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1997年カナダにおける原科孝雄先生講演から
日本語訳へ
The Presentation about Up-to-DateJapanese Therapeutic Environment 15th Harry Benjamin International Gender Dysphoria Symposium
Van Couver Sept. 1997Prof. Takao Harashina, Saitama Medical School, Plastic Surgery
Japan which is considered to be one of the advanced country in terms of economy, technology, industry or medicine has long been in dark age for those who suffer from gender dysphoria. The reason why Japan is so underdevelopped in this field and past and present status of transsexualism in Japan will be discussed.
This is my first case of penile reconstructions which was done 12 years ago. This 26 year old man lost his penis in a traffic accident only 3 months after his marriage. We have reconstructed his penis with deltoid flap incorporating with a rib cartilage and he became a father of two sons. We have published this fact in an urologic journal and then it was reported widely through medias.
Then one FTM transsexual person came into my clinic asking for construction of neo-penis. I was so shocked when he told me that he tried to lower his voice by injuring his own vocal code using steel wire only because he hated his female voice.
He also showed me a book entitled - Is it poddible to change sex? It was also a big surprise for me that the book was published in 1976, almost 20 years ago.
I also found that one FTM transsexual person was publishing minicommunicating journal, FTM Nippon. He is probably the only FTM transsexual in Japan who had gender confirming surgery overseas. Through that journal a few patients visited my clinic. These patients had counselling by psychiatrists and also hormone treatments.
In May 1995 we applied for permission for surgical treatment of transsexuals to the Ethics Committee of our Medical School, beleaving that we and two patients are fully ready for it.
The apprlication caused big confusion in the Ethics Committee because even the chairman of the committee who is a professor of psychiatry had actually no knowledge about transsexualism. It took one year for them to come to the conclusion.On July 1996 the Ethics Committee of Saitama Medical School announced its decision to permit surgical treatment of transsexuals under sertain circumstances. There are three main conditions. The first is to draw up guidelines for the diagnosis and treatment of transsexuals. The second is to organize a treating team. The third is to try to obtain social recognition on this problem.
The reaction of medias was overwhelming and positive because it was the first time in Japan that the problem of transsexualism was discussed openly and majority of the people considered that sex change operation is conducted for personal hobby or professional profit.
As a result of fevorable reaction of the media the Japanese Federal Department of Health and Welfare has asked the Japanese Society for Psyhiatry and Neurology to draw up national guidelines for the diagnosis and treatment of transsexuals. The special committee was organized in the Society last September and a Gender Clinic has been fouded at Saitama Medical School.
On May this year the Special committee of Japan Society of Psychiatry and Neurology has issued guidelines for the diagnosis and treatment of transsexuals.
There are several reasons why Japan is so underdevelopped country in this field.
The biggest reason is that Japanese people including physicians have long believed that sex change operation is prohibited by the low. In 1969, almost 30 years ago, one gynecologist was found guilty for conducting orchidectomy in three male prostitutes. The reason for the guilty was that it violated the Eugenic Protection Law which says that normally functioning reproductive organs should not be removed or irradiated without good reason. Since then Japanes people who are obedient to law or authority has continued to believe that sex change operation is against law and nobody has ever spoken up that the surgery can be necessary for transsexual persons and this kind of surgery has never been conducted officially in this country and long dark age for those who suffer from gender dysphoria has ensued. However the sentence of the trial clearly said that transsexual surgery can be regarded as justifiable medical activity if clients are properly evaluated, counselled and diagnosed preoperatively. Unfortunately that doctor was also involved in drug problem and was punished rather severely.The second reason is that there are many poor entertainment TV programms which treat these transsexual or transgender person as Pierrot in comic books. These TV programms had profound effects on Japanese people to have strong prejudice on these people.
The third reason is that Japanese people are generally very conservative and strongly influenced by Jukyou or onfuciansm. So people hesitated to discuss openly about sex and there exists actually no sexology in our country.This shows the number of patients who have visited my clinic since 1992.
October 1995 what was being discussed in the ethics committee was leaked through mas media for the first time. July 1996 the ethics committee reported its decision and May 1997 guidelines for the diagnosis and treatment of transsexuals was issued.
Each occasions extensive reports through mass medias increased the number of clients who have visited my clinic.It seems strange that in this data nearly 70 % of one hundred and twelve clients is FTM. The probable reasons for this is that each time the media reported that it is FTM transsexuals that are being discussed about surgical treatment in the ethics committee.
Another reason is that it is easier for MTF transsexuals to obtain necessary informations such as orchidectomy and so it is not necessary for MTF transsexuals to visit university hospital and spend lots of time for counselling.
Previously mentioned Japanese Eugenic Protection Law does not refer to the surgery of breast or hormone treatments. So we see many transsexual patients who have already had mastectomy or augmentation mammaplasty or hormone treatsments. So it is relatively easy for us to diagnose these patients who have these procedures already.
Though we are approaching the stage where the medical problem will be solved we still have a long way for the law problem tu be settled.
As was mentioned before Japanese Eugenic Protection Law does not necessarily prohibit the sex change operation. After guidelines for the diagnosis and treatment of transsexuals have been issued the Ministry of Justice announced its comment that gender confirming surgery could be regarded as legal if the guidelines shoud be properly followed.
As for Civil Law change of the first name is not so difficult if the applicant continues to use his or her preferred name for certain period of time, ideally more than 5 years.
As for the change of document or birth certificate there has been no case in which it was permitted at the court.This gentleman has been an employee of a big company for long time as a male and has lived with his female partner for more than 20 years. He had mastectomy long time ago and recently had oophorectomy and salpingectomy due to myoma uteri.
Even so his application to change documant was denied because it is still not practice of this country to change document for this reason and the appearance of his external genitalia is still not that of a male.At present this case is pending at the Supreme Court.
We are now just on the start line. We still have a lot to solve to help improve welfare of those who suffer.
Our special thanks are directed to those people who have taught, guided and helped us.
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