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AMERICAN JOURNAL OF PSYCHOTHERAPY

FREQUENCY OF TRANSVESTISM

The number of transvestites and transsexualists in the United States is enormously difficult to estimate because too many of them keep their secret well-hidden; some are discovered only after death. An investigation is now in progress in California to procure an approximate idea of how many may be in that state. While there could be several hundred or more, they are hardly enough to con- stitute a problem for society even if restrictive laws were relaxed with the help of medical certificates.

TREATMENT

As far as the treatment of transvestism is concerned, my pre- vious remarks may suffice on this occasion. The management of transsexualism, however, requires a few supplementary comments, especially as far as the conversion-operation is concerned.

Transsexualism is undoubtedly a rare condition, rare in propor- tion to the population. Its treatment is even more perplexing than that of etiology because medical considerations are so greatly com- plicated by social and legal ones.

In my opinion, psychotherapy for the purpose of curing the condition is a waste of time. A basic conflict would be too firmly anchored in the constitution. All that the psychiatrist can possibly do is to relax tension, to develop and reinforce realistic thinking, and to supply guidance. That, of course, is not a cure.

The transsexualist is primarily interested in having a conver- sion-operation performed and therein lies the dilemma which taxes the physician's conscience to an unusual degree.

The operation itself would consist in castration, the amputation of the penis (peotomy) and the possible plastic formation of an artificial vagina. But, alas, even if the patient had reached this goal, it may not always solve his problem. His femininization cravings may never end. The later realization that a complete change of sex including the ability of child-bearing is impossible and that only a change of secondary sex characteristics has been and can be accomplished, may leave some patients still frustrated even after a more or less extended period of relief. That is the tragedy and the pitfall in consenting to this irreversible procedure. And yet, in some cases, it may be the lesser evil and we may have to accept this chance as a calculated risk.

The patient who is constantly on the verge of a reactive psy-