Genesis of the Hymenoptera and the Phases of their Evolution

relatively insoluble, they have turned toward the surgeon for surgical reassignment of sex. The technique and early operative results of the first few cases are presented. The anatomical results leave a good deal to be desired-particularly in the conversion of female to male (6 cases)-but surprisingly enough their psychologic adjustment, in spite of functional anatomical difficulties, appears to be better than male to female (29 cases). The understatement of the year is contained on page 373, "Two men committed suicide and their postoperative condition was therefore definitely worse." As it has only been in the past few years that such operations have been performed in this country, any follow-up evaluation is of necessity incomplete. It is likely that many, if not all, transsexuals imagine that the conversion procedure would result in a relatively normal-appearing functional male or female genitalia. This is far from the case, but a recent visit to Yale by Dr. Milton Edgerton, Chief of Plastic Surgery at Johns Hopkins, indicates that operative techniques are being steadily improved. Of the reported 3,000 patients who have written to Hopkins applying for sex reversal procedures, the serious question can be raised as to how many would actually benefit from the procedure. Patients seeking sex reassignment operations are almost by definition to some degree unstable and maladjusted. One of Dr. Harry Benjamin's patients who approached this reviewer was a male prostitute living with a woman, who wanted to have a conversion to female so he could live with her as a lesbian. Another patient presented a more practical problem. A male who wears female clothes in the State of Connecticut can be (and was in this case) arrested for impersonation. On arrest the presence of breasts (from estrogen) and a penis gave the police pause as to whether confinement would be in the men's or women's wing of the prison. (He/she got solitary.) While the subject is a fascinating one, and this authoritative book will undoubtedly contribute to an overall knowledge of sexuality, it would seem well if sex conversion efforts were limited to one or two centers. There is grave question as to how many patients will ever be restored to a normal way of life. Certainly with present surgical techniques there is no way to affect a complete transformation of such patients. The amount of medical, psychiatric, and surgical manpower required to run a Gender Identity Clinic is such that it might be better spent elsewhere. This should be considered for the present a research rather than a service endeavor.