Feminine Transformations: Gender Reassignment Surgical Tourism in Thailand

Abstract

Every year, hundreds of transgendered people from the United States, Europe, Asia, Canada, and Australia travel to Thailand to undergo cosmetic and gender reassignment surgeries (GRS). Many GRS clinics market themselves almost exclusively to non-Thai trans women (people assigned a male sex at birth who later identify as female). This article draws on ethnographic research with patients visiting Thailand for GRS to explore how trans women patients related their experience of medical care in Thailand to Thai cultural traditions, in particular “traditional” Thai femininity and Theravada Buddhist rituals and beliefs. Foreign patients in Thai hospital settings engage not only with medical practices but also with their perceptions of Thai cultural traditions—which inflect their feminine identifications. I draw on two patients' accounts of creating personal rituals to mark their gender reassignment surgery, placing these accounts within the context of biomedical globalization and debates about the touristic appropriation of non-“Western” cultural practices.

Key Words:

• medical travel
• somatechnics
• South East Asia
• transsexuality
• transgender
• transnationality

ACKNOWLEDGMENTS

Thanks to Andrea Whittaker, Elizabeth Cartwright, Lenore Manderson, and the anonymous reviewers for invaluable edits and suggestions. My thanks also to Peter Jackson, Prempreeda Na Ayutthaya Pramoj, and Nantiya Sukontapatipark in Thailand for help with documenting the history of Thai gender reassignment surgeries, and especially to the trans women who consented to be interviewed for this project.

Notes

Flier advertising “Sex Change: Sex Reassignment Surgery Male to Female,” produced by Yanhee International Hospital, Bangkok, Thailand, 2006.

In this article, I use GRS (gender reassignment surgery) as an umbrella term including genital and non-genital procedures, including orchiectomy or castration; vaginoplasty, the construction of a neo-vagina; and breast augmentation and facial feminization surgery. Trans masculine surgeries are more often non-genital and might involve a mastectomy and the construction of a masculine chest; the removal of the uterus and ovaries; the release of the clitoris from the labia to construct a microphallus; or the creation of a penis and testicles. Following standard usage in transgender theory (Whittle 2006), this article also refers to trans people, women and men: the prefix “trans” describes communities or individuals who do not live as the sex they were assigned at birth. Thus, “trans woman” refers to what is glossed elsewhere as male-to-female or MTF; “trans man” refers to what is glossed elsewhere as female-to-male or FTM.

Only one Thai surgeon, at Yanhee International Hospital, specializes in gender reassignment surgeries for trans men. An entirely different set of knowledges and symbolic representations attend the medical travel of trans men to Thailand for GRS, which I intend to explore in a future project.

See Hale's suggested guidelines for writing about transsexuality (1997).

Kathoey is the most popular term in Thailand to describe gender variance. Others are sao praphet sorng [second type of woman]; and tom, describing masculine female-bodied people. Kathoey is a far more fluid category and covers a wider range of cross-gender practices than the English language term “transsexual”: it is sometimes understood as a “third sex,” and has been used in the past to refer to effeminate homosexual men as well as those assigned male at birth who feel like, or want to be, women (Jackson 1997:170). Kathoey can mean both gender identity or expression, and sexual practice, or both at the same time (Costa and Matzner 2007:19).

For example, many Thai surgeons claim that they were among the first in the world to develop a genital vaginoplasty technique that includes a fully sensate clitoris and appears cosmetically indistinguishable from a non-trans woman's vagina.

Interview with Dr. Suporn, June 24 2006.

An excellent Foucauldian analysis of the medicalization of gender variance in the WPATH Standards of Care as well as psychiatric frameworks such as the DSM can be found in Spade (2006).

My analysis here relies heavily on previous research on kathoey or sao praphet sorng identities and practices and neglects to engage with tom identities and gender reassignment practices. On toms in Thailand, see Sinnott (2004).

Personal communication with the clinic manager at the Suporn Clinic, June 2006.

However, in interviews most surgeons agreed that they would operate on Thai candidates for GRS without requiring psychiatric assessment.

In Australian hospitals it is almost impossible to obtain body parts removed through surgery due to the legal regulation of surgical remains.

Additional information

Notes on contributors

Aren Z. Aizura

AREN Z. AIZURA is a post-doctoral fellow in Gender Studies at Indiana University, Bloomington. He completed his PhD dissertation, “Travellers across the Boundaries of Sex: Travel, Transnationality and Trans Subjectivations,” at the University of Melbourne, Australia in 2009. Aizura has published scholarly articles in Inter-Asia Cultural Studies and Asian Studies Review, and has chapters forthcoming in the edited volumes Trans Gender Migrations and Queer Bangkok (Hong Kong University Press 2011).