Zingg, König, Cornu, Wildholz & Blaser, 1980
Medical, Urological and Psychiatric Clinic, University Clinic Bern, Bern, Switzerland

The publication reports about females treated in Bern. The main emphasis of the representation lies on technical questions of the urological and plastic surgery interventions and the complications that occurred. This is the urological pendant of the psychiatric dissertation of Simona-Politta (1983). The same sample is described that, at the same time, is an expanded partial sample of operated patients described in the publication of König et al. (1978). For a general characterization of the patients of Bern, the works of König et al. (1978), Simona-Politta (1983) and Dudle (1979) are referred to.

• Sample
• Study Methods
• Evaluation Fields and Criteria
• Results
• Suicide Attempts/Role Re-reversal
• Follow-up Studies Mentioned
• Authors' Conclusion

Study Methods
Regular follow-up controls were made by endocrinologists, in greater intervals also by psychiatrists and surgeons. Specific research instruments or methods are not mentioned.

Evaluation Fields and Criteria
Evaluation fields and criteria are not mentioned. Mainly surgical results and complications are referred to. Aspects of social evaluations are referred to briefly.

Results
Of the 12 females whose primary surgeries were further than one year back, seven were satisfied with the achieved results. Four had sexual difficulties (pain during sexual intercourse, non-orgasmic). Two of them desired corrective surgery. In one female additionally two corrective procedures were necessary. "The achieved result is now so good that, according to the patient -- who works as a prostitute -- even the most demanding clients achieve their desires" (p. 74).
"From a cosmetic point of view, the result of the vaginoplasty can be evaluated as satisfactory to very good" (p. 74). With one exception, all females are socially integrated. One female is in a psychiatric clinic because of a psychopathy and a slight debility; the sex reassignment has conduced a great improvement and a relaxation in a previously suicidal and pyromaniac patient. Four females have continuous relationships with a male or are married. None of the females regrets the surgery.

Follow-up Studies Mentioned
Benjamin, 1966; Hamburger et al., 1953; Hastings, 1974; Hore et al., 1975; König et al., 1978; Laub & Fisk,1974; Pauly, 1965, 1968; Steiner, 1976; Stürup, 1976; Turner et al., 1978

Authors' Conclusion
"(a) With transsexuals, an interdisciplinary working group must examine the patient in depth and repeatedly before any type of sex reassigning therapy is started. (b) Every irreversible surgery has to be preceded by an at least one-year-long, possibly longer, trial period of the hormone treatment and the living in the desired role (cross-dressing). (c) The patient must be informed by different physicians of the working group about the type of hormonal and surgical treatments as well as possibilities and limitations. (d) The patient has to always be reminded that the patient needs life-long hormonal substitution treatment after surgery, not only because of his sexual needs, but also because of the need of anabolic hormones" (p. 75).