In 1972, Sweden was the first country to pass special legislation regulating surgical and legal measures required for sex reassignment, thereby granting the sex-reassigned person the rights and obligations of the new sex (Walinder & Thuwe, 1976). Ever since then, unmarried Swedish citizens are allowed to obtain publicly financed sex reassignment if they are diagnosed as transsexuals. The patient applies to the National Board of Health and Welfare. An extensive medical certificate, in which documentation for the diagnosis is elaborated, must accompany the application. Because these data are always collected, this procedure implies that all data from all applicants for sex reassignment are on file, which facilitates phenomenological studies. Given that legislation is known to influence moral values in a society (Monteith, 1993), the Swedish law is likely to have boosted the public's positive views on transsexuals, as seen in a recent Swedish poll. Interestingly enough, this survey of attitudes towards transsexuals also demonstrated that those respondents who believed that transsexualism is caused by biological factors had a less restrictive view of trans-sexualism than those people who viewed transsexuality as a psychological problem (Landen & Innala, 2000).
A review of the annual frequency of applications for sex reassignments in Sweden between 1972 and 1992 showed a stable rate of, on average, 11.6 applications per year with an MTF/FTM sex ratio of 1.4/1.0 (Landen, Walinder et al., 1996). Since then, however, the annual frequency has almost doubled in Sweden, an escalation attributable to an increase in MTF applicants, and this has changed the sex ratio accordingly. Phenomenological studies of the Swedish cohort have shown that transsexu-alism manifests itself differently in MTF and FTM (Landen, Walinder et al., 1998). The MTF group are older than the FTM group when requesting sex reassignment surgery and have less cross-gender behavior as children, more frequent heterosexual experience, more frequent occurrence of fetishism, more frequent history of suicidal attempts, more often a history of marriage and parenting of children, and a lower level of education and socioeconomic status.
Most importantly, an outcome study of the Swedish cohort demonstrated that family opposition against the sex reassignment, belonging to the secondary group of transsexualism, and a history of psychotic disorder predicted regrets of sex reassignment (Landen, Hambert et al., 1998).
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