Imagine a scalpel digging deep into your innards as if to remove them. That is how Vidya, a transgender in Chennai, felt when she underwent castration at a clinic in Kadapa, Andhra Pradesh, for just Rs.6,000. It was performed in barely 20 minutes in an operation theatre frighteningly reminiscent of a slaughterhouse. Vidya describes her experience in great detail in her autobiography I am Vidya, published by Kizhakku Pathipagam. She recounts in it the fear, the anxiety, the excruciating pain and the final sense of relief of discarding her maleness. She refers to the experience of liberation from the male identity as nirvana. The nirvana pain of an aravani is worse than a womans labour pain. I kept calling the name of matha [Bahuchara Matha] to withstand the pain, she says.
Access to safe sex-reassignment surgery (SRS) remains a widely neglected medical issue in India. Despite the advances made in the field of cosmetic surgery, the majority of transgender persons can afford only crude methods of castration. Unfortunately, transsexuality is more a subject of cheap jokes than of any serious medical inquiry in India.
Dr. Chakrapani Venkatesan, M.D., working with Solidarity and Action against the HIV Infected in India (SAATHII), Chennai, said the medical fraternity was reluctant to address the needs of transgender persons largely because of the lack of clarity on transgender-specific issues. He recalled how as a student of Madras Medical College, Chennai, in the late 1990s, he held the view that all transgender persons were hermaphrodites, which, he later discovered, was not true.
He said that transsexual behaviour was best understood as a neuro-developmental condition though the American Psychiatric Association identified it as a gender identity disorder, defined as a significant discomfort with ones assigned gender. One way to come out of this identity disorder is to merge with the desired sexual/gender identity through SRS. But with emasculation being illegal, and the legal position on SRS largely ambiguous, government hospitals are unwilling to pursue SRS.
A proper SRS goes well beyond mere emasculation. It involves pre-operative and post-operative counselling. After the first few rounds of counselling, the person would be given hormone therapy to feel more masculine or more feminine as desired. This follows a real-life test in which the person will have to prove his or her ability to pursue normal life with the altered sex.
Surgical removal and reconstruction of body parts is done only in the end. This is followed by cosmetic treatment. As of now, most transsexual men within transgender communities are castrated at a fairly young age without any precaution or procedure. If government hospitals can undertake SRS it can go a long way in decreasing the morbidity and mortality following emasculation by quacks, said Venkatesan.
According to him, urinary stenosis/stricture following emasculation is common among castrated persons. Besides, several transgender persons looking for services such as facial hair removal, scalp hair growth and voice change are inhibited by the expenses involved. During his research Venkatesan found that several transgender persons resorted to taking hormonal injections without medical supervision to feel more feminine.
Tista Das, a transgender activist in Kolkata, made news when she became the first person in the city to undergo SRS at a private clinic five years ago. She said that if done in the right manner, the surgery can be a rewarding experience. She discounted as false the notion that SRS could lead to abnormalities or ruin the persons health in the long run. I feel more confident about myself and I feel like a complete woman now, she said.
Tista said she had approached leading government hospitals in Kolkata for the surgery but the response ranged from ridicule to blunt refusal. One doctor, she said, suggested her not to fantasise unnecessarily about becoming a woman. It was only after this she turned to the private clinic. Tista could, however, afford to shell out the Rs.2 lakh needed for the operation, which itself, she says, was a subsidised fee as she knew the doctor. This is not the case with ordinary transgender persons, who are struggling to survive through sex work or begging.
Vidya Venkat
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