Horrific case report after genital surgery *TW distress*

[Faffertea]

This link has been shared by @FOJN on the Marci Bowers thread but I feel the person involved deserves to be remembered and for the horrific injuries inflicted on them in the name of so called medical care to be known more widely so that when this house of cards finally falls these doctors are held to account.

If you read the journal article be warned there are graphic medical images at the end.

For those who cannot, this is a case report of the death of an 18 year old from complications after genital surgery. They died from overwhelming infection originating from their own bowel which was used to create a facsimile of a vagina after puberty blockers and cross sex hormones meant they didn’t have enough penile tissue to use.

Necrotising fasciitis is one of the worst post operative complications I have ever seen and this young person, just legally an adult had 60% of the body area of their skin and subcutaneous tissue removed to try and treat it.

The article lists serious surgical complications as 0.6% or roughly 1 in 200 patients. That’s about the same as the failure rate of a vasectomy and 5x higher than the most serious complication (perforation of the womb) when fitting contraceptive coils.

I am here in tears having read this case, knowing the suffering this young person will have been through. They deserve to be remembered.

I really wonder about 'informed consent' on this and other procedures for people suffering acute gender dysphoria.

For other illnesses such as anorexia nervosa or acute mental health crisis, there would be questions as to the mental capacity of someone in acute distress to give informed consent.

This is true for small procedures, and I would expect the larger and more risky a procedure is, the more certain you would need to be as a surgical team that this person was absolutely in the right state of mind to fully understand what they were entering into and the possible complications.

18 is not a child, and most mentally healthy young adults have mental capacity given sufficient time and information. However a young age would again mean that you had to give extra time to be sure this was truly informed consent.

There is also the question of coercion - someone performing this surgery needs to be sure that the person consenting is not being coerced or incentivised in some way. I'm not sure this would be the domain of a surgeon and would require a psychological assessment - was this carried out in specific relation to surgery?

Failed on so many counts. I'm of the personal opinion that this is deeply immoral and unethical surgery and the harms cannot be justified.

Sorry I should have said that I can't see how ethically Drs can operate on someone so young.

The abstract summary says: the genital surgery had a positive impact on the patients quality of life.

What??

I guess that's in the very narrow sense where you might be thinking about the "quality-adjusted life year" as a measure.

^https://en.wikipedia.org/wiki/Quality-adjusted_life_year^

So "quality of life" is on one axis, and length of life is on the other axis. You could die shortly after treatment, but still claim a brief improvement on the quality of life axis.

Was anyone else struck by the disingenuity of this statement? "The absence of a functional vagina has a negative effect on the (sexual) quality of life of biological women and transgender women."

An absolute refusal to admit that this is nothing to do with biological women. It's all about performing a mutilating operation on an adult male.

I know it is a paper about the medical aspects, but was struck by the lack of detail / evidence for the reasons for the surgery. Basically one sentence: quality of sex life for Transwomen needs a functioning vagina’.

The patient was 18. In the UK one third of 28-24 yo are not sexually active. Many women at 18 are not yet familiar with ‘quality’ of sexual experience, and have not achieved a good quality sexual experience.

And yet this 18 yo was literally butchered in pursuit of this ‘quality’.

That is just horrendous.

My heart goes out to the young man and to his surviving family.

And as for the surgeons... How do they sleep at night?

18-24 yos

As @FOJN has pointed out, the procedure has been used (and I think was first used) in some actual women who did not have a vagina.

The numbers are bound to be tiny but the fact that it is used in women has been leveraged in an attempt to normalise intestinal vaginoplasty in men.

I noticed that too @RoyalCorgi
I didn't know about the treatment for MRKH mentioned above, the only other circumstance I can think of is post cancer treats I think anyone who has had cancer treatment that ended in loss of the vagina would have other concerns and medical issues that creating a new vagina and messing with the bowel is probably low on the list and unlikely to be recommended.

God, this is sickening. How can this type of surgical intervention possibly be seen as a valid ‘treatment’ for gender dysphoria? I can’t bring myself to look at the photos, but my DS’s are around that age and the thought makes my blood run cold.

RIP poor boy.

Part of the problem is that people are distorting the technical/medical "quality of life" scale.

The original concept was that "perfect health" = "1.0".

To say that "having a vagina" improves a man's quality of life requires you either to let the scale go above 1.0 - he's better than healthy - or to claim that a man without a vagina is somehow not healthy.

This is really based on substituting the technical medical meaning of "quality of life" for the everyday one, where having a Mercedes rather than a Daewoo improves your quality of life.

The Health Service is supposed to be looking specifically at health. Not consumer desires. A man is not "unhealthy" if he is not a woman.

I had quite a heated discussion elsewhere with several trans women who had neo vaginas. They all boasted about how wonderful it was, how it looked and felt no different to the old fashioned ones and how happy they were. Half the problem is that those who have had dreadful experiences are shouted down, no one gets to hear about the failures, the lack of sensation, or any medical issues. And making a neo vagina out of the bowel? I mean are the two types of tissue really similar? I really don't think that they are. People are having very complicated surgery without knowing or understanding exactly what can go wrong. I suspect that where the patient is paying no medical professional will be telling all of the truth including what can go wrong. BTW I've seen some neo penises as well, grim, and the last thing I would want.

I notice that this is quite an old case - the date on it is 2017. I wonder what happened to this young man's family - did they sue the doctors for negligence? Did they give permission for those horrific pictures to be used in a medical journal? It makes me sick to think that these doctors' reaction on the death of a patient is not some soul-searching about the wisdom of carrying out such an operation but "At least we can get a paper out of this."

Surely there will be a reckoning about all this one day?

how it looked and felt no different to the old fashioned ones

The mind boggles as to what experience this could possibly be based on.

Utterly barbaric.
And this is happening to kids. Funded by our taxes.

What the fuck.

The issue of informed consent is a tricky one because there is a need to balance two opposites -autonomy vs paternalism. As doctors are we here to give patients what they want even if it could harm them as long as they are informed of the risks (autonomy)? Or do we say as medical professionals we know best and refuse to do anything a patient wants if we don’t agree it’s right for them (paternalism)?

In the UK there has been a long history of paternalism and I’d argue for many women there still is by some doctors. However, we have moved away from this towards a concept of shared management and a balance of risks vs benefits. So where an intervention is likely to be of more benefit than harm, and as long as a patient is fully informed of the potential risks we tend to fall down on the side of autonomy.

This is changing in the UK with more and more people seeing the NHS as being there to provide what they want, when they want and medical professionals are there to facilitate that, not offer them their medical expertise or opinion. That is much closer to the model of the US in which healthcare (at least for those wealthy enough) is consumerist. If I am paying Dr A for their services, then I expect to get what I want. After all, the customer is always right. That fundamentally shifts the relationship between doctor and patient. Throw into this that sadly in medicine there will always be doctors who are not in it for altruistic reasons but to make money, make a name for themselves or because it gives them one of the few legal routes to exert huge amounts of power over another human and you have the situation we have now with so called “gender affirming” care and other cosmetic surgeries. And that’s before you throw the people with nefarious intent pushing these interventions into the mix to create “best practice” guidance with no evidence base (looking at you WPATH). Add in the online voices telling these kids and their parents it’s transition or die and you can see why they go for it.

I think there are echoes here of Kiera Bell’s case. Can someone consent to a procedure without being able to actually comprehend what it is they are giving up and what it is they are risking?

All surgery carries infection risk.

This person was far too young to be making this huge decision for unnecessary and life-changing surgery - technically an adult but no surgeon should have agreed to this. I presume it was private surgery, so a profit motive.

I know someone who has had this surgery - much older and able to make their own decisions - but there were infections post-operatively which were utterly miserable. The whole thing involves inserting a form into the created vagina daily to keep the new orifice patent. Sounds totally grim to me.

In addition I have a GC who is soon to be 18 and is wanting gender reassignment surgery, so it is a source of great anxiety to me.

*how it looked and felt no different to the old fashioned ones

The mind boggles as to what experience this could possibly be based on.*

Pure delusion. A surgically created facsimile of a vagina will never be the same as a natal one. It’s is human’s attempts at recreating nature. If we’re talking specifically about the procedure here where the colon is used then we’re talking about 2 different types of tissue with different natural bacterial environments. The vagina is self cleaning, it has a delicate bacterial balance to help it do so and cells lining it produce secretions to do thus too. Any women who had had thrush knows what it’s like when that microbiome balance is disrupted.

The cells lining the colon, while similar are not the same. They do produce secretions too but the intestinal flora (naturally occurring bacteria) are different- pre-dominantly e.coli- so it is not self cleaning and will smell different. My understanding is they also require frequent dilations because the body is trying to close what is essentially a surgical cavity.

I didn't question how they knew. Too much information, even for me. But I did think that it really was a case of the person conning themselves, rather than admit that it wasn't great.

Having viewed the images, which are like something out of a horror movie. Pictures like this should be displayed on every notice board in schools promoting transgender ideology, all the LGBTQ + celebratory months etc. this is the stark reality of when surgeries go wrong, which they do. Not fluffy glittery unicorns & pink & blue striped flags.

That's what I was wondering,it's not as if any of them had an actual vagina removed in order to allow the creation of a new and improved one.

If Channel 4 want to show young people bodies, they should be showing them these pictures.

It’s monstrous.

Another famous young person I’ll call JJ had this revolting surgery. I remember watching the episode when the doctor explained about the lack of penile tissue meant traditional vaginoplasty would not be possible. JJ and their parents were shocked - nobody had ever told them. I believe JJ has needed four corrective surgeries since.

And I hope this person is added to the list of the 'Trans Day of Remembrance'. I also very much hope there will be no more cases like it. Ever.

We don't know enough about the risks of any of these procedures. Puberty blockers - off label drugs for prostate cancer, used to treat children. Cross sex hormones. What risks of heart disease?

And we see surgeons like Sidhbh Gallagher operating on morbidly obese children who are covered with self harm scars. I haven't forgotten the patient who suffered horrific necrosis after their surgery from Gallagher, either.

Remember all of this is cosmetic surgery which creates enormous profit.