Ethics of phalloplasty on female patients.

I don't think it's ethical to do cosmetic phalloplasty on women at all, for the following reasons:

1. Extremely high rates of complication suggest there is no established protocol for these surgeries so it's experimental
2. Female urethra much shorter than male so I don't see how the normal passage of urine could be established
3. Need to harvest the flesh from a limb, creating a potentially permanent disability
4. Nerve damage from harvest
5. Faux penis is as far as I can tell only attached to the mons pubis by stitching and skin graft - no muscle holding it there as with men - won't gravity eventually do its job?
6. It cannot get erect without a secondary device

Basically it seems like an utter clusterfuck of an eperimental cosmetic surgery which - unlike established cosmetic procedures such as breast implants - requires a lot of cutting into, removing and rejigging highly complex nerve centres.

I'm utterly baffled by the fact that any medical regulator seems to think this particular procedure is ok tbh

I wonder how Susie Green is taking it, now that the NI loophole has been closed?

One bright bit of news is that the current government has just announced it is extending the ban on Puberty Blockers.

I look forward to more information on this but it is something for now.

https://www.gov.uk/government/news/puberty-blockers-temporary-ban-extended

Yes, but they act as if it's not made up, that's what's so weird. Different numbers of supposed "genders" are spouted by various gender ideology sources, all as if it's the ultimate truth and must be validated. They're so close to just saying "everyone has their own gender identity, which is variable and culturally defined, and is not the same thing as sex". Instead they insist on lumping these vague heaps of genders in with "male and female". It undermines their own case. Which as you say is a good thing. I just find it mindboggling how they can't see it, and how anyone in authority ever began to take it seriously.

It's better if it's made very clear that they are made up and arbitrary groupings of characteristics, tropes, etc.

That's what gender is, it's fundamentally 'made up'. The problem is that the line between material reality (sex) and social construct (gender) is being blurred, some would say intentionally.

Many NHS clinicians would ‘empire build’ if given a chance.

An adult studying gender may grasp that 'gender', as a collection of arbitrary social constructs, has an infinite number of permutations. Why anyone would try to set a number to such a concept is somewhat baffling.

I also find it really odd that they do that, because it clearly demonstrates that they're made up! The number is always changing (I thought it was 72 in some "educational" materials) and people obviously make up new pronouns and gender terms to reflect their own personal musings. Which is fine, but it's called a personality and there are 8 billion of them - it's ridiculous to try to say that any newly coined "gender" category is something that actually exists in the same way as male and female exist. And putting them in the same category as male and female will of course massively confuse kids.

I aso find that whenever I see videos of teachers and diversity trainers etc. talking about this, they seem very uncertain and shallow on the details. They're sure they're morally in the right and on the side of the oppressed, but when they say "100 genders blah blah" it always sounds like "must regurgitate what it said in the training paperwork, I'm not sure how it makes sense but we'll gloss over that..."

Certainly members of WPATH who work for the NHS have suggested that any and all bodily/genital modifications should be considered by the NHS.

https://www.telegraph.co.uk/news/2024/04/12/nhs-trangender-doctor-jonathan-arcelus-male-female-genitals/

By which I mean it seems to me that genital surgery is as much an act of violent self harm as it is anythign to do with actually trying to achieve any semblance of pseudo genitalia of the opposite se.

Good point. Where does the boundaries on these modifications sit?

Are we going to fund on the NHS body modifications for all transgender identities then? Including nullifications?

One might question whether the severe distress/dysphoria at one's genitals that is a feature of gender dysphoria encourages people to mutilate said genitalia as a form of self harm.

Basically, a glorified Shewee.

I agree, that would be much safer in health terms.

But then they couldn't pretend say that it was an intrinsic part of their body that they should always have had because they were always really male and there had been a misassignment at birth and any surgery is merely correcting a defect.

And further, 'There are over 100 sexes, and you can choose which one you want to be, and/or change it if you want'.

Sadly, the womb implants are fed directly from research groups who drip feed stuff like this to the media. I only wish it was Chinese whispers on social media.

I read a quote from one of the doctors from Sweden who were involved in delivering the baby from the women with a uterine transplant that said he thought implants into males was only decades away and could see no ethic issues around it.

It really does seem like some researchers see transgender health as a rich experimental ground. To me it seems to be a road built on vulnerable people who have no physical needs to address to save lives, but instead these researchers are focused on extreme modifications of bodies to cure mental health issues.

It's quite scary how children trust parents, teachers, and institutions like the BBC, although it really shouldn't surprise us.

If we tell children there are '100 genders', they will accept it.

An adult studying gender may grasp that 'gender', as a collection of arbitrary social constructs, has an infinite number of permutations. Why anyone would try to set a number to such a concept is somewhat baffling.

I suppose one could parse it down more accurately to 'people generally tend to group their collection of arbitrary social constructs into at least vaguely related (although not always) common tropes, which we could label as 'gender identities' and people often seem to coalesce around these nodes of grouped/collected stereotypes about clothing, aesthetics, and behaviours.'

To a child in school, though, this is incomprehensible.

What a child will understand is: 'There are over 100 sexes'.

Although to be fair. A rudimentary prosthetic penis that could channel urine and be removed for cleaning looks like a better option to me at this point. Surgical "solutions" are certainly not working any better than that and are causing really awful problems. At least a prosthesis could be made to look realistic.

With regard to the 3d printed penises and womb transplants for men I think its largely down to a kind of "chinese whispers" effect on social media.

There will be a mainstream report about 3d printing of organs or tissues like printing skin for burns patients. That report may speculate on future applications such as more complicated organs.

Someone may then speculate that this could be used to grow organs for use in genital surgery in the future.

A few posts and retweets later this has turned into doctors are on the brink of being able to grow penises using 3d printing.

Another couple of post and retweets later this turns into doctors can already 3d print a penis. These final posts then just get repeated everywhere but are totally disconnected from the original mainstream medical report.

That surely must be along the lines of implanted uteruses allowing male people to experience pregnancy. Under what conditions will a male person’s genetic coding be completely retrospectively modified to enable the male body to build another human being except with constant artificial supplementation. It is effectively experimenting with growing humans in a bag like the lamb in a bag.

And yet, just how much media does that possibility get? There has been a constant stream of articles declaring it is imminent.

It must be very hard for children and young people to sort through it all and to work out what is truth and what is false.

I think this kind of makes sense.

Yes. Children don't believe that adults would lie about this sort of thing. When I heard about "sex changes" as a child, I assumed they meant people could change sex.*

I was quite aggrieved when I discovered they didn't mean sex changes.

So children will naturally assume that if these procedures are being routinely performed, and treated as if they're routine and normal, then they must be good procedures. It would take quite a conceptual leap to figure out how/why adults would be bullshitting about this so loudly.

*(Okay, actually I was a bit puzzled, because it didn't seem to fit my understanding of what medicine was capable of in other domains, like limb regrowing or whatever, but that wasn't enough to make me immediately reject it).

My DD, admittedly 4yrs ago, was under the impression (and I truly kid you not) that they could 3d print a functioning penis and simply attach it…

I think this kind of makes sense. Kids are being taught that you have a choice/you know best about whether you’re a boy or a girl and that doctors can get it wrong when you’re born. Yet they naturally develop an understanding of the difference between the sexes and learn to recognise it. So a lot of kids who have no real understanding of complex surgery (why would they), they must be imagining that whatever happens when you say you’re trans, you come out as the real, actual, functional opposite sex.

No one is allowed to mention anything negative or unaffirming about it, like that it’s likely to be a lifetime of pain and ill health and unconvincing anyway, or that your body actually stays the same sex. So how will they know? It makes sense that they try to fill in the gaps about how it works, and probably pass around rumours and speculation. Only kids with a source of reality in their lives will know to even question it. And by the time they’re in the pipeline and find that everything isn’t straightforward with perfect results, it’s too late. Too late to get a healthy body back and very difficult to say “hang on I wasn’t told the truth” when you’ve made it your whole existence.

I’m not sure they do understand that, though, or there is so much misinformation about the science. My DD, admittedly 4yrs ago, was under the impression (and I truly kid you not) that they could 3d print a functioning penis and simply attach it…

Not to mention that a body isn’t a meccano set, so the idea of almost any sort of ‘reassignment’ surgery being truly reversible is just fantasy.

You also have to wonder if it has dawned on them that society's resources are finite, and that if they aren't, perhaps there are some better claims to be made on them...