Sexual Adjustment Team

It was initially started as an Implementation Team for Genital Alteration Surgery at Dr. Kariadi Semarang Hospital to help intersex and transsexual cases.  In September 15th 1979, the director of Dr. Kariadi Hospital proposed to Ministry of Health to change the name of Implementation Team for Genital Alteartion Surgery (Tim Pelaksana Operasi Penggantian Kelamin) into Sexual Adjustment Team (Tim Pelaksana Operasi Penyesuaian Kelamin). The team consisted of experts in urology surgery, plastic surgery, gynecology, anesthesiology, Adult and Child endocrinology, genetics, andrology, psychiatry, psychology, pathology, legal, religion and social-medical staff.

The proposal was granted by the release of Health Ministry’s Decision Letter (Keputusan MenKes RI no.191/MENKES/SK/III/1989), which allowed Dr. Kariadi Semarang Hospital and its Team of Experts (Sexual Adjustment Team) to perform sexual adjustment operations. Afterwards, on June 12th 1989, Dr. Kariadi Semarang Hospital formed a new team. Subsequently, the decree of Sexual Adjustment Team was modified in October 1st 1999 in conjunction with scientific developments, the retirement of some experts, and the need of additional members. The team realized that they needed to link up their members and changed policy for not performing an operation for transsexuals (person who is psychologically impaired without any physical, especially genital impairment), but only for intersexuals (person who is ill and needs sexual assignment and genital reconstruction). This decision caused another modification toward the decree of the Director of Dr. Kariadi SK No. YM 01.01 – 497 on May 19th 2003 with many staffs of CEBIOR involved in this team. Afterwards, CEBIOR played a role in laboratory diagnosis and recording patient’s data. Nowadays, by joint decree of the Director of Dr. Kariadi Hospital and the Dean of FMDU No.KP.08.02-514/100/FK/2006, Prof. dr. Sultana MH Faradz, PhD has been appointed as the current main leader of Sexual Adjustment Team.

The activities performed by Sexual Adjustment Team are bimonthly meetings, special multidisciplinary meetings for case discussion, clinical and laboratory examinations (including hormonal, cytogenetic, and molecular genetic examination), sexual adjustment operations, pre- and post-operative counseling, patient’s home visits by social worker, scientific meetings, collaboration with overseas, such as Radboud University Nijmegen Medical Centre, Nijmegen for diagnosis and Erasmus Medical Center, Rotterdam for diagnosis, research and management. We adopted the policy of Sexual Adjustment Team in Erasmus MC, Rotterdam with the expectation that this policy will receive national consensus. All members of the team have been working as volunteer and trying to raise funds to help poor patients especially for laboratory examination. Some economically middle-class and high-class patients also give some donations for poor (low economy class) patients.

Sexual Adjustment Team receives patients from some departments of Dr. Kariadi Semarang Hospital such as from Outpatient Department, Urology Department, Endocrinal Pediatric, Internal Medicine Department, and Obstetric & Gynecology Department. Besides, the team also accepts patients from other centers and private clinics in Semarang and its surroundings. Some patients come directly to the genetic clinic, CEBIOR, and are carried by each of the team members.

The team has settled a service system that is implicated to every patient. At the beginning, patients are referred to CEBIOR in order to complete their data (address, telephone number, etc) and execute several examinations such as physical, cytogenetic, DNA, and hormonal. If it is indicated, patient could also receive HCG injection at the same time. Afterwards, data will be sent to the Sexual Adjustment Team, which consists of experts from various disciplines. The team will discuss about the diagnosis, best management and therapy. This discussion is held monthly and involves several patients at one time. If it is necessary, patients will be discussed with Prof. Stenvert Drop, MD, PhD (Sexual Adjustment Team in EMC Rotterdam) for diagnosis, management, and further sample examination. Apparently, most of the patients come from low economy class. Hence, frequently the funds came from the team members’ collection. In other words, Sexual Adjustment Team is never and will never be a money oriented team. It stands to help others who need it.

The initiation of research collaboration on DSD was started with the seminar and workshop in 2004 by the visit of DSD team from Sophia Children Hosptal/Erasmus University Rotterdam. The delegation were Prof. Dr. Leendert Looijenga (molecular pathologist), Prof.Dr. Stenvert L.S. Drop (pediatric endocrinologist), Prof. Dr. Frank de Jong (molecular biochemist), Dr. Katja Wolffenbuttel (pediatric urologist), and Dr. Arianne Dessen (psychologist).
The initiation of research collaboration on DSD was started with the seminar and workshop in 2004 by the visit of DSD team from Sophia Children Hosptal/Erasmus University Rotterdam. The delegation were Prof. Dr. Leendert Looijenga (molecular pathologist), Prof.Dr. Stenvert L.S. Drop (pediatric endocrinologist), Prof. Dr. Frank de Jong (molecular biochemist), Dr. Katja Wolffenbuttel (pediatric urologist), and Dr. Arianne Dessen (psychologist).

Support Group

The existence of support group will provide essential reinforcement for patients. They will feel that they are not alone in facing these problems. There are others who also have the same issue to deal with. It will ease the psychological burden of the patients.  A patient support group called Forkis (Forum Komunikasi Intersex) has been established by some patients and the team members since 2007.  The team members initiated a cafetaria in FMDU campus with the support of the Dean FMDU and the Central Java governor as a meeting point for patients and families.

The bimonthly DSD team meeting with patients held in Dr. Kariadi Hospital. Patients and their family were invited to get genetic counseling and information about the diagnosis and management.
The Student cafetaria at the old campus nearby Dr.Kariadi hospital that organized by Patient support group.
The bimonthly DSD team meeting with patients held in Dr. Kariadi Hospital. Patients and their family were invited to get genetic counseling and information about the diagnosis and management.
The bimonthly DSD team meeting with patients. Some cases need to be discussed together between the team members.
The bimonthly DSD team meeting with patients. Some cases need to be discussed together between the team members.
The  Sexual Adjustment Team organized a meeting with some patients in CEBIOR along with  the visit of DSD Team from MCRI/  University of Melbourne, Australia (Asc. Prof Dr. Tiong Yang Tan, MD, DR. Aurore Bouty, MD, and DR. Katie Ayers) on 15 March 2017.
The Sexual Adjustment Team organized a meeting with some patients in CEBIOR along with the visit of DSD Team from MCRI/ University of Melbourne, Australia (Asc. Prof Dr. Tiong Yang Tan, MD, DR. Aurore Bouty, MD, and DR. Katie Ayers) on 15 March 2017.