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首页> 外文期刊>The journal of sexual medicine >Self-Castration by a Transsexual Woman: Financial and Psychological Costs: A Case Report
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Self-Castration by a Transsexual Woman: Financial and Psychological Costs: A Case Report

机译：变性妇女的自我嘲讽：财务和心理成本：病例报告

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Introduction. The out-of-pocket cost for an elective orchiectomy, which is often not covered by health insurance, is a significant barrier to male-to-female transsexuals ready to proceed with their physical transition. This and other barriers (lack of access to a surgeon willing to perform the operation, waiting times, and underlying psychological and psychiatric conditions) lead a subset of transsexual women to attempt self-castration. Little information has been published on the financial costs and implications of self-castration to both patients and health care systems. Aim. We compare the financial and psychological costs of elective surgical orchiectomy vs. self-castration in the case of a transsexual woman in her 40s. Methods. We interviewed the patient and her providers and obtained financial information from local reimbursement and billing specialists. Results. After experiencing minor hemorrhage following the self-castration, our patient presented to the emergency department and underwent a bilateral inguinal exploration, ligation and removal of bilateral spermatic cords, and complicated scrotal exploration, debridement, and closure. She was admitted to the psychiatric service for a hospital stay of three days. The total bill was US $14,923, which would compare with US $4,000 for an elective outpatient orchiectomy in the patient's geographical area. Conclusions. From a financial standpoint, an elective orchiectomy could have cost the health care system significantly less than a hospital admission with its associated additional costs. From a patient safety standpoint, elective orchiectomy is preferable to self-castration which carries significant risks such as hemorrhage, disfigurement, infection, urinary fistulae, and nerve damage. Healthcare providers of transsexual women should carefully explore patient attitudes toward self-castration and work toward improving access to elective orchiectomy to reduce the number of self-castrations and costs to the overall health care system. Further research on the financial implications of self-castration from different health care systems and from a series of patients is needed.
机译：介绍。择期睾丸切除术的自付费用通常不包括在健康保险中，这是准备好进行身体过渡的男女变性者的重大障碍。这种障碍和其他障碍（缺少愿意执行手术的外科医生，等待时间以及潜在的心理和精神疾病）导致一部分变性女性尝试自我self割。关于自费ration割对患者和医疗系统的财务成本和影响的信息很少。目标。我们比较了在40多岁的变性妇女的情况下，选择性外科睾丸切除术与自我cast割术在经济和心理上的成本。方法。我们采访了患者及其提供者，并从当地的报销和计费专家那里获得了财务信息。结果。自cast割后出现少量出血后，我们的患者来到急诊室，进行了双侧腹股沟探查，结扎和切除双侧精索，以及复杂的阴囊探查，清创和闭合。她被送往精神科住院三天。总费用为14,923美元，而在患者所在地区进行门诊选择性睾丸切除术的费用为4,000美元。结论。从财务的角度来看，选择性的睾丸切除术在医疗保健系统上的花费可能远少于医院入院所需的费用，同时还会带来额外的费用。从患者安全的角度出发，择期睾丸切除术比自体铸造术更可取，因为它具有显着的风险，例如出血，毁容，感染，尿瘘和神经损伤。变性妇女的医疗保健提供者应仔细探索患者对自cast的态度，并努力改善择期睾丸切除术的使用率，以减少自number的次数和整个卫生保健系统的成本。需要进一步研究来自不同医疗体系和一系列患者的自我self割的财务影响。

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