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Città della Salute e della Scienza. C.I.D.I.Ge.M. Centro Interdipartimentale Disturbi Identità di Genere Molinette. MULTIDISCIPLINARY APPROACH IN TRANS PEOPLE CARE: THE EXPERIENCE OF A GENDER TEAM IN A ITALIAN PUBLIC INSTITUTION. Fondazione Carlo Molo ONLUS. - PowerPoint PPT Presentation
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P. Bogetti, A. Cavalot, C. M. Crespi, G. Datta, A. Gualerzi, C. Manieri,
V. Mineccia, M. Molo, L. Petruzzelli, P. Petruzzelli, L.Rolle, M. Timpano
MULTIDISCIPLINARY APPROACH IN TRANS PEOPLE CARE: THE EXPERIENCE OF A GENDER TEAM IN A ITALIAN PUBLIC
INSTITUTION.
Città della Salute e della Scienza
C.I.D.I.Ge.M. Centro
Interdipartimentale Disturbi Identità di Genere
Molinette
Fondazione Carlo Molo ONLUS
THE TRANSFORMATION PROGRAM
OSSERVATORIO NAZIONALE SULL’IDENTITÀ DI GENERE (1998)
STANDARDS OF THETRANSFRMATION PROGRAM
OF GENDER IDENTITY (www.onig.it)
Italian guidelines, elaborated by ONIG based on the WPATH Standards of Care adapted to our culture and social model.
These Standard are not state laws, but associate professionals are to follow and respect them.
,
the Italian reality
the law 164/1982
…and its integration
INFORMATION DESK
Città della Salute e della Scienza
San Giovanni Battista Molinette Hospital
Fridays 1.30 pm - 4.30 pm
Tel. 011/633.36.92
CARING TEAM
URO-ANDROLOGYPLASTIC SURGERY
ENDOCRINOLOGY
PSYCHIATRYPSYCHOLOGY
GENERAL LAPAROSCOPIC SURGERY
E.N.T. (Ear Nose and Throat)
GYNECOLOGY
PSYCHODIAGNOSIS
R.L.E. REAL LIFE EXPERIENCE
6 months
12 months
18 MONTHS18 MONTHS
THE TRANSFORMATION PROGRAM
WELCOME MEETING
Inform on pathway Collect health notes Hand out brochures Ensure signed informed consent Book the first appointment
PROCEDURE (1)
PSYCHO-DIAGNOSIS
• Clinical interviews
• Tests
• Medical examinations
(endocrinological and psychiatric)
• Hormonal Therapy
• Psychological support
• Programmed medical
examinations
R.L.E.
PROCEDURE (2)
Final Team Report
Legal procedure to obtain the
authorization for
Sexual Reassignment Surgery
S.R.S.
Surgery
02/11/09
PSYCHOLOGIST
Before Hormonal treatment clinical interviews
During RLEpsychological support (if required also with the family)
After SRSPsychological support (if required) and group sessions based on Sexocorporelle Approach (Prof. Desjardins)
from 2005 to 2014
398 subjects: 283 MtF115 FtM
NOW IN CHARGE
Before HT: 21 MtF19 FtM
Subjects attending C.I.D.I.Ge.M – a Public Health Service for GID people in Turin, Italy, in order to enter the programme for Sex Reassignment Surgery,
from January 2005 to February 2012
1179
191
n = 281
Other
Non-GID
GID
Drop out
PSYCHIATRIST
Before Hormonal treatment clinical evaluation
During RLE/AfterSRSIf necessary
ENDOCRINOLOGIST
Cross-Sex Treatment
FtM
Testosteron
Persons in charge in R.L.E. : 50 MtF/23 FtM
Follow-Up (post-S.R.S.):
58 females/21 males
MtF
17β-Estradiolo
Androgen antagonist
82 patients (90% coming from other regions)
Cricotyiroid approximation with condroplastic surgery when required and possible
Waiting list for surgery: 18 months
85% of successes 3 complications in a short-long term: all resolved
Hospitalization: 24 hours in a double room
OTORHINOLARYNGOLOGIST
VOCAL CORDS SURGERY
10 patients MtF for mammoplasty
3 patients MtF for genitals’ revsion (clitoris and labia) Waiting list for mastoplasty : 18–30 months
1 complication, resolved
Hospitalization: 1-2 days in a double room (for female)
Waiting list for genitals’ revision: 12-18 mounths
PLASTIC SURGEON: MAMMOPLASTY and GENITALS’ REVISION
A
B
E
D
C
Almost 1 year After HT to evaluate breast development
Cut off for the
surgery in NHS:> 6 cm distance between the muscle and the nipple
With X-Ray mammography
FtM: 18 casesTotal laparoscopic bilateral
hysteroannessiectomy
associated with bilateral mastectomy Waiting list: 4-6 months
Hospitalization: 3-5 days in a single or double
room (with males)
No complications in the short/long term (only 1
case of postoperative pyrexia)
GENERAL SURGEON and GYNECOLOGIST: GENERAL LAPAROSCOPIC, PLASTIC AND GYNECOLOGICAL SURGERY
MtF:10 cases access to the gynecological clinic
The most common problems are:
- worry about inadequate vaginal length and
caliber
- poor lubrication
- fear of having penetrative sex intercourse
We found in all cases a good aesthetic and
functional result with an appropriate vaginal
size for penetrative sexual intercourse.
UROLOGIST
52 patients MtF
10 patients FtM Waiting list: 24 months
Patients in waiting list: 24 MtF ; 12 FtM
Hospitalization: 7 days in a single room
Revisions for: 3 vaginal stenosys (ileovaginoplasty), 7 uretral meatus stenosys and 5 asimmetric labia majora and hipertrophic clitoris
italian guidelines are strong based to the social and cultural environment
gender team works in a public hospital: waiting list and kind of services provided
services provided are hormonal therapy, SRS, and, in some rare case, mammoplasty ; services not provided are laser and mammoplasty
OPEN ISSUES
THANK YOU !
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