Ethics of phalloplasty on female patients.

[RainWithSunnySpells]

I first would like to credit batteredpancakes from the fruit farms who shared the following post (pg 1405 SRS thread) from Griffen Sivret who died last month. This was originally posted on Reddit by Griffin two years ago and it discusses the complications post surgery:

'It took me a long time to come to terms with everything that happened to me in recovery, acknowledging my medical trauma. I was and still am hesitant to completely blacklist a surgeon that got me and others closer to comfort with our bodies. But no one should ever have to go through things like this again. This is my experience and can only speak for myself, but know there are several others of us who have been hurt and traumatized by this team.

I had stage one of RFF phallo with Dr Ganor and the gender surgery team at BCH in Boston, MA in April 2021. I had additional surgeries related to stage one complications on 6-7, 6-22, 6-30, and 11-18. For most of 2021 after receiving care here and throughout my consult process, I:

-Was told that urological complications happen in 40-50% of patients. I’m not aware of any patient of theirs that DIDN’T experience urological issues or didn’t take multiple surgeries to fix.

-Staging/method of my surgery changed 4 times throughout the process to “minimize complications”, including once right before my surgery with little to no warning. The staging did nothing to prevent/minimize complications.

-You are given direct emails to staff/PA’s in plastics, but nothing for urology. You have to call the general urology line, wait for hours while writhing in pain, and sometimes not even receive a call back. If it’s the weekend or before 8/after 5, you’re out of luck. Even if your catheter bag is filling with blood or you can’t pass urine, your only advice will be “flush the tube” after waiting hours.

-Had limb swelling and chest pain ignored and misdiagnosed as being “normal” or constipation for weeks until I had DVT in both legs, blood clots in my pelvis, and bilateral pulmonary embolism. I still have joint pain and swelling issues in my legs from DVT damage.

-Urology staff ignored my breathing concerns and listed my lung functions as normal in my ER report the night before my ICU admission for clots despite struggling to breathe and my chest audibly gurgling. They discharged me without any medications after saying “I wasted my time driving down there”. There was a chance the clots could’ve killed me soon after if I didn’t get a second opinion.

-BCH didn’t read any notes or reports written by staff at the hospital I was receiving clot treatment at. BCH supposedly discovered a urethral diverticulum for the first time on 6/22, but this was already diagnosed by the previous hospital on 5/11.

-Urology did nothing to treat my diverticulum for nearly 6 months, despite discovering it. It made me completely incontinent and in diapers 24/7 for that entire time frame. They said my “leakage was normal”.

-Urology would not diagnose or examine me for bladder stones despite getting new UTI’s every single week and constant lower left back pain. I had stones for at least 4 months straight with no treatment.

-Urology would not examine me for a stricture despite it getting to the point where I couldn’t push anything through my urethra except a couple drops. I told them multiple times, they said it was “probably constipation” and an exam was not necessary. I had stricture symptoms for over 4 months with zero treatment.

I believed that this team had my best interests for far too long and falsely thought “I was just that one unfortunate case”. There was hurt people before me, there was hurt people after me. The team has new doctors and staff that have greatly improved complications and experiences, don’t get me wrong. But the experience didn’t change whatsoever when several of us gained permanent complications, weren’t given treatment for months, literally almost died because of their frequent inactions. Honestly fuck this hospital and how it’s treated patients of the past as well as everyone now.

Dr Ganor is a great surgeon with an iffy bedside manner and not very warm, especially after you experience unplanned complications that stray your surgical path. But several other doctors and staff on the team, especially in the urology department, have given out reprehensible care or a lack thereof that has left patients in recovery limbo, traumatized people, or threatened some peoples’ lives. Their team changes, but the trauma and memories stay. I’m barely complete with stage one and don’t know when or if I’ll be having any more surgeries. I really can’t recommend anyone go to this team if they want optimal urology care, a short surgical timeline, or efficient treatment.'

Secondly I would like to credit cuddle striker, also of the farms, who posted the following (pg 1404 SRS thread):

'I'll repeat information I posted long ago in this thread.

hysterectomy, castration, penectomy, mastectomy, and no-depth cosmetic vulva construction are all low risk surgeries that are well-studied due to their common use for non-trans people. adults who wish to change their body to suit them can get these surgeries for low expense, low risk.

anything done by the surgeons mentioned in this thread that promise more? that's experimental, untested work. it's surgery that is being used to promote a surgeon, work that's being done purely for cash flow.

the culture of silence in the community that gets this work done, contributes to death and disfigurement. desperation to get better work done, fear of reprisal from the surgeons, and hush culture are all dangerous things. bad results are bad results, and the high expectations are unrealistic and often dangerous.

until these surgeries are properly studied, and surgeons are sharing data and notes, these are not safe surgeries for anyone to get.

personally I do not care what adults decide to do with their bodies, dangerous or otherwise. however as a medical worker I think these kind of surgeries need to be studied properly, developed correctly, and overseen. publication of results and techniques should be a requirement.

the issue here stems originally from loose standards regarding plastic surgeons, since most of their work is privately paid there's a lower standard of care in that field.

a proper team for this kind of surgery would be a urologist, a plastic surgeon, a neurologist, anesthesiology, psychiatry, orthopedics, and physical therapists as well as a dedicated wound care and follow-up team. what we see now is a few nurses, anesthetics and a surgeon in the room, from start to finish. it's unsafe.'

I though that cuddle's post was thought provoking. Phalloplasty on a female is clearly experimental and unsafe. Reading Griffin's post from 2022, is especially heart breaking as we know that her future was one of renal failure, a brain bleed and death. I strongly believe that this surgery has major ethical concerns and that these should be brought into the open and discussed fully and without influence from ideology. Evidence based medicine is the gold standard and that is not what we are seeing currently by any stretch of the imagination. Why does this cohort of people (MTF/trans identifying females/however you wish to word it) not deserve the best - which is evidence based medicine?

This is not 'life saving care' and it is time that that myth was fully rejected.

Don't expect them to do the emotional labour of working out the impossible! They're here to make demands, not work out logistics!

Additional steroids, for clarity.

We demand nothing less than the total abolition of the clinic, of psychiatry, and of the medical-industrial complex.
Where the fuck do they think the drugs are going to come from if the 'medical-industrial complex' is abolished?

I know! And the free surgery, of many complex kinds, and the free blood tests, and the free medical training, and all the safety and efficacy info. (In fact to get the safety and efficacy info they'd need the medical establishment to step up, not down, because they haven't been doing that properly.)

Some numpty actually wrote that and presumably thought "yay this 'Manifesto' is good to go, hit publish!"

Was that the group who wanted free training in surgery so they could operate on each other?__

Yes

Their demands include any surgery they wish on demand and reversals of those surgeries on demand so they don't have to live with any fear of regret
I thought the regret rate for transition was negligible!

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...

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.

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…

Flipping heck! It's almost like all this technology coupled with the activism of 'right think' has made people dumber.

I've noticed with several people, that they don't try to remember or properly understnd things 'because they can always google it' (or similar) and secondly, why do you need to understand things when there is a nice easy list to stick to of what good people think. If 'you' agree with one thing on the list, then the whole list is uncritically accepted.

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 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).

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.

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.

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.

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'.

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.

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

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.

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.

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?

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.

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/

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..."

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