sex of ones choice (or the sex that the individual perceives themselves to, in fact, be -- regardless of the outer ‘encasement’ of their genetic body), as in the case of transsexuality.

The second is gender confusion, a condition that exists when the individual, due primarily to childhood sexual trauma, is unsure of what gender they feel comfortable being, regardless of their genitals -- whether they desire to ‘present’ themselves in a masculine or feminine manner.

The third is cross-gender choice, as is the case with transgenderism, wherein the individual makes a conscious choice to abrogate the gender distinctions of the culture and live a life wherein their ‘presentation’ is amorphous or androgynous. (This third issue may be originally caused by sexual trauma or gender confusion, but it is more or less resolved by the individual choosing to ignore the dichotomous gender polarities of our culture, rather than adhere to rigid social roles that simply don’t fit their chosen lifestyle.)

In the case of transsexuality, the individual, while trying to cast aside the sexual socialization bequeathed to them since childhood due in the main to the genitals with which they were born (based upon our cultural balkanization of sexual role socialization, that demands quite different behaviors from those born with penises or those born with vulvas), often ends up trading one set of rigid, limiting sexual behavioral requirements for an entirely different yet equally rigid and limiting sexual socialization demands. The only way to move beyond these stultifying polarities is by choosing a ‘third’ choice, as enunciated by both Kate Bornstein and Pat Califia, wherein while one may change ones genitals via sexual reassignment surgery and ones secondary sexual characteristics via hormone treatments or one may choose simply to retain ones genitals of birth, but live a life radically different from the one that the society expects of ‘identified’ men or women. This person actively chooses to remain outside the cultural ‘boxes’ that limit sexual expression and truly be an individual, in the most radical sense of the word. For all the talk of our culture about individuality, we are in the ultimate sense a most conformist culture; when people in this culture truly act in a distinctly individualistic manner, they often face ridicule or run the risk of being ostracized, but then that is the very point of transgenderism: choosing to face the arrows of ridicule and live ones life is a manner that is truest to the reality of the individual.

Even for more prosaic heterosexual couples, understanding the artificiality of gender would be of assistance. In this culture we are so thoroughly wrapped up in heterosexist perceptions of reality that we fail to see how that definition of the world is itself profoundly limiting. Gender, as transgenderism points out, is a fluid spectrum of possibilities, with many different kinds of behavioral outcomes unimagined by the majority of the population. Even psychological work with mainstream couples would be assisted by this knowledge; men could see that there are areas of nurturing and non-assertive behavior open to them, and women could see that there exist wider boundaries for strength, assertion, and self-determination not heretofore understood within the bounds of their marital or cohabiting bond.

Even biological determinism is held in question by the existence of transsexuality, which posits that one can choose ones sexuality, both in gender expression and genital appearance and function. With increasing medical advancements in plastic surgery and hormone endocrinology, it is no longer necessary to be locked into a body that one feels is not ones own, and which some people feel is limiting their humanity in this world. The earlier medical treatments were somewhat sexist, in that genetic men who felt a sense of sexual dysphoria could obtain sexual reassignment surgery much more easily than females (as the doctors put it, it was easier to create a cavity than to create a functional extension). Whereas males could obtain surgery which allowed them to be sexually reassigned as females, and in the end have an esthetically pleasing vulva and functional clitoris and vagina, it is now possible, with advances in microsurgery, for females who have great discomfort with their sexual bodies to be sexually reassigned as males and have the surgery produce a reasonably functioning (with hydraulic aids) and esthetically pleasing penis.

The limitation now is not one of class status or race, but one of economic means, given that the cost of electrolysis, hormones, psychological and medical certifications, and surgery, plus post-surgical follow-up and additional plastic surgery to enhance secondary sexual characteristics, are prohibitive to most individuals who seek such a change, unless they have the good fortune of having a medical provider who will consider the possibility of such surgery to be medically and psychologically necessary.

Conclusion

The increasingly widespread occurrence of transgenderism (be it fluid heterosexuality or homosexuality, rejection of sexual role determinism, or open display of gender behaviors not assigned to an individual simply due to a given set of genitals) brings into stark relief the limitations of classical gender differences and calls into question the demand that an individual has to be one sex or the other to be human. Transsexuality, itself one position on the spectrum of transgenderism, further calls into question the anatomical demand that the individual must be limited throughout their lives to the sexual determinism demanded at birth.

Though the ‘functionality’ of surgically constructed vulvas, clitorises, and penises has not been perfected to a degree to allow for consistent orgasmic derivative pleasure, it does allow certain individuals, whose level of sexual dysfunction is so profound that the sex of birth is felt to be horrifically constricting, to gain a sense of personal anatomical integrity and emotional self-acceptance not allowed heretofore. Generally such individuals are satisfied with the results, however imperfect, given how long they have often waited to resolve their sexual identity disorientation. Their main ire is directed toward the demand of the medical/psychological establishment to ‘live the life’ of classical gender dichotomies in order to quality for certification for sexual reassignment surgery.

Finally, what is quite clear is that Kinsey’s scale of sexual identity is wholly inadequate to address the increasing complexity of gender identification allowed by both a more fluid sociocultural landscape and medical surgical advancements. One should more properly view the sexual topography as a hologram, where multiple combinations of sexual and gender possibilities exist.  Gender freedom is indeed possible, if only we allow individuals to manifest their true personal ‘sense’ of self.

Footnotes:

1. (1)Books that include: In Search of Eve: Transsexual Rites of
   

Passage, by Anne Bolin; Transgender Nation, by Gordene Olga

Mackenzie; My Story, by Caroline Cossey; The Uninvited

Dilemma: A Question of Gender, by Kim Elizabeth Stuart; To Be

A Woman, by Jerry/Jerri McClain; The Last Sex: Feminism and

Outlaw Bodies, Arthur and Marilouise Kroker, Eds.; Sexual

Landscapes: Why We Are What We Are, Why We Love Whom We Love, by James D. Weinrich, Ph.D.; Transsexuals: Candid Answers To Private Questions, by Gerald Ramsey, Ph.D.; Female Perversions, by Louise J. Kaplan; and Transgender Warriors, by Leslie Feinberg, to name but a few.

2. (2)Pat Califia, Sex Changes: The Politics of Transgenderism. Cleis Press, San Francisco, 1997.
   

(3) Kate Bornstein, Gender Outlaw: On Men, Women, and The Rest of Us. Vintage Books, New York, 1994.

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Mariposa Men’s Wellness Institute was founded in 2001

to help men become emotionally healthy.