This is my body and I’ll handle it: how much do we, transgender people, know about sex reassignment surgery?

Here the original version by Egon Botteghi for intersexioni

The translation is by Lea Vittoria Uva

This article is inspired by the story published by Elena Trimarchi

Before meeting my partner, a transgender woman, I believed that vaginoplastic surgery, the building of a neovagina, was today a procedure with definite outcomes and very rare complications.

I thought that she could simply “choose” to have one set of genitals attributable to femininity, or find her balance in another way, while I, as a transgender man, had to deal with a “gap” that was harder to bridge, since phalloplastic surgery is at a much more experimental level, with outcomes that are very hard to predict.

I had reached this conclusion by reading books that only talked about sex reassignment surgery for MtF (male to female) in a positive way, describing techniques, interviewing surgeons, bringing testimonies only of the moment of surgery and of its preparation; they made of surgery the arriving point of a hard and “desperate” path, but hard only up until that moment, because after surgery the doors of heaven would open.

Clearly, I lacked of real and honest contacts with women who had gone through this surgery, without catwalks, conventions, without having to convince others and yourself that everything is fine, someone who’d speak their mind about this.

My partner didn’t share this lack of contact with others, and therefore had a much more realistic idea of the situation: she knew people who, after surgery, had urinary infections, clitoral necrosis, or problems with their limbs due to the position kept for hours during surgery.

Now I’m also wiser and I understand that trans women have to take a leap into the unknown when they decide to have genital reconstruction. But what is the information available to these women? What are the expectations and myths within the transsexual community in regards to surgery?

I read on the website of S.Camillo-Forlanini Hospital, under “Complications” in the description given for vaginoplasty, a procedure performed in this hospital:

“Even though it’s rare, there can be severe complications. This procedure requires much care since it involves an area of the body where there are particularly vulnerable organs such as the rectum and the bladder. Wounds on these organs can create fistulas (openings between the rectum and the neovagina, or between the bladder and the neovagina) with consequent loss of urine or feces through the neovagina itself, and a number of resulting problems, including severe ones (local or generalized infective processes). These complications require delicate and elaborate reparative surgery and the processing of the complex psychological effects related to said complications.

Less severe and infrequent complications are hematoma, seroma, infection or suppuration; they generally heal spontaneously with proper medications.

Sometimes part of the skin used to create the vagina’s internal lining can be so little vital that it leads to necrosis. In this case, a marked shrinkage of the vagina can be determined, since the dead skin causes a scar which tends to pull back. If that is the case, a new surgery can be needed to remodel and enlarge the neovagina.”

Are complications deemed “severe” only if they constitute a danger to the patient’s life, or also if they compromise the outcome of the surgery in the long term, without them being a matter of life-or-death for the person?

Is having to go through surgery again a severe complication, or not?

For example, vagina’s stenosis is when a neovagina loses its depth and therefore becomes inadequate for a sexual penetrative life, or closes entirely: is that a severe complication or not?

Knowing the reasons why a transsexual woman decides to undergo such a complicated surgery I’d say yes, but it doesn’t seem so rare, if we look at the results of a study presented at a national SIA convention, in Turin, in October 2012.

To my surprise, I read that out of forty-two patients who underwent a surgery to build a neovagina between 2005 and 2012 at CIDIGEM in Turin, eight had stenosis, and three a complete coarctation of the vagina itself; that makes it one in four.

Interesting how the same study says there are no statistic elements to predict this complication… patients must simply be lucky.

As a transsexual person, I have to say that undergoing further surgeries isn’t a minor complication, from both a physical and an emotional viewpoint.

How prepared are trans* people to to deal with all this stress, and how much are they, instead, made to believe that surgery will be the end of their suffering, with even tragic repercussions when this doesn’t happen?

A Swedish research, “Long-Term follow up of Transsexual Persons Undergoing Sex Reassignament Surgery”, studied the follow up of people who underwent sex reassignment surgery in that Country from 1973 to 2003, and drew thought-provoking data: higher risk of suicide in the transsexual population compared to the cisgender one, and more resorting to psychiatric help.
The authors of the study advise more post-op psychological support, and more access to body care.

This, in my opinion, is also an Italian problem: in our country, transsexual people have to undergo a preventive psychotherapy – which, according to ONIG protocols, can’t last less than six months – in order to access the transition process, even if “only” hormonal.

This may prove to be an oxymoron and a situation that can cause difficulties to both the operator and the user: a forced psychoterapy, effectively a forced medical treatment. This said, when the “gate keeper” (the psychologist or psychiatrist involved) diagnoses GID to the patient, and when the patient is given access to hormones and surgery (after the court’s permission), the transsexual person is left alone. Alone with a body that is changing, alone to deal with a transphobic society and institutions, alone when looking for information on surgery, alone when said surgery doesn’t end up being what they believed it’d be or doesn’t go how it was supposed to go.

How much do the operators of specialized centers inform users about the outcomes of surgeries? Is any attention given so that “patients” have a clear idea of what will be done to their bodies, and so that their expectations are realistic?

I’ve met a psychologist who does post-op interviews to transsexual people at the Cattinara Hospital in Trieste, after I had my top surgery in that facility. He told me that many people have completely unfounded expectations about the surgery they just had, like the “neo-woman” who believed they would “implant” an uterus in her body.

For this reason, he’s trying to strengthen this support service inside this facility.

I’ve personally witnessed the case of a gynecologist who had to call the structure that was following her FtM patient to ask if the boy had or did not have his uterus removed, since he didn’t know. Yet he had his hysterectomy performed not long before!

It would therefore be beneficial to concentrate the operators’ (and the trans community’s) efforts on the support these people need in the hardest moments (like when surgery doesn’t go how it was supposed to), rather than on preventive psychology, which most trans people perceive as hostile and punitive.

It would also be essential that surgeons gave clear and verifiable information regarding the outcomes of the surgeries they perform, regarding possible complications and the numerical incidence of those.

All of this is hardly doable without a follow up on sex reassignment surgeries and if transsexual people do not feel sufficiently comfortable to honestly and calmly discuss their experiences, to the benefit of the entire community.

The transsexual body is not a body that can be mangled, considered doomed and done for at the start, it’s a body to be respected instead, because, as all living bodies, it’s researching its own happiness and its greatest expression of well-being.