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Once upon a time, sex and gender were a team. Gender aligned with natal sex, and both aligned with desire (heterosexual, to be sure): male genitalia rendered you masculine and desirous of women; female genitalia made you feminine and inclined you toward men. Nowadays everything is up for grabs. No longer do genitals and gender predict desire: same-sex and same-gender love, like changes in desire across lifetimes, are deemed normal. Our grasp of the shifting relations among the categories once grouped under the rubric of “psychosexuality” is much more nuanced. Consider Saketopoulou's subtle assessment of her patient's possible futures: “Jenny might be a transgender girl rather than a proto-gay boy” (p. 788).
It was Freud (1905), of course, who first opened this Pandora's box. As he contended, drive, aim, and object are linked only loosely. Now, however, the sexual stays are loosed even further. We are challenged to consider that, since genitalia and gender identity are themselves but soldered together, any mismatch between them could cause sufficient psychic pain that surgical interventions might be just what the patient, and therefore the doctor, ordered. I won't opine on what Freud would have said about sexual reassignment or gender confirmation surgery, although at the close of “Psychogenesis of a Case of Homosexuality in a Woman” (1920, p. 172) he does wonder about it, albeit more to control his enigmatic and frustrating patient and less to serve her desire (Harris 1991).
That gender dysphoria may now be assuaged by surgical modification obliges psychoanalysis to reconstrue the body. Saketopoulou's