Zaal Kikvidze Gender Reassignment

For specialized articles on surgical procedures, see Sex reassignment surgery (male-to-female) and Sex reassignment surgery (female-to-male).

Sex reassignment surgery or SRS (also known as gender reassignment surgery, gender confirmation surgery, genital reconstruction surgery, gender-affirming surgery, or sex realignment surgery) is the surgical procedure (or procedures) by which a transgender person's physical appearance and function of their existing sexual characteristics are altered to resemble that socially associated with their identified gender. It is part of a treatment for gender dysphoria in transgender people. Related genital surgeries may also be performed on intersex people, often in infancy. A 2013 statement by the United NationsSpecial Rapporteur on Torture condemns the nonconsensual use of normalization surgery on intersex people.[1][2]

The American Society of Plastic Surgeons (ASPS) calls this procedure Gender Confirmation Surgery or GCS.[3][4] Another term for SRS includes sex reconstruction surgery, and more clinical terms, such as feminizing genitoplasty or penectomy, orchiectomy, and vaginoplasty, are used medically for trans women, with masculinizing genitoplasty, metoidioplasty or phalloplasty often similarly used for trans men.

People who pursue sex reassignment surgery are usually referred to as transsexual (derived from "trans", meaning "across", "through", or "change", and "sexual", pertaining to the sexual characteristics—but not necessarily sexual actions—of a person).

While individuals who have undergone and completed SRS are sometimes referred to as transsexed individuals,[5] the term transsexed is not to be confused with the term transsexual, which may also refer to individuals who have not undergone SRS, yet whose anatomical sex may not match their psychological sense of personal gender identity.

Sex reassignment surgery performed on unconsenting minors (babies and children) may result in catastrophic outcomes (including PTSD and suicide—such as in the David Reimer case, following a botched circumcision) when the individual's sexual identity (determined by neuroanatomical brain wiring) is discrepant with the surgical reassignment previously imposed.[6][7][8]Milton Diamond at the John A. Burns School of Medicine, University of Hawaii recommended that physicians do not perform surgery on children until they are old enough to give informed consent, assign such infants in the gender to which they will probably best adjust, and refrain from adding shame, stigma and secrecy to the issue, by assisting intersexual people to meet and associate with others of like condition. Diamond considered the intersex condition as a difference of sex development, not as a disorder.[9][10]

Scope and procedures[edit]

The best known of these surgeries are those that reshape the genitals, which are also known as genital reassignment surgery or genital reconstruction surgery (GRS)- or bottom surgery (the latter is named in contrast to top surgery, which is surgery to the breasts; bottom surgery does not refer to surgery on the buttocks in this context). However, the meaning of "sex reassignment surgery" has been clarified by the medical subspecialty organization, the World Professional Association for Transgender Health (WPATH), to include any of a larger number of surgical procedures performed as part of a medical treatment for "gender dysphoria" or "transsexualism". According to WPATH, medically necessary sex reassignment surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation ... including breast prostheses if necessary, genital reconstruction (by various techniques which must be appropriate to each patient ...)... and certain facial plastic reconstruction."[11] In addition, other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial electrolysis.

A growing number of public and commercial health insurance plans in the United States now contain defined benefits covering sex reassignment-related procedures, usually including genital reconstruction surgery (MTF and FTM), chest reconstruction (FTM), breast augmentation (MTF), and hysterectomy (FTM).[12] In June 2008, the American Medical Association (AMA) House of Delegates stated that the denial to patients with gender dysphoria or otherwise covered benefits represents discrimination, and that the AMA supports "public and private health insurance coverage for treatment for gender dysphoria as recommended by the patient's physician."[13] Other organizations have issued similar statements, including WPATH,[14] the American Psychological Association,[15] and the National Association of Social Workers.[16]

Different SRS procedures[edit]

The array of medically indicated surgeries differs between trans women (male to female) and trans men (female to male). For trans women, genital reconstruction usually involves the surgical construction of a vagina, by means of penile inversion or the sigmoid colon neovagina technique; or, more recently, non-penile inversion techniques that provide greater resemblance to the genitals of cisgender women. For trans men, genital reconstruction may involve construction of a penis through either phalloplasty or metoidioplasty. For both trans women and trans men, genital surgery may also involve other medically necessary ancillary procedures, such as orchiectomy, penectomy, mastectomy or vaginectomy.

As underscored by WPATH, a medically assisted transition from one sex to another may entail any of a variety of non-genital surgical procedures, any of which are considered "sex reassignment surgery" when performed as part of treatment for gender identity disorder. For trans men, these may include mastectomy (removal of the breasts) and chest reconstruction (the shaping of a male-contoured chest), or hysterectomy and bilateral salpingo-oophorectomy (removal of ovaries and Fallopian tubes). For some trans women, facial feminization surgery, hair implants, and breast augmentation are also aesthetic components of their surgical treatment.


People with HIV or hepatitis C may have difficulty finding a surgeon able to perform successful surgery. Many surgeons operate in small private clinics that cannot treat potential complications in these populations. Some surgeons charge higher fees for HIV and hepatitis C-positive patients; other medical professionals assert that it is unethical to deny surgical or hormonal treatments to transsexuals solely on the basis of their HIV or hepatitis status.[17]

Other health conditions such as diabetes, abnormal blood clotting, ostomies, and obesity do not usually present a problem to experienced surgeons. The conditions do increase the anesthetic risk and the rate of post-operative complications. Surgeons may require overweight patients to reduce their weight before surgery, any patients to refrain from hormone replacement before surgery, and smoking patients to refrain from smoking before and after surgery. Surgeons commonly stipulate the latter regardless of the type of operation.

Potential future advances[edit]

See also: Transgender pregnancy, Uterus transplantation § Application on transgender women, and Male pregnancy § Humans

Medical advances may eventually make childbearing possible by using a donor uterus long enough to carry a child to term as anti-rejection drugs do not seem to affect the fetus.[18][19][20][21] The DNA in a donated ovum can be removed and replaced with the DNA of the receiver. Further in the future, stem cell biotechnology may also make this possible, with no need for anti-rejection drugs.

Standards of care[edit]

See also: Legal aspects of transgenderism

Sex reassignment surgery can be difficult to obtain, due to a combination of financial barriers and lack of providers. An increasing number of surgeons are now training to perform such surgeries. In many regions, an individual's pursuit of SRS is often governed, or at least guided, by documents called Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC). The most widespread SOC in this field is published and frequently revised by the World Professional Association for Transgender Health (WPATH, formerly the Harry Benjamin International Gender Dysphoria Association or HBIGDA). Many jurisdictions and medical boards in the United States and other countries recognize the WPATH Standards of Care for the treatment of transsexualism. For many individuals, these may require a minimum duration of psychological evaluation and living as a member of the target gender full-time, sometimes called the real life experience (RLE) (sometimes mistakenly referred to as the real life test (RLT)) before genital reconstruction or other sex reassignment surgeries are permitted.

Standards of Care usually give certain very specific "minimum" requirements as guidelines for progressing with treatment for transsexualism, including accessing cross-gender hormone replacement or many surgical interventions. For this and many other reasons, both the WPATH-SOC and other SOCs are highly controversial and often maligned documents among transgender patients seeking surgery. Alternative local standards of care exist, such as in the Netherlands, Germany, and Italy. Much of the criticism surrounding the WPATH/HBIGDA-SOC applies to these as well, and some of these SOCs (mostly European SOC) are actually based on much older versions of the WPATH-SOC. Other SOCs are entirely independent of the WPATH. The criteria of many of those SOCs are stricter than the latest revision of the WPATH-SOC. Many qualified surgeons in North America and many in Europe adhere almost unswervingly to the WPATH-SOC or other SOCs. However, in the United States many experienced surgeons are able to apply the WPATH SOC in ways which respond to an individual's medical circumstances, as is consistent with the SOC.

Most surgeons require two letters of recommendation for sex reassignment surgery. At least one of these letters must be from a mental health professional experienced in diagnosing gender identity disorder, who has known the patient for over a year. Letters must state that sex reassignment surgery is the correct course of treatment for the patient.[22][23]

Many medical professionals and numerous professional associations have stated that surgical interventions should not be required in order for transsexual individuals to change sex designation on identity documents.[24] However, depending on the legal requirements of many jurisdictions, transsexual and transgender people are often unable to change the listing of their sex in public records unless they can furnish a physician's letter attesting that sex reassignment surgery has been performed. In some jurisdictions legal gender change is prohibited in any circumstances, even after genital or other surgery or treatment.

Quality of life and physical health[edit]

Patients of sex reassignment surgery may experience changes in their physical health and quality of life, the side effects of sex steroid treatment. Hence, transgender people should be well informed of these risks before choosing to undergo SRS.[5]

Several studies tried to measure the quality of life and self-perceive physical health using different scales. Overall, transsexual people have rated their self-perceived quality of life as ‘normal’ or ‘quite good’, however, their overall score was still lower than the control group.[25] Another study showed a similar level of quality of life in transsexual individuals and the control group.[26] Nonetheless, a study with long-term data suggested that albeit quality of life of patients 15 years after sex reassignment surgery is similar to controls, their scores in the domains of physical and personal limitations were significantly lower.[5][27] On the other hand, research has found that quality of life of transsexual patients could be enhanced by other variables. For instance, trans men obtained a higher self-perceived health score than women because they had a higher level of testosterone than them. Trans women who had undergone face feminization surgery have reported higher satisfaction in different aspects of their quality of life, including their general physical health.[28]

Looking specifically at transsexual’s genital sensitivities, trans men and trans women are capable of maintaining their genital sensitivities after SRS. However, these are counted upon the procedures and surgical tricks which are used to preserve the sensitivity. Considering the importance of genital sensitivity in helping transsexual individuals to avoid unnecessary harm or injuries to the genitals, allowing trans men to obtain an erection and perform the insertion of the erect penile prosthesis after phalloplasty,[29] the ability for transsexual to experience erogenous and tactile sensitivity in their reconstructed genitals is one of the essential objectives surgeons want to achieve in SRS[29][30] Moreover, studies have also found that the critical procedure for genital sensitivity maintenance and achieving orgasms after phalloplasty is to preserve both the clitoris hood and the clitoris underneath the reconstructed phallus.[29][30]

Erogenous Sensitivity is measured by the capabilities to reach orgasms in genital sexual activities, like masturbation and intercourse.[29] Many studies reviewed that both trans men and trans women have reported an increase of orgasms in both sexual activities,[31][5] implying the possibilities to maintain or even enhance genital sensitivity after SRS.

Psychological and social consequences[edit]

This article or section appears to contradict itself. Please see the talk page for more information.(April 2016)

After sex reassignment surgery, transsexuals (people who underwent cross-sex hormone therapy and sex reassignment surgery) tend to be less gender dysphoric. They also normally function well both socially and psychologically. Anxiety, depression and hostility levels were lower after sex reassignment surgery.[32] They also tend to score well for self-perceived mental health, which is independent from sexual satisfaction.[31] Many studies have been carried out to investigate satisfaction levels of patients after sex reassignment surgery. In these studies, most of the patients have reported being very happy with the results and very few of the patients have expressed regret for undergoing sex reassignment surgery.[33]

Although studies have suggested that the positive consequences of sex reassignment surgery outweigh the negative consequences,[34] It has been suggested that most studies investigating the outcomes of sex reassignment surgery are flawed as they have only included a small percentage of sex reassignment surgery patients in their studies.[35] These methodological limitations such as lack of double-blind randomised controls, small number of participants due to the rarity of transsexualism, high drop-out rates and low follow-up rates,[36] which would indicate need for continued study.

Persistent regret can occur after sex reassignment surgery. Regret may be due to unresolved gender dysphoria, or a weak and fluctuating sense of identity, and may even lead to suicide.[37] During the process of sex reassignment surgery, transsexuals may become victims of different social obstacles such as discrimination, prejudice and stigmatising behaviours.[38] The rejection faced by transsexuals is much more severe than what is experienced by LGB individuals.[39] The hostile environment may trigger or worsen internalised transphobia, depression, anxiety and post-traumatic stress.[40]

Many patients perceive the outcome of the surgery as not only medically but also psychologically important. Social support can help them to relate to their minority identity, ascertain their trans identity and reduce minority stress.[38] Therefore, it is suggested that psychological support is crucial for patients after sex reassignment surgery, which helps them feel accepted and have confidence in the outcome of the surgery; also, psychological support will become increasingly important for patients with lengthier sex reassignment surgery process.[38]

Sexual satisfaction[edit]

The majority of the transsexual individuals have reported enjoying better sex lives and improved sexual satisfaction after sex reassignment surgery.[5] The enhancement of sexual satisfaction was positively related to the satisfaction of new primary sex characteristics.[5] Before undergoing SRS, transsexual patients possessed unwanted sex organs which they were eager to remove. Hence, they were frigid and not enthusiastic about engaging in sexual activity. In consequence, transsexuals individuals who have undergone SRS are more satisfied with their bodies and experienced less stress when participating in sexual activity.[5]

Most of the individuals have reported that they have experienced sexual excitement during sexual activity, including masturbation.[5] The ability to obtain orgasms is positively associated with sexual satisfaction.[31] Frequency and intensity of orgasms are substantially different among transsexual men and transsexual women. Almost all female-to-male individuals have revealed an increase in sexual excitement and are capable of achieving orgasms through sexual activity with a partner or via masturbation,[5][41] whereas only 85% of the male-to-female individuals are able to achieve orgasms after SRS.[42] A study found that both transmen and transwomen reported that they had experienced transformation in their orgasms sensuality. The female-to-male transgender individuals reported that they had been experiencing intensified and stronger excitements while male-to-female individuals have been encountering longer and more gentle feelings.[5]

The rates of masturbation have also changed after sex reassignment surgery for both trans women and trans men. A study reported an overall increase of masturbation frequencies exhibited in most transsexual individuals and 78% of them were able to reach orgasm by masturbation after SRS.[31][5][43] A study showed that there were differences in masturbation frequencies between trans men and trans women, in which female-to-male individuals masturbated more often than male to female[5] The possible reasons for the differences in masturbation frequency could be associated with the surge of libido, which was caused by the testosterone therapies, or the withdrawal of gender dysphoria.[31]

Concerning transsexuals’ expectations for different aspects of their life, the sexual aspects have the lowest level of satisfaction among all other elements (physical, emotional and social levels).[43] When comparing transsexuals with biological individuals of the same gender, trans women had a similar sexual satisfaction to biological women, but trans men had a lower level of sexual satisfaction to biological men. Moreover, trans men also had a lower sexual satisfaction with their sexual life than trans women.[31]

At birth[edit]

Main article: Sex assignment § Assignment in cases of infants with intersex traits, or cases of trauma

Infants born with intersex conditions might undergo interventions at or close to birth.[44] This is controversial because of the human rights implications.[45][46]

Society and culture[edit]

The Iranian government's response to homosexuality is to endorse, and fully pay for, sex reassignment surgery.[47] The leader of Iran's Islamic Revolution, Ayatollah Ruhollah Khomeini, issued a fatwa declaring sex reassignment surgery permissible for "diagnosed transsexuals".[47] Eshaghian's documentary, Be Like Others, chronicles a number of stories of Iranian gay men who feel transitioning is the only way to avoid further persecution, jail, or execution.[47] The head of Iran's main transsexual organization, Maryam Khatoon Molkara—who convinced Khomeini to issue the fatwa on transsexuality—confirmed that some people who undergo operations are gay rather than transsexual.[48]

Thailand is the country that performs the most sex reassignment surgeries, followed by Iran.[48]

India is offering affordable sex reassignment surgery to a growing number of medical tourists.[49]

In 2017, the United StatesDefense Health Agency for the first time approved payment for sex reassignment surgery for an active-duty U.S. military service member. The patient, an infantry soldier who identifies as a woman, had already begun a course of treatment for gender reassignment. The procedure, which the treating doctor deemed medically necessary, was performed on November 14 at a private hospital, since U.S. military hospitals lack the requisite surgical expertise.[50]


In Berlin in 1931, Dora Richter, became the first known transgender woman to undergo the vaginoplasty[51] surgical approach.

This was followed by Lili Elbe in Dresden during 1930–1931. She started with the removal of her original sex organs, the operation supervised by Dr. Magnus Hirschfeld. Lili went on to have four more subsequent operations that included an unsuccessful uterine transplant, the rejection of which resulted in death. An earlier known recipient of this was Magnus Hirschfeld's housekeeper,[52] but their identity is unclear at this time.

On 12 June 2003, the European Court of Human Rights ruled in favor of Van Kück, a German trans woman whose insurance company denied her reimbursement for sex reassignment surgery as well as hormone replacement therapy. The legal arguments related to the Article 6 of the European Convention on Human Rights as well as the Article 8. This affair is referred to as Van Kück vs Germany.[53]

In 2011, Christiane Völling won the first successful case brought by an intersex person against a surgeon for non-consensual surgical intervention described by the International Commission of Jurists as "an example of an individual who was subjected to sex reassignment surgery without full knowledge or consent".[54]

As of 2017 some European countries, mostly eastern, require forced sterilisation for the legal recognition of sex reassignment.[55]

See also[edit]


  1. ^Report of the UN Special Rapporteur on Torture, Office of the UN High Commissioner for Human Rights, February 2013.
  2. ^Center for Human Rights & Humanitarian Law; Washington College of Law; American University (2014). Torture in Healthcare Settings: Reflections on the Special Rapporteur on Torture's 2013 Thematic Report. Washington, DC: Center for Human Rights & Humanitarian Law. 
  3. ^"Gender Confirmation Surgeries". American Society of Plastic Surgeons. Retrieved 2017-08-07. 
  4. ^"About ASPS". American Society of Plastic Surgeons. Retrieved 2017-08-07. 
  5. ^ abcdefghijklDe Cuypere, G.; TSjoen, G.; Beerten, R.; Selvaggi, G.; De Sutter, P.; Hoebeke, P.; Monstrey, S.; Vansteenwegen, A.; Rubens, R. (2005). "Sexual and Physical Health After Sex Reassignment Surgery". Archives of Sexual Behavior. 34 (6): 679–690. doi:10.1007/s10508-005-7926-5. PMID 16362252. 
  6. ^Boyle, G.J.(2005). The scandal of genital mutilation surgery on infants (pp. 95-100). In L. May (Ed.), Transgenders and Intersexuals, Bowden, South Australia: Fast Lane (imprint of East Street Publications). ISBN 1-9210370-7-5ISBN 9-780975-114544
  7. ^Colapinto, J. (2002). As Nature Made Him: The Boy Who Was Raised as a Girl. Sydney: Harper Collins Publishers. ISBN 0-7322-7433-8ISBN 9-780732-274337
  8. ^"Sexual Identity, Monozygotic Twins Reared in Discordant Sex Roles and a BBC Follow-Up". Milton Diamond, Ph.D. Retrieved 1 August 2011. 
  9. ^Diamond, Milton; Sigmundson, H. Keith (October 1997). "Management of intersexuality. Guidelines for dealing with persons with ambiguous genitalia". Arch Pediatr Adolesc Med. 151 (10): 1046–50. doi:10.1001/archpedi.1997.02170470080015. PMID 9343018. Retrieved 24 April 2013. 
  10. ^Diamond, Milton; Beh, Hazel. (2008). "Changes In Management Of Children With Differences Of Sex Development". Nature Clinical Practice Endocrinology & Metabolism. 4 (1): 4–5. 
  11. ^see WPATH "Clarification on Medical Necessity of Treatment, sex Reassignment, and Insurance Coverage in the U.S." available at: "Archived copy"(PDF). Archived from the original(PDF) on 2011-09-30. Retrieved 2011-10-07. 
  12. ^See discussion of insurance exclusions at:
  13. ^AMA Resolution 122 "Removing Financial Barriers to Care for Transgender Patients". see:
  14. ^See WPATH Clarification Statement
  15. ^APA Policy Statement Transgender, Gender Identity, and Gender Expression Non-Discrimination. See online at:
  16. ^NASW Policy Statement on Transgender and Gender Identity Issues, revised August 2008. See
  17. ^See WPATH Standards of Care, also WPATH Clarification.
  18. ^Doctors plan uterus transplants to help women with removed, damaged wombs have babies. Associated Press.
  19. ^Fageeh, W.; Raffa, H.; Jabbad, H.; Marzouki, A. (2002). "Transplantation of the human uterus". International Journal of Gynecology & Obstetrics. 76 (3): 245–251. doi:10.1016/S0020-7292(01)00597-5. PMID 11880127. 
  20. ^Del Priore, G.; Stega, J.; Sieunarine, K.; Ungar, L.; Smith, J. R. (2007). "Human Uterus Retrieval From a Multi-Organ Donor". Obstetrics & Gynecology. 109 (1): 101–104. doi:10.1097/01.AOG.0000248535.58004.2f. PMID 17197594. 
  21. ^Nair, A.; Stega, J.; Smith, J. R.; Del Priore, G. (2008). "Uterus Transplant: Evidence and Ethics". Annals of the New York Academy of Sciences. 1127 (1): 83–91. Bibcode:2008NYASA1127...83N. doi:10.1196/annals.1434.003. PMID 18443334. 
  22. ^"Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People"(PDF). Archived from the original(PDF) on September 20, 2012. Retrieved 2013-10-31. 
  23. ^"WPATH Standards of Care". 2003-12-17. Retrieved 2014-08-11. 
  24. ^See WPATH Clarification Statement, APA Policy Statement, and NASW Policy Statement
  25. ^Gómez-Gil, Esther; Zubiaurre-Elorza, Leire; Antonio, Isabel Esteva de; Guillamon, Antonio; Salamero, Manel (2013-08-13). "Determinants of quality of life in Spanish transsexuals attending a gender unit before genital sex reassignment surgery". Quality of Life Research. 23 (2): 669–676. doi:10.1007/s11136-013-0497-3. ISSN 0962-9343. PMID 23943260. 
  26. ^Castellano, E.; Crespi, C.; Dell’Aquila, C.; Rosato, R.; Catalano, C.; Mineccia, V.; Motta, G.; Botto, E.; Manieri, C. (2015-10-20). "Quality of life and hormones after sex reassignment surgery". Journal of Endocrinological Investigation. 38 (12): 1373–1381. doi:10.1007/s40618-015-0398-0. ISSN 1720-8386. PMID 26486135. 
  27. ^Kuhn, Annette; Bodmer, Christine; Stadlmayr, Werner; Kuhn, Peter; Mueller, Michael D.; Birkhäuser, Martin (2009). "Quality of life 15 years after sex reassignment surgery for transsexualism". Fertility and Sterility. 92 (5): 1685–1689.e3. doi:10.1016/j.fertnstert.2008.08.126. PMID 18990387. 
  28. ^Ainsworth, Tiffiny A.; Spiegel, Jeffrey H. (2010-05-12). "Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery". Quality of Life Research. 19 (7): 1019–1024. doi:10.1007/s11136-010-9668-7. ISSN 0962-9343. PMID 20461468. 
  29. ^ abcdSelvaggi, G., Monstrey, S., Ceulemans, P., T'Sjoen, G., De Cuypere, G., & Hoebeke, P. (2007). "Genital sensitivity after sex reassignment surgery in transsexual patients". Annals of Plastic Surgery. 58 (4): 427–433. doi:10.1097/ PMID 17413887. 
  30. ^ abHage, J. J., Bouman, F. G., De Graaf, F. H., & Bloem, J. J. (1993). "Construction of the neophallus in female-to-male transsexuals: the Amsterdam experience". The Journal of Urology. 149 (6): 1463–1468. doi:10.1016/S0022-5347(17)36416-9. PMID 8501789. 
  31. ^ abcdefWierckx, K.; Van Caenegem, E.; Elaut, E.; Dedecker, D.; Van de Peer, F.; Toye, K.; Hoebeke, P.; Monstrey, S.; De Cuypere, G.; T’Sjoen, G. (2011). "Quality of life and sexual health after sex reassignment surgery in transsexual men". The Journal of Sexual Medicine. 8 (12): 3379–3388. doi:10.1111/j.1743-6109.2011.02348.x. PMID 21699661. 
  32. ^Smith, Y. L. S.; Van Goozen, S. H. M.; Cohen-Kettenis, P. T. (2001). "Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: a prospective follow-up study". Journal of the American Academy of Child & Adolescent Psychiatry. 40 (4): 472–481. doi:10.1097/00004583-200104000-00017. 
  33. ^Lawrence, A. A. (2003). "Factors associated with satisfaction or regret following male-to-female sex reassignment surgery". Archives of Sexual Behavior. 32 (4): 299–315. doi:10.1023/A:1024086814364. PMID 12856892. 
  34. ^Monstrey, S.; Vercruysse Jr., H.; De Cuypere, G. (2009). "Is Gender Reassignment Surgery Evidence Based? Recommendation for the Seventh Version of the WPATH Standards of Care". International Journal of Transgenderism. 11 (3): 206–214. doi:10.1080/15532730903383799.

Loss of traditional knowledge aggravates wolf–human conflict in Georgia (Caucasus) in the wake of socio-economic change

4D Research Institute, Ilia State University, Room 310, Building E, 5 Cholokashvili Ave., 0162 Tbilisi, Georgia

4D Research Institute, Ilia State University, F building, room # 311, 5, Cholokashvili Str., 0162 Tbilisi, Georgia

Zaal Kikvidze, Phone: +995 32 294 197, Email: eg.ude.inuaili@ezdivkik.laaz.

Corresponding author.

Author information ►Article notes ►Copyright and License information ►

Received 2014 Sep 10; Revised 2014 Nov 3; Accepted 2014 Nov 6.

Copyright © Royal Swedish Academy of Sciences 2014

This article has been cited by other articles in PMC.


Reports of the damage from wolf attacks have increased considerably over the last decade in Georgia (in the Caucasus). We interviewed locals about this problem in two focal regions: the Lanchkhuti area (in western Georgia) and Kazbegi District (in eastern Georgia) where livestock numbers had increased by an order of magnitude owing to dramatic shifts in the local economies over the last decade. This coincided with expanding habitats for wolves (abandoned plantations, for example). We found that the perceived damage from wolves was positively correlated with a poor knowledge of wolf habits and inappropriate livestock husbandry practices. Our results suggest a loss of traditional knowledge contributes strongly to the wolf–human conflicts in Georgia. Restoring traditional, simple but good practices—such as protecting herds using shepherd dogs and introducing bulls into the herds—can help one solve this problem.

Electronic supplementary material

The online version of this article (doi:10.1007/s13280-014-0580-1) contains supplementary material, which is available to authorized users.

Keywords: Carnivore–human conflicts, Wolves, Livestock husbandry, Socio-ecological studies, Traditional knowledge, Georgia


Conflicts between humans and wolves are common in countries where there are sizable populations of this species (e.g. Bisi et al. 2007; Balčiauskas 2008). Georgia is one such country where the existence of viable wolf populations, genetically connected to populations in neighbouring countries, is well documented (Kopaliani et al. 2014; Pilot et al. 2014). The last decade has seen a sharp increase in complaints on wolves killing livestock and even attacking humans in rural Georgia (Kopaliani et al. 2009). Here we explore the problem of intensified wolf–human conflicts in two focal regions of Georgia: (1) an area in western Georgia around Lanchkhuti which includes villages in Guria, Imereti, and Adjara provinces, and (2) Kazbegi District in eastern Georgia (Electronic Supplementary Material, Fig. S1). The climates of these two regions contrast markedly: the villages of the Lanchkhuti area enjoy a warm temperate maritime climate that allows oranges and tea to be grown, whilst the villages of Kazbegi District are situated in the subalpine zone, where the main crop is potatoes. Nevertheless, both focal regions have undergone dramatic changes in their economies after the collapse of the Soviet Union, and we have hypothesized that these changes could be a considerable contributor to increased conflicts between wolves and humans.

Comparing these two regions with their contrasting climate, and hence different types of local economies, can help in revealing general drivers of wolf–human conflicts in Georgia (Stimson 2014). Despite the differences, the two regions also show several similar characteristics. Firstly, beginning with the 1970s, the local economies became specialized and export-oriented. In the Lanchkhuti area, growing mandarin oranges and tea for export to Russia became the single-most important source of income. At the same time, Kazbegi District became a corridor for the gas pipeline connecting Russia to Armenia. Villages along the pipeline were supplied with free gas, and this prompted locals to build gas-heated greenhouses and grow strawberries and vegetables to export to Russia. As a result of economic specialization, the villagers in both regions often abandoned livestock husbandry. In the early years of this millennium, Russia closed the market for Georgian agricultural goods, and free gas was no longer available for greenhouses. The export-oriented economies both in the Lanchkhuti area and Kazbegi District collapsed and villagers switched back to livestock husbandry. Cattle numbers correspondingly increased about tenfold (Tevzadze 2009). At the time of our fieldwork, a farmer in the Lanchkhuti area typically owned 10–15 heads of livestock, almost entirely cows. In Kazbegi District, a farmer typically owned about 50–100 heads of livestock, mostly cows (ca. 80 %), sheep (up to 15 %), horses (up to 4 %) and very few donkeys (less than 1 %). Before the economic switch in the Lanchkhuti area, the tea farmers owned only one or two cows. Similarly, before the economic shift in Kazbegi District, greenhouse farmers owned no more than one or two cows and no sheep at all.

Secondly, both regions have seen considerably increased numbers of wolves (Kopaliani et al. 2009; Tevzadze 2009). Villagers in the Lanchkhuti area stated that they had found traces of a wolf presence in places where it had been absent for the last 50–60 years, and the re-appearance of wolves had become especially noticeable and frequent over the last 5 years. An increase in suitable habitats for wolves was documented in both regions (Electronic Supplementary Material, Figs. S2, S3). In the Lanchkhuti area, these are abandoned tea plantations, while in Kazbegi District, these are thickets of the common buckthorn (Hippophae rhamnoides). Actually, wolves had never been spotted near the greenhouses or tea plantations before the economic shift, and once the farmers had switched back to livestock husbandry and the number of cattle had started to increase, wolves became a problem. The wolves that attacked livestock lived close to pastures and villages, and damaged mostly the converted farms. The abandoned tea plantations or buckthorn thickets are close to these farms, and only they suffered from increased wolf attacks.

Last, but not the least: in both regions, there were villages with poor roads where the export-oriented economy was not feasible, and livestock husbandry had remained the main traditional occupation of the inhabitants. The livestock of these traditional farmers did not increase, and this provided us a reference baseline to see whether increased wolf–human conflicts were widespread or, rather, related to cases of switching back to livestock husbandry.

We designed a semi-structured questionnaire and interviewed villagers of the Lanchkhuti area and of Kazbegi District. We hypothesized that the change in local economies, from exported agricultural goods to subsistence livestock production, was associated with the increase in wolf–human conflicts. Our secondary hypothesis was that the impact of agricultural change was greater for households without a cultural tradition of livestock husbandry (e.g. the use of large shepherd dogs and bulls to deter predators).

Materials and methods

We conducted our study in 2008–2009. Respondents were interviewed face-to-face by the research team members, and semi-structural questionnaire forms were completed at these meetings (Wengraf 2001). The questionnaire consisted of four parts: the first contained usual questions of a demographic character (age, education, gender, income). The second was designed to assess (1) respondent’s knowledge of wolf behaviour and (2) his/her fear of wolves (Electronic Supplementary Material). The third part asked respondents to assess the damage from wolves in terms of lost animals (sheep, cows, horses and donkeys) and the number of dogs killed by wolves. Finally, the fourth part of the questionnaire collected data about the history and practice of livestock husbandry (whether the respondent’s family had recently switched or not to livestock husbandry from another business, what size of dogs they owned (small, mid-sized or large shepherd dogs), and whether there were bulls in the herds. Farmers interviewed usually represented their own family except in assessing of the damage to cattle from wolf attacks. In the latter case, they would rather refer to the damage per village. These data were used by us as an assessment of the perceived damage from wolves. Some of the farmers also added the damage to their own farms, but the data were incomplete and we did not use them.

We constructed a socio-ecological data matrix from the completed questionnaires. Quantitative data (age, income, damage expressed as the numbers of lost livestock/dogs) were entered into the matrix as numbers without any transformations. Qualitative data and assessments were quantified as follows. The presence and the size of owned dogs were described with a four-grade scale (no dog = 0, small dog = 1, mid-sized = 2 and large shepherd = 3). Respondents were either school leavers (=1) or university graduates (=2). Fear of wolves was assessed with a five-grade scale (very low = 1 to very high = 5). A knowledge of wolf behaviour was similarly assessed on a five-grade scale (very poor = 1 to very good = 5). The data as to whether respondent’s family switched to livestock husbandry recently from another business, or whether it was their traditional activity were entered as a binary variable (traditional = 0 and switch = 1).

The socio-ecological data matrix was used to calculate descriptive statistics and the Pearson correlation coefficients among the socio-ecological variables. All statistical analyses were conducted using the Statistix 9 program (Analytical Software, Tallahassee, FL, USA).

In subsequent years, we revisited the study areas and met with some of the farmers who were interviewed during 2008–2009. We asked their opinion about the wolf problem in their region, and used these opinions to monitor how the human–wolf conflict was developing in the focal regions.


We completed a total of 34 semi-structured questionnaires from the villages of east and west Georgia. In western Georgian villages, we interviewed eight respondents whose families had switched from growing tea and mandarin oranges to livestock husbandry, while another six families from the same region had maintained traditional livestock husbandry. In eastern Georgia, sixteen families had switched from greenhouse business to livestock husbandry, whilst another four families had maintained traditional livestock husbandry. The mean age of respondents was 46 ± 13 SD years, the oldest being 80 and the youngest 16 years old. On average, respondents estimated the damage to his/her village as 36 ± 37 SD heads of cattle, minimum and maximum ranging from zero to 156 for the last year. The mean number of lost dogs was 2 ± 2 SD, the minimum and maximum ranging zero to ten. Five respondents did not keep any dog, whilst others were owners of small dogs (seventeen respondents), mid-sized (three respondents) or large ‘shepherd’ dogs (nine respondents). The analysis of the responses to the questions showed that the knowledge of wolf behaviour ranged from very poor to very good and, similarly, fear of wolves also ranged from very low to very high (see below). Mean income was stated as less than 500 Georgian Laris (GEL) by eastern Georgian respondents and below 150 GEL by western Georgian respondents. Usually, there were 20–50 livestocks per dog (irrespective of dog size).

The demographic data (age, education), the husbandry history (switch or traditional livestock husbandry), respondents’ perceptions of increased loss of cattle (estimated numbers of lost animals and dogs, fear of wolves) and management styles (dog size, the knowledge of wolf behaviour) correlated with each other in distinct ways (Table 1). The switch to livestock husbandry, the fear of wolves and perceived damage showed a strong positive correlation with each other. The correlation between knowledge of wolf behaviour and the owned dog size was also positive and tight, yet these two variables correlated strongly and negatively with the switch to husbandry, fear of wolves and the perceived damage. There were other cases of significant (albeit not so strong) correlations: education correlated positively with age, the number of lost dogs and the switch to livestock husbandry; the number of lost dogs also correlated positively with a fear of wolves but negatively with a knowledge of wolf behaviour (Table 1).

Table 1

Correlation matrix of socio-ecological variables in Kazbegi District, Republic of Georgia. Only statistically significant values (Pearson’s correlation) are shown where bold characters highlight strong links (correlation coefficient >0.5)....

The results of correlation analyses indicated clusters of variables that were highly associated with the socio-economic switch from an export to a local economy (Fig. 1). Specifically, we can distinguish two groups of variables that strongly correlated with the perceived damage from wolves and with each other. First, a fear of wolves and the switch to livestock husbandry correlated positively with the damage from wolves; second, the dog size and the knowledge of wolf behaviour correlated negatively with the damage from wolves. This grouping of variables reflects that, overall, the socio-ecological profile of respondents that switched recently to livestock husbandry differed strikingly from that of the respondents who had maintained husbandry traditions unbroken (Fig. 2). The two groups were comparable in age and education, yet respondents who switched recently to livestock husbandry reported overwhelmingly more damage from wolves, kept smaller dogs, showed a much greater fear of wolves and much less knowledge of wolf habits, and all the lost dogs belonged to them. In contrast, the respondents who retained an unbroken tradition of livestock husbandry reported no perceived increase in damage from wolves, kept large-sized dogs and bulls among their cattle, showed less fear of wolves and a much better knowledge of their habits, and did not report any lost dogs (Fig. 2). While respondents who switched recently to livestock husbandry easily appreciated the importance of shepherd dogs for cattle protection, the role of bulls was not so obvious to them. In contrast, the respondents who kept to traditional livestock husbandry explained that bulls can protect their herds from wolf attacks by causing cows to remain in closer proximity to each other. Experienced herders installed one bull in each group of cows and the bulls protected them from wolves simply by keeping the cows together (all the owners of large shepherd dogs were those who also kept bulls in the herds).

Fig. 1

Schematic representation of the interplay among the socio-ecological variables. Solid and dashedarrows refer to positive and negative correlations, respectively. Two groups of positively correlated variables can be distinguished that (1) increase the...

Fig. 2

Socio-ecological profiles of two groups of villagers; Traditional—families that retained the unbroken livestock husbandry tradition; Converted—families that switched to livestock husbandry recently from other businesses. Variables are...


Our findings show that a poor understanding of wolf behaviour and poor livestock management constitute a considerable part of the problem in wolf–human conflicts in Georgia. Negative attitudes towards large carnivores, particularly wolves, have complicated efforts to restore predator populations in Scandinavia (Røskaft et al. 2007; Bisi et al. 2007). Village dwellers are usually those who have strongly negative attitudes (Balčiauskas et al. 2005). Poor knowledge of habits and behaviour of large carnivores can be one driver of those attitudes, along with a high probability of wolf–human conflicts where an increased number of livestock meets wolf populations (Røskaft et al. 2003). However, our study shows that the problem is not fear of wolves per se, but the poor practices of livestock management. This is highlighted by the contrast between the villagers who kept an unbroken tradition of livestock husbandry and those who switched to livestock husbandry recently after the economic crisis. The respondents who kept to traditional livestock husbandry did not report any increased damage from wolves, used shepherd dogs to protect their cattle, and installed bulls in the herds. Conversely, the respondents who shifted to livestock husbandry recently were those who reported increased damage from wolves but did not use shepherd dogs (hence the negative correlation between dog size and perceived damage by wolves) and did not keep any bulls. The poor knowledge and practice of livestock husbandry by this group of respondents can be explained by the recent economic history of these regions. Previously, livestock husbandry was a small part of the local economy when the major agricultural activity was production of export crops, e.g. tea in the Lanchkhuti area and greenhouse vegetables in Kazbegi District. Cattle (if any) were kept almost all the time at or near the home, and there was little need to protect them in pastures. Hence, the use of shepherd dogs was discontinued and bulls were considered ‘useless’ by these families. The crisis and the resulting shift of major economic activity to livestock husbandry brought about a dramatically increased numbers of cattle in both regions, but this increase happened without changing habits of cattle care. In other words, these villagers ‘had forgotten’ how to protect their cattle, and they did not acquire shepherd dogs or install bulls in the herds even though livestock husbandry became the most valuable part of their economy. Similar problems of poor management associated with increased damage to livestock from wolves have also been reported from elsewhere—in particular from southern Italy (Meriggi and Lovari 1996; Ciucci and Boitani 1998). Complaints about wolf attacks in Georgia started to appear after 2003, the ‘pivotal’ year of the economic switch. This coincided with an increase in livestock and suggests an apparent correlation with herd sizes. However, we did not analyse this correlation quantitatively because data on the size of owned herds was not reliable as the respondents were reluctant to disclose precise numbers.

Traditional farmers used to keep their herds on the pastures for months, led by bulls. In the evenings, farmers took only the milch cows back home accompanied by shepherd dogs, and this movement of cows from pasture to villages occurred without wolf attacks. In contrast to this, the converted farmers organized ‘herding’ (either hiring other villagers as herders, or sharing the duties among themselves), but this measure was insufficient, and their herds mostly suffered from wolf attacks during the evenings when returning from pastures in conditions of poor visibility. Wolf attacks also occurred in these villages at nights, as small dogs could not defend livestock against wolves. Moreover, small dogs would hide if they detected wolves nearby. Hence, the protection afforded by dogs depended on their size. Large dogs were kept at home during the day, but they protected the farm and livestock at night. Small dogs followed their owners all the time but were not able to protect the herd.

Apparently, owning shepherd dogs and bulls can effectively reduce damage from wolves. Actually, this can be the main avenue to improve livestock’s defence against wolves, and the experience of the farmers who kept traditional livestock husbandry shows that the conflict between wolves and humans can be managed. Conservationists (in a broad sense) can also contribute to solving these conflicts. Wolf populations can be monitored closely in order to reveal and remove the ‘problematic individuals’ who specialize in hunting livestock and attacking humans (Linnell et al. 1999, 2003; Löe and Röskaft 2004).

Soon after our study (specifically, in 2011), construction of a cascade of hydroelectric stations began along the river Tergi and its tributaries in Kazbegi District. Later, two large landslides occurred which blocked the main roads in 2014. The construction works and landslides severely disturbed the new wolf habitats (buckthorn thickets) and, apparently, wolves left the vicinities of villages. As a result, wolf attacks on livestock sharply decreased over the last 2–3 years, and the converted farmers have lost their motivation to change their husbandry practices. We suggest that after the completion of construction works, the wolves will be back, and the conflict between them and the converted farmers will restart. In the Lanchkhuti area, however, the situation is different: the converted farmers (at least those who took part in our study) are starting to introduce large shepherd dogs to protect their herds. Accordingly, the reports on wolf attacks are apparently reducing. We suggested to the local authorities as well as non-governmental groups an organized campaign to accelerate the implementation of appropriate husbandry practices among the converted farmers. So far, the response from these stakeholders appears to be slow.


Our work highlights the importance of traditional knowledge for carnivore–human relationships. Socio-economic shifts are possible in any part of the world where carnivores and farmers cohabit, and one driver of the increased conflicts between the predators and farmers can be just a poor knowledge of wolf behaviour and of the lost traditions of husbandry. Yet this problem can become easily manageable by restoring good practices based on simple traditional measures of cattle protection such as owning large shepherd dogs and bulls.


The authors are grateful to the Georgian Rustaveli Foundation 2007 project “Human and Wolf Conflict in Georgia”; They offer their thanks to Natia Kopaliani and Zurab Gurielidze for valuable advices and participation in data collection and ecological surveys. Also, the authors thank Keti Rcheulishvili for her effective help in conducting interviews. We express special thanks to Jason Badridze, the pioneer of studies on wolf behaviour in Georgia; without his contribution and commitment to the wolves, our involvement would be impossible.


Zaal Kikvidze

is a professor of interdisciplinary studies at the 4D Research Institute of Ilia State University, Tbilisi, Georgia (Caucasus). His research interests include plant and animal community ecology, environmental education and ethnoecology.

Gigi Tevzadze

is a professor of interdisciplinary studies at the 4D Research Institute of Ilia State University, Tbilisi, Georgia (Caucasus). His research interests include ecological and sociological studies, philosophy and political anthropology and evolution of human behaviour.


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