Experts have questioned a legal requirement for people with gender identity disorder to undergo sex reassignment surgery to officially change their registered sex.
"There are various types of people among those with gender dysphoria, including those who need sex-change surgery," Katsuki Harima, a psychiatrist, told a recent symposium in Tokyo.
"But I doubt if it is an ethical practice to require even those who do not feel significant physical pain to have the surgery to legally change their gender."
Under the current law, GID people are allowed to change the way their sex is listed in their family registries if they fulfill several conditions, including the absence of functioning reproductive organs as a result of gender reassignment operations.
Harima, also a board member of the Japanese Society of Gender Identity Disorder, attended the symposium, organized by the Japan Federation of Bar Associations, as a panelist.
Another panelist, Fumino Sugiyama, shared his view, saying, "There are GID people, who reluctantly consider sex change operations to find jobs" so the difference between their gender identity and their gender in family registries will not be noted in their resume.
Sugiyama, a female-to-male transgender who once represented Japan in women's fencing, has been unable to change his registered sex as he still has internal genitalia following breast-removal surgery.
"The breast was visible (to show a woman's body), but I don't want to put the knife to my body" in order to follow the legal system, Sugiyama said.
Sugiyama is a leading campaigner for better understanding of sexual minorities, and played a key role in the passage by Tokyo's Shibuya Ward government of an ordinance authorizing the issuance of certificates recognizing same-sex partnerships as being equivalent to marriage.
Many countries around the world, including European nations and several states in the United States, approve of change of registered sex of GID people even if they do not go through gender reassignment surgeries, according to the JFBA.
The World Health Organization and other institutions issued a joint statement in 2014, noting that the requirement to undergo sterilization surgeries as a prerequisite to receiving gender-affirmative treatment and gender-marker changes "run counter to respect for bodily integrity, self-determination and human dignity, and can cause and perpetuate discrimination against transgender and intersex persons."
Shoko Sasaki, a clinical psychotherapist, said at the symposium that gender reassignment surgery does not necessarily stabilize the gender identity of people with gender dysphoria, citing a female-to-male transgender person who was unsure about undergoing surgery to remove internal genitalia.
He thinks it more fitting to not have a womb and ovaries, but is also aware that he cannot have fully-functioning male sex organs, and that gender reassignment surgery can only have a limited outcome, according to Sasaki.
"In that case, sex-change surgery is not relevant to stabilization of his gender identity," she said. "The legal requirement for gender reassignment surgery to officially change registered sex sometimes causes 'social pain' to people with gender dysphoria as they feel they are prevented from changing their family registry," Sasaki added.
According to the Japanese Society of Psychiatry and Neurology, the number of transgender people visiting medical institutions in Japan totaled 22,435 by the end of 2015, of whom 4,671, or 20.8 percent, changed gender in their family registry.