Happiness is … gender-affirming surgery

Thando Thengwa’s physical pain does nothing to quash her joy. “I am so, so happy. It is indescribable,” the 37-year-old says from the Nelson Mandela Academic Hospital, where she is recovering from eight hours of gender reassignment surgery.

“I can feel the pain, yes. But the excitement itself counteracts the pain. For the first time, to be honest with you, I can stand naked in front of a mirror without hating the parts of my body that I did not like.”

After 13 years of “always knocking on hard walls” to undergo the physical process of aligning her body to her gender, Thengwa has finally realised her dream.

In 2017, the Mail & Guardian reported about the shortage of surgeons in South Africa able to perform gender-affirming surgery. In that report, Thengwa said she found the inaccessibility of surgery “really discouraging, really hurting”.

READ MORE: ‘Ambassadors’ for trans surgery rally for better services

“Personally,” she said then, “I don’t see South Africa as a good place for trans people to live in because it is so difficult to get healthcare services that are relevant to us. We need more surgeons and more facilities that do gender-affirming healthcare — not that, when you go a hospital, they say, ‘It’s not our priority’.”

The number of government hospitals that offer gender-affirming healthcare is increasing, with facilities in Gauteng, the Western Cape, the Free State, KwaZulu-Natal and the Eastern Cape. It is only Cape Town’s Groote Schuur Hospital that offers both breast and genital surgery, but the waiting list is at least 25 years long.

Determined not to wait for decades and also to “open doors for my fellow sisters”, Thengwa created a gap.

At a gender-affirming healthcare training workshop for doctors in East London this year, the KwaZulu-Natal-based trans rights activist approached doctors from the Nelson Mandela Academic Hospital attending the workshop and volunteered herself as a patient for a live gender-reassignment surgery training session.

She knew the doctors from her 2017 orchidectomy (the removal of testes). For transgender women undergoing gender reassignment surgery, an orchidectomy precedes the vaginoplasty (the construction of a vagina using skin grafts).

Groote Schuur’s Kevin Adams conducted the surgery. “It went very well. They have good surgeons there,” he says.


“It seems as though there is a demand in the area for these kinds of operations,” he added

With the demand for gender-affirming surgeries on the rise, a conference was held in Pietermaritzburg last year to generate more interest from doctors. The conference, as well as subsequent training sessions, including the recent one in East London, was put together by trans rights organisation, Gender Dynamix.

The organisation’s executive director, Liberty Matthyse, says the training conference was aimed at equipping surgeons, particularly in the public sector, with a theoretical knowledge of gender-affirming procedures for trans men and women.

Adams also believes there is a need for more surgeons to be skilled in this area. “This needs to be rolled out more broadly,” he says. “There is a definite demand for it. We don’t have enough doctors who are trained to do these kinds of operations, so it is definitely something that needs to gain momentum.”

Thengwa knows this all too well. Although she is happy, she can’t help thinking about her “fellow sisters, who are actually travelling the same journey I am”.

“I do not want them to experience what I have, being rejected by one hospital after the other. So I hope this opens doors for them, too. My hope and prayer is for us in South Africa to establish systems that welcome us all, a wholly inclusive healthcare system.”

Carl Collison is the Other Foundation’s Rainbow Fellow at the M&G

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Carl Collison
Carl Collison
Carl Collison is a freelance journalist who focuses primarily on covering queer-related issues across Africa
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