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A former RAF navigator has become the oldest person in Britain to have sex change surgery – at the age of 81.

The NHS op for Ruth Rose, once a man named James, drew criticism because of her age. But she said: “I always knew I was in the wrong body.”

Ruth has only one regret about her sex change – she ­wishes she had bigger boobs.

But the oldest Briton to have gender ­realignment surgery is otherwise delighted with life as a woman.

After longing to be female since the age of nine, Ruth finally achieved her wish this summer – in an operation on the NHS which is bound to spark controversy.

She used to be James, a divorced father of three and grandfather of four.

But she started living as Ruth four years ago and then began having female hormone therapy.

The final stage of her transformation – removal of the male sex organs – took place in July.

Ruth is aware that she will ­attract ­criticism. But she insisted: “You get people who can’t keep slim or who smoke and have all the related health issues – but the NHS will still treat them.

“They would operate on someone who had a great bulge on their cheek. It might not be malignant, but it could cause ­embarrassment. Well, a transgender ­operation is similar to that.”

Charity worker Ruth smiled as she said in a candid interview with the Sunday People: “I’m now fully equipped.

“I’m enjoying the fact that I have made the transition. My main thing in life isn’t going around saying I am a lady now. But not a day had gone by since I was nine when I didn’t think I was in the wrong body. I always felt I was a woman.

“It was my doctor who told me to go ahead. She said, ‘Go to the clinic and get it done.’”

Ruth, of Newhaven, East Sussex, began living more openly as a woman after ­divorcing the mother of their three ­children 11 years ago.

She is an activist and public speaker for charities like Age UK but said: “I stopped going to events as a man four years ago.

“When I was married, I was living half as a man and half as a woman, dressing up to see friends but a man at home.”

Having a totally different operation successfully helped Ruth make up her mind that she was not too old to go through the medical procedure that made her fully a woman.

She recalled: “I went in for a hip and knee replacement or I faced life in a wheelchair.

“My doctor had said I should have the gender ­transformation operation but I thought I was too old. I thought I had left it too late. But the surgeons wouldn’t have done it if they didn’t think I could go through with it.

“I am the oldest person to have it done.”

Ruth’s procedure and treatment on the NHS cost £4,000.

She said: “A lot of people think it’s just a case of chopping it off, but it’s much more than that.

“Some people are ­assessed for eight to ten years by psychiatrists. The rate of suicides for people waiting for transgender operations is seven times higher than normal. People are living lives of despair.

“The surgeons I have spoken to say they have saved hundreds of lives by stopping people from committing suicide.”

Ruth was in hospital for five days in July having the procedure.

She said: “It was very painful and took six to eight weeks to heal up. But I am very happy with the results.”

Without wanting to go into full detail about her surgery, Ruth explained she did not have a full construction.

She said: “It would have been ridiculous for me to ask for a vagina so I could go sleeping around. It would be inappropriate.

"I was offered it but turned it down. I won’t talk about the intimacies of it. A woman who had a hysterectomy wouldn’t go into detail about that.

“The intimate sides are as private as a woman would want. I don’t at my age expect to have a sexual partner and wouldn’t know what to do with it if I did.

“It’s not about having a sexual ­relationship. But it’s nice to feel you have sexuality. It’s nice to feel feminine.

“Frankly, I don’t envisage getting that intimate.

“But I feel so much happier now. I thought my life as a woman would never be fully fulfilled at my age.

“It’s as if the last vestige of sham has been taken away. It was much more than getting rid of some obnoxious ­unwanted parts. I felt euphoric.”

Ruth, or James as she then was, felt the urge to be a woman while at school and began dressing up in secret.

At 18 she started an apprenticeship in mechanical engineering, joined the RAF at 23 and married in 1961.

Despite Ruth’s secret desire for change, the couple stayed together for 42 years. She went on: “I did not tell my wife about my feelings.

“I thought if I got married those feelings would go away. But they didn’t.”

The marriage ended in an amicable ­divorce and they are still close.

Ruth recalled: “We are a close-knit family and they are tolerant. But my decision to go for gender realignment surgery came as a shock to them.”

Speaking of the changes she has experienced, Ruth explained: “Hormone treatment has affected my mental ­approach to life. I’d had a long-felt need for change. Gradually the hormones change your attitude towards life and towards your emotions, which is so nice.

“It fills me with joy in so many ways that I notice my womanhood. It just falls into place.”

There were unforseen physical adjustments as well.

She explained: “There are some things you learn as a child which are gender orientated and you have to unlearn them.

“Men’s and women’s jacket buttons do up differently.

“Bending over to pick things up is ­another. As a man you bend over from the waist with your legs apart – but as a woman you crouch down and pick things up from the side.

“I’m sure I’ve become much more like a woman in so many ways.

“I would never describe myself as a great driver – but now I’m forgetting to signal before I turn.”

Ruth said: “I wish I could grow a bigger bust but I don’t think I will. The surgeon told me I would end up with a bra cup size one down from my sister.

“I haven’t put any extra on my bum either. You may ask, at my age, why should I care. But it’s nice to become more shapely.

“One thing that has changed is that my waistline has gone higher. Women’s waistlines are four inches higher than men’s. And that’s certainly happened.

“But some things cannot be changed. Women’s forefingers are usually longer than their ring fingers and mine will always remain the same as it was.”

She added: “I have never been abused by anybody about this and I wouldn’t expect to be. We are not freaks to be on show and it is so nice to be part of a community in the gender that I feel is right.

“Life is very nice to me at the moment. I stay fit and healthy. I swim in the sea every day of the year and go sailing.

“The fact that I am a different gender to the one I was born is not an issue.”

Was the NHS right or wrong to fund Rose's surgery?

Wrong: Roger Goss, co-director of Patient Concern

“With the NHS so short of money, most people wouldn’t support surgery of this kind.

“That may sound harsh – but it’s realistic.

“As for doing it at 81...what’s their life expectancy? Frankly, it’s ridiculous.

“While we have huge empathy for people with gender problems, we have more sympathy for those in chronic pain for whom the NHS is not providing relief because it’s too expensive.

“With the NHS so short of money, there have to be priorities.

“In most people’s view, gender realignment would rate as a low priority.

“What about all the people with cancer who cannot get the drugs that extend their lives? They are being rationed left, right and centre.

“So how can any hospital afford this kind of thing?”

Right: Psychologist Susan Quilliam

“It’s incredibly brave of her.

“However minor the operation, it’s not a trivial change. It’s not like a tattoo.

“If someone is in the wrong body then I think surgery is a good idea.

“If they feel as if they’ve been in the wrong body for that long, I think they should be able to go through with the operation.

“If you are coming towards the end of your life and you’re given the chance to have the body you always wanted, it has to be the right thing to do.

“Being faced with life in a wheelchair would have been a wake-up call.

“The operation will hugely improve her chances of being physically healthy.

“All those men or women out there who are opposed to her having surgery should think about how they would feel if they were in the

wrong body.

“They wouldn’t feel good about themselves.

“With the doctor suggesting that she have the operation, of course she is going to say yes.”