The Phalloplasty Philes- You tuber documents trans surgery realities

[TheBurmundseyIndustrialEstate]

A no holds barred look by You tuber TT Exulansic at recent patients who have been through phaloplasty surgery in the US, using their own Tic tok content. She looks at the enormous costs and the horrendous yet repeated and predictable complications.

I'm going to suggest a little bit of caution with TTExulansic's content. She's clearly very intelligent, knowledgable, and funny. However...

1. She has a clear agenda, based on her history as a transman. Which is a valid perspective to have, but not an unbiased one.

1. Her professional expertise is unclear. She's studied gender studies with the experts? And linguistics? And is a pathologist? That's an, uhhhh, unusual combination of expertise.

1. There are times where she's simply wrong about core knowledge in my own bit of healthcare. Just plain wrong. And, when challenged, she doubles down on that wrongness. She does that with the same absolute confidence as she does on those things I know nothing about, which undermines my trust in them.

1. She reminds me of the sort of student who has read all the books and has memorised all the things, but has no clinical experience to put it into perspective. So, in the latest video, on her list of differentials for the bleed is an ectopic pregnancy caused by the surgeon impregnating the patient in theatre. That suggests to me someone who hasn't worked in an operating theatre for the past twenty years. There are always a lot of people about. Inappropriate comments, yes, entirely believable; full on penis in vagina sex to completion in an unconscious patient - no, really not. Yes, I'm aware that unconsented genital examinations have happened - which is abhorrent - but not recently, and that's not PIV sex. It's beyond implausible, yet she gives it credence as a realistic possible cause of the bleeding. And she doesn't mention a post-operative infection, which would typically (I know nothing about gynae!) be the commonest cause of late wound breakdown and haemorrhage.

So, yeah, she's great and very funny. But approach with a bit of caution.

I haven't seen the latest video @Motorina
and I agree, the chances of an aberrant employee finding an opportunity to impregnate an unconscious patient are unlikely but sadly I would say not impossible.

www.bbc.co.uk/news/uk-england-32486188.amp

I think its more realistic that the person suffered a tear, rupture which is really easy to happen, but in most circumstances the doctor would warn you about this, how to avoid and to seek immediate treatment. So the fact the person didn't do this but decided to spend the night gaming instead points to some kind of disordered mind which doesn't bode well for how they will respond to their further surgeries.

I agree about taking everything with a pinch of salt but hemorrhaging for hours because you're too embarrassed to seek medical help, and the fact the person doesn't seem to realise how close they were to death points to someone who's mental health has not been assessed correctly.

@ElliottSmithsfingers

I had a post deleted on another thread for suggesting trans people have mental health issues, so the current terms of the debate damage them in the first place. If somebody wanted their arms chopped off as they thought they'd be happier without, would they be humoured in the same way? And the people who urge caution slated as armless-phobes?

Surely gender dysphoria is a mental health issue by definition, how can that be post-deletion-worthy? Ditto AGP.

Ditto loads seem to be on the autistic spectrum (as an aside, always worth asking the question when someone mentions a trans person they know - are the on the autistic spectrum. In my experience the answer is often yes, and if it's "no" then there is almost always something else going on (divorced parents, fucked up relationship with step father; serious accident leaving young girl disfigured and seeking to opt out of womenhood etc)

Then you have the fact that so many seem to be depressed.

Then you have the fact that you'd literally need to be insane not to have mental health issues as a kid nowadays - environmental destruction and economic hopelessness is enough to send anyone over the edge, but throw in the negative impact of social media and kids have got no chance.

There's a current Twitter thread by 4thwavenow with screen shots of parents discussing consenting on behalf of their children to blockers en route to these surgeries. One in particular is asking for information about loss of sexual function and asking for information before consenting to this on behalf of a child that doesn't understand.

It's quite extraordinary.

[quote FannyCann]I haven't seen the latest video @Motorina
and I agree, the chances of an aberrant employee finding an opportunity to impregnate an unconscious patient are unlikely but sadly I would say not impossible.

www.bbc.co.uk/news/uk-england-32486188.amp[/quote]
Abhorrent. Absolutely abhorrent.

But not in an operating theatre. Too many people there to keep the anaesthetised person alive. At bare minimum an anaesthetist, an ODP, the surgeon and at least one nurse. Typically 6 or 8 people in my experience of much more trivial surgery, albeit that's in the UK.

Raping the patient would require the collusion of all of them, which is just so improbable that putting it in a differential but not stating common things like infection is the sort of approach typical of clever students who have memorised the text book, but who haven't seen enough patients to develop clinical judgement about which are likely to be important. Particularly as it's vanishingly that this patient, after years of puberty blockers, is fertile.

I guess I'm just flagging that she's very intelligent, very well read, but shouldn't be taken as gospel about everything.

I'm guessing her training is in speech pathology. I agree that she would be more effective if a bit less obviously snide / partisan. The videos speak for themselves for the most part.

She's a detransitioner? Really? She hasn't mentioned that in the videos I'd seen.

@vivariumvivariumsvivaria

She's a detransitioner? Really? She hasn't mentioned that in the videos I'd seen.

Yes, she mentions it in the comments on some of the videos, and also on her twitter. She never had surgery but lived as a transman until she was cured of her dysphoria through therapy. Hence the particular perspective she brings.

That's very interesting, Motor.

I had been wondering why she knew so much about all this stuff. She's comprehensive and must spend hours on tik tok sourcing the videos.

I like the direct, no nonsense language she uses. It's refreshing.

I think she is also a lesbian as she talks about the LGB community and refers to it as 'our', meaning she belongs to it too?

With her being a Detransitioner and same-sex attracted, that would align with what we are seeing coming out of reports and papers.

Not to derail and I haven't seen the relevant video so don't know her working or the context, but whilst I agree Motor it is hard to imagine a situation in theatre where it would be possible to rape an unconscious patient since there are always plenty of staff around, but many people use the words "theatre" or "theatre Dept" to include, eg the recovery area. Whilst highly unlikely, given that in the example I linked the nurse raped unconscious women in A&E behind the curtains, I suppose it would be possible within a quiet recovery unit. My hospital now has curtains with a fastening and the words "respect my privacy" printed down the side so what goes on behind the curtains would be unwitnessed.

Also these young women seem to have such a poor understanding of biology that unplanned pregnancy by the normal method is also a possibility.

So I suppose on the spectrum of differential diagnoses, ectopic pregnancy whilst very unlikely and almost certainly bottom of the list, shouldn't be completely discounted as a possibility.

Seen the first and need a break before I watch the second. It's really really heart-breaking; the poor things seem so ill afterwards, not happy or healthy at all.

Have not read the thread apart from the first half dozen posts, as I then watched the video. Will read the rest when I've recovered from my horror a bit.

@fannycann I think you're right that the word 'theatre' is used quite loosely. In this particular case, though, the woman was having a hysterectomy, so would have to have been impregnated either preop (thus whilst fully conscious) or after being anaesthetised but prior to surgery. She'd also been on testosterone for a number of years and was almost certainly infertile.

I guess she could have theoretically walked into theatre pregnant, but one would like to think that, when doing an elective hysterectomy on a woman of childbearing age, you'd get them to pee on a stick pre-op.

It just seemed really odd to put ectopic pregnancy in the differential for post-op bleeding in those circumstances, when there were so many more likely causes. It's proper hearing hooves and thinking unicorns territory.

(In the unit I work in, stage one recovery has no curtains, deliberately, so that a patient deteriorating is spotted fast. Stage two is wards, with curtains, but I don't think I've ever seen them closed. There's always plenty of nursing staff about. Whilst I recognise some predatory men can be very crafty, I really don't think it would be possible to rape a patient at any stage of the process. I say that more for reassurance for any woman having surgery than out of relevance to this topic.)

I was just watching some of her videos today! Unbelievable!! So horrifying! She makes excellent points.