Doctoral Thesis
Refine
Document Type
- Doctoral Thesis (2) (remove)
Has Fulltext
- yes (2)
Is part of the Bibliography
- no (2)
Keywords
- Transgender (2) (remove)
Institute
- Geschichtswissenschaften (1)
- Medizin (1)
Background: Mastectomy in male transgender patients is an important (and often the first) step toward physical manhood. At our department, mastectomies in transgender patients have been performed for several decades.
Methods: Recorded data were collected and analyzed for all male transgender patients undergoing mastectomy over a period of 24 years at our department.
Results: In total, 268 gender-reassigning mastectomies were performed. Several different mastectomy techniques (areolar incision, n=172; sub-mammary incision, n=96) were used according to patients' habitus and breast features. Corresponding to algorithms presented in the current literature, certain breast qualities were matched with a particular mastectomy technique. Overall, small breasts with marginal ptosis and good skin elasticity allowed small areolar incisions as a method of access for glandular removal. In contrast, large breasts and those with heavy ptosis or poor skin elasticity often required larger incisions for breast amputation. The secondary correction rate (38%) was high for gender reassignment mastectomy, as is also reflected by data in the current literature. Secondary correction frequently involved revision of chest wall recontouring, suggesting inadequate removal of the mammary tissue, as well as scar revision, which may reflect intense traction during wound healing (36%). Secondary corrections were performed more often after using small areolar incision techniques (48%) than after using large sub-mammary incisions (21%).
Conclusions: Choosing the suitable mastectomy technique for each patient requires careful individual evaluation of breast features such as size, degree of ptosis, and skin elasticity in order to maximize patient satisfaction and minimize secondary revisions.
The marginalization of the hijra identity in postcolonial Pakistan perpetuates the inequalities that have dogged the transgender community since the colonial era. Although Pakistan has since ratified all concerned UN treaties aimed at protecting transgender people and preventing human rights violations against them, the country’s gender-variant population nevertheless remains vulnerable to these transgressions. As such, this study aims to explore the following inquiry: “What are the lifeways of the hijra community and how do hijra people face human rights violations in their daily life activities?”
The identity construction of the hijra is a complex process. Pakistan is a patriarchal society that determines gender based on biological sex. While a genitally ambiguous child is generally recognized as intersexed, the family usually obscures this circumstance or tries to enforce a predominantly male identity onto the child. To some degree, an intersexed child is allowed to perform feminine roles, particularly when compared to a biologically male individual who is inclined toward femininity. They may partake in “girls’ games” or in “women’s chores” like cooking; they may opt to don feminine clothing and jewelry or practice walking and talking “like a girl.” Many family members and relatives consider such actions a threat to family honor and/or an indication of weakness, which in turn renders the child vulnerable to sexual or physical assault. Abuse also causes some gender-variant children to drop out of school. As adults, many hijras do not see childhood sexual encounters as assault, particularly because they considered themselves to be feminine even from a young age. Nevertheless, experiences of isolation, abuse, and exclusion often compel a gender-variant child to seek company outside of his/her family of orientation.
Many transgender individuals see redemption in joining the hijra community: there, a new identity is defined and shaped. New members mirror themselves after more senior hijras. In the community, relationships are solidified through similar childhood experiences and interests as well as a shared freedom to express the outer reflection of an “inner feminine soul.” Here, they accept the childhood label affixed to them by heteronormative society: hijra. In fact, the identity now becomes the key to economic viability and socialization.
The predominant livelihood strategies within the hijra community are dancing and prostitution. New members must adhere to stringent norms and rules; they risk (sometimes severe) punishment if they do not. For example, a new hijra must adopt a very strict feminine appearance; if she does not appear feminine enough she may be socially isolated or physically punished. Similarly, a hijra is required to remain passive during sex. In fact, because hijras are stereotyped as passive and vulnerable, many clients physically exploit or even rape them. If she tries to resist, a hijra may face physical violence and, in extreme circumstances, death. Reporting abuse to law enforcement authorities often leads to further exploitation. As such, whether dancing or performing sexually, hijras are encouraged to do whatever is asked of them.
In the last decade, the Supreme Court of Pakistan has taken significant steps to ensure the rights of transgender people. The Court has similarly compelled local governments to amend existing legislation in order to protect the transgender community. Nevertheless, discrepancies exist in legislative and judicial interpretations of the transgender identity, which continues to impede the struggle for basic rights. Indeed, there is a long way to go in the effort to incorporate transgender people into the folds of mainstream Pakistani society.