NYTimes: A Vagina Won't Make Me Happy - But It's My Right to Get One Anyway

I just find it a very slippery slope. You are applying your judgements onto the procedure

No one is doing that. This is about medical ethics, something you should understand as a nurse. No ethical doctor will perform a procedure that will make the condition of the patient worse. The writer of the article under discussion has admitted that surgery will damage their mental health and lead to more suffering, yet they are still insisting they must have that surgery. I understand this person is in the US, maybe things are different there, but in the UK a doctor who agreed to provide any kind of treatment on that basis would be, rightly, disciplined and likely struck off.

I agree it is entirely up to drs to decide on any treatment or surgery, as I said.

I do find it interesting that there are surgeons willing to perform some quite questionable cosmetic surgery (where do ethics fit in these cases?) and that we are accepting of the increase in cosmetic surgery such that it is becoming almost the norm now to have it done.

Perfectly put 2rebecca
Thank goodness we have the gate keeping of NHS GPs.
For every patient who thinks they have a right to surgery I would say surgeons have a right to refuse to perform that surgery for whatever reason, be it ethical, professional judgement or steering clear of bonkers patients telling them how to do their job and avoidance of future court cases.

I read this article earlier and I must say it is illuminating in quite a few respects. First off, an attempt to describe gender dysphoria :

"Dysphoria feels like being unable to get warm, no matter how many layers you put on. It feels like hunger without appetite. It feels like getting on an airplane to fly home, only to realize mid-flight that this is it: You’re going to spend the rest of your life on an airplane. It feels like grieving. It feels like having nothing to grieve."
I found that helpful.

I also watched a Facebook discussion between trans people arguing about whether gender dysphoria as a diagnosis is wrong for gender ID and sort of drawing a line between the UMBRELLA how it is preventing "real" trans from getting their hormones or whatever...

My point is that I'm seeing cracks in the ideology and new ways to dredge up some arguments to gender critical voices.. (the FB thing is on Esther Betts page)

The NYT essay is deeply disturbing. The "king" thing? The dad is a pediatrician,,,hmmm therapy please.. " Take it from my father, a pediatrician, who once remarked to me that he would no sooner prescribe puberty blockers to a gender dysphoric child than he would give a distemper shot to someone who believed she was a dog."

It's astounding this was published in the Sunday NYT. Not sure what to make of it

Quite why I should have any right to pass judgement on what another person does with their body I have no idea.

Since children are being put on puberty blockers to facilitate gender reassignment in their future we have as much right to pass judgement on this as any other form of abuse.

If it wasn’t for gender reassignment surgery there would be no pretext for sterilising children.

No other medical treatment gets given "on demand" to people. Why should hormones and surgery to try and make you more like the opposite sex be any different?

I'm a GP and am often saying no to requests for opiates, benzos, sick lines, referrals for stuff that doesn't meet referral guidelines and is normally dealt with in primary care.
I have to abide by GMC guidelines and if that seems to be me being authoritarian that is part of my gatekeeper role that is essential if the NHS doesn't go bankrupt or have 3 year waiting lists and everyone on prescription opiates and sick lines.
I do think a lot of private plastic surgery is dubious ethically. Body dysmorphia is a real condition and surgery rarely cures the problem.
I've not yet met a transsexual who can really explain exactly what they think they could "do" in their desired gender that they can't do in their current one. What does Pippa Bunce do that Phillip Bunce can't? Why can't you be your authentic self without altering your body and wanting your pronouns changed?

I'm a woman because of my female body not because of the way I think and dress. My job and hobbies are unisex. It seems an overly simplistic way of viewing the world and gender changing treatments seem to be completely the wrong answer to the problem of gender dysphoria when many sufferers seem to have an almost OCD type preoccupation with gender and gender stereotypes rather than focusing on what sort of person they are and what they want to achieve in life.

Shouldn't the standard just be to do the surgery where strong suffering/dysphoria (psychological assessment) has been demonstrated and an improvement in life quality can be reasonably expected (psychological assessment, studies on outcomes)?

I can't see what else should factor in. I very much doubt limb removal will make people happier. The wish is a symptom not an end to itself. For SRS there are people who are happier with it, while others are not. You get similar mixed bags for all kinds of cosmetic procedures and there the responsibility of doctors should lie, to weed out notorious self-harmers or people who aren't really dysphoric but just want to win the 'flattest tummy contest' in the fitness center.

Taking the breast example: If a woman is so dysphoric about her breasts that she insists on surgery, the function of the breast won't be super important, as she'll probably never nurse her child due to the sysphoria, anyway, no?

I just find it a very slippery slope. You are applying your judgements onto the procedure. For someone that hates certain parts of their body maybe losing the ability to breast feed, maybe even losing sexual pleasure is a price worth paying for them? I don't know because I've never felt it.

Maybe cosmetic surgery appears less serious to the individual but what price for society? Is the increasing popularity actually encouraging more girls and women to hate their own bodies? Are we all starting to see the norm as being surgically sculpted and enhanced? I would argue that the more mainstream cosmetic procedures are more damaging to society because they are becoming normalised and because more people are doing them.

I absolutely would support better support services because I don't think that any of these life changes should be made without considerable thought.

Weetabix Thanks for your thoughtful answer.

I'm with you about not being able to contemplate being that unhappy with your body for whatever cosmetic surgery people want.

I'm already concerned about the growing normalisation of cosmetic surgery already - but at least that's for body parts that are being changed cosmetically, but those parts are at least retained in some way.

But if we all just go "hey, whatever you need, not my business" and it slips towards not retaining body parts, actually removing body parts that provide natural bodily functions like urination, sexual function and pleasure, lactation, etc, that to me seems like a concerning step.

Both for what we expect of the medical profession, and of the message we give to upcoming generations. A tummy tuck keeps your tummy and doesn't create a continual wound. A face lift keeps your face. Creating a neo-vagina destroys a penis and creates a wound.

People who choose to self-medicate with heroin because it helps their mental health problems don't impact my life.

Essentially they're not my business. But that shouldn't mean I don't support services who help them seek support in other ways that are less destructive to their bodies and lives?

Scrumplestiltskin

Yes I do. I was a nurse on a urology ward. I nursed a patient who had had it done. I do know.

How is it any of my business?

pombear

I'm not pretending that it isn't huge surgery. I can't contemplate how desperate you must feel to consider having it done but I feel the same about all cosmetic surgery. When I see programmes about tummy tucks or breast implants or face lifts where they peel your face away from your skull I cannot imagine wanting that done. But as far as I'm concerned it's between the patient and their doctor and it's really none of my business.

With regards limb amputations - I don't know. Gut reaction makes me want to say no. But I don't know enough about it. I don't know what the medical advice is. If respectable doctors (ie not a butcher with a folding table in a back alley somewhere) assesses that it is in the patient's best interest then again, that is between the patient and their dr.

What I would hope is that for all of this surgery all patients are given as much support, counselling etc as they may need so that they can be absolutely clear that it is what they want and they appreciate all risks.

This discussion just feels as though it is none of my business. It won't impact on my life so I feel that I have no right to comment and I certainly won't judge anyone that has it done.

I'm not sure why we can support someone having a boob job or their ears pinned back
I'm not really in favour of any cosmetic surgery, save perhaps something like unusually prominent ears that are causing real misery due to bullying, which don't require very invasive surgery.
But Weetabixandshreddies do you know what neo vaginoplasty involves? It is not even vaguely comparable to boob jobs etc. I've read up comprehensively on all the different methods, and read the studies on complications etc, and honestly it's nothing less than barbaric.

Weetabix whilst I can completely see your rationale there, I'm not sure I can follow and understand it all the way through to its conclusion.

Most cosmetic surgery alters an existing body part whilst still retaining that body part (though pinned back...the ears remain.
Either enlarged or reduced, boobs remain. Maybe de-bumped or thinned... the nose remains, alljust altered,still remaining body parts).

Gender 'reassignment' surgery (I find the wording slightly 'coy' considering what actually happens) tends to equal things gone.

Testicles...removed, gone. Breasts...removed, gone. Penis...stripped, inverted, pretty much 'gone' in the form as most of us would know a 'penis'. Vaginectomy..vagina, gone.

Quite why I should have any right to pass judgement on what another person does with their body I have no idea.

I'd be interested in your view on those who have the type of body dysphoria where they believe they need to remove limbs such as legs and arms. Should the medical community proceed regardless as noone should pass judgement on what others want to do with their body?

Honestly as long as the risks are explained fully I see no difference between someone having gender reassignment surgery or any other form of cosmetic surgery.

Quite why I should have any right to pass judgement on what another person does with their body I have no idea.

I'm not sure why we can support someone having a boob job or their ears pinned back because they are seriously affected by it but then say no you can't have reassignment surgery even if you are seriously affected by your natal body.

Surely the clue is in the term "cosmetic surgery" - ie not surgery to cure an illness (like a mastectomy) or correct an abnormality (like a cleft palate), but a surgical procedure to make something appear different but without changing its functionality. Cutting off a penis and testicles and creating an inverted space using spare skin is about as far away from cosmetic surgery as one could get

Being born male or female isn’t a congenital deformity that needs ‘correcting’ like a cleft palate.

Nobody is pointing and laughing at a boy and saying ‘ha ha that boy looks like a boy!’

Being born male or female doesn’t make speech difficult.

Stop appropriating other peoples problems for your TRA ideology.

Have you no fucking empathy?

No they didn’t. I’m not arguing that at all.

I’m saying that cosmetic surgery is a broad church, and should be on the nhs based on clinical need.

SRS surgery should be a last resort for those with diagnosed GD who have not responded to non surgical treatments

It should not be on demand.

Right. Because all the cosmetic surgeries that we see performed fall into this category?

The ever increasing boob jobs that some celebs have or the multiple face lifts where they end up unrecognisable or with severe complications from scaring etc? All of those drs acted ethically? No.

But then are quite quick,as in this instance, to advocate cosmetic surgery in order to change their appearance because it distresses them so much???

There needs to be clinical justification. When a doctor prescribed a drug /device they remain responsible for that prescription. So ‘off label’ drugs are sometimes prescribed, but doctors generally tend to be conservative and do that only when there’s a track record of the drug being used in that way - with clear evidence of benefits outweighing harms.

What’s the benefit here? Chu themselves says it won’t help. The doctor retains the responsibility for what they do and prescribe - to force them to do something they KNOW will harm the patient is unconscionable

I cannot see the difference. If you honestly believe that someone with gender dysphoria basically needs to learn to live with their body as it is then you are a hypocrite if you support someone else changing their body for a cosmetic reason.

Nobody is actually saying this. No one is saying that someone with dysphoria shouldn’t be allowed to have surgery in order to relieve their dysphoria.

What is being disputed is Chu’s assertion that people should have medical treatments, on demand, that will not help them in any way, even if those treatments are detrimental to the person’s health and well-being.

Providing treatments that have no benefit, and will actively harm, a person is against medical ethics.

In that article, the author is describing becoming increasingly distressed and suicidal with each step of the transition process. Chu states that having a neovagina will not bring relief of that distress or suicidal ideation. Chu states that these will get worse. And putting forth the argument that doctors shouldn’t consider patient outcomes and well-being when offering treatments, but that people should get medical treatments and surgeries if they want it.

Not if it’s necessary. Not if it’s going to relive suffering. Not if it’s going to beneficial. Not if the benefits outweigh the risks.

And that doctors have no right to deny treatments that will not benefit patients and will actively harm them.

That doctors have no right to not actively do harm to their patients.

That is neither sane nor rational.

There's gender dysphoria (very rare, in fact, but does exist) which can be helped by surgery - but not always, as we know.

And then there's autogynephilia (and other such fetishes) which in some men results in a demand for breast enhancements, apparently.

I am playing devils advocate.

People are very quick to say that those with gender dysphoria should be given help to come to terms with the bodies that they dislike so much they want to change.
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But then are quite quick,as in this instance, to advocate cosmetic surgery in order to change their appearance because it distresses them so much???

I cannot see the difference. If you honestly believe that someone with gender dysphoria basically needs to learn to live with their body as it is then you are a hypocrite if you support someone else changing their body for a cosmetic reason.

I think that if anything about your body is so deeply upsetting to you that you want surgery, then do it. But I'm not going to differentiate and say one surgery is ok and another isn't.

Cosmetics/plastics is the same thing. The intent may differ but the discipline is the same. Anyway, I’m playing devils advocate and I do get your point - where is the line drawn on non essential surgery?

There is a grey area - our kid should indeed be ok as they are but life and other kids can be cruel. Breast reduction can be seen as purely cosmetic but it also does bring health benefits for women who are suffering from back issues etc. I know someone who had rhinoplasty for some sort of septum issue or something which aided her breathing.

Should SRS be done on the nhs? No I don’t think it should. Neither should some cosmetic surgery. There needs to be clinical justification for it.

I had cosmetic surgery at the age of 12. It was deemed so necessary that my American insurance company actually paid for it. The risks were practically nonexistent, the healing process was minimal, and the likely outcome would be a reduction in my distress at being bullied by peers, so it was done. I am a radical feminist and have no problem with this. I don't regret having it done and I would do it again if I were 12. Cosmetic surgery covers a very wide range of procedures.

Another reason is that I take estrogen — effectively, delayed-release sadness, a little aquamarine pill that more or less guarantees a good weep within six to eight hours.

I would like an explanation for this absurd statement. Perhaps the artificial estrogen that this person is taking is not working in a very natural fashion since estrogen is a female hormone. This absolutely stinks of misogyny. Women are not producing a crying hormone in our ovaries.

This person reads like a masochist begging to be abused. The problem with masochists is very straightforward: the moral imposition on the other person is immense. If someone begs a doctor to abuse them, and the doctor agrees, the doctor has just degraded himself as a human being and as a physician. Doctors are allowed, I think, to have self respect and to make moral choices?

Doctors are not slaves. They have their own conscience, the medical ethics board, and their reputation in their professional community to consider. You want to force someone to perform unethical surgery on you? Learn to do it yourself and leave other people alone.

This especially angers me because I am close to several doctors, including my father and my brother, and it disgusts me that people think that doctors are there simply to obey orders.

Weetabix
What if the child has - courtesy bullying - become severely dysphoric regarding the ears, to the point kid won‘t leave the house? Would you really advice the kid should undergo years of therapy (which won‘t cure this bullying society) instead of granting kid the wish to get them surgically ‚fixed‘?