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.

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.

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.

Cuddle has posted a follow up to their earlier post on the Farms. I thought that it would be helpful to add it here.

'not experimental at all. it's external plastic surgery; they simply use existing tissues to construct the external "look" of a vulva. the loose skin remaining after castration are what is used; these tissues and the skin are already attached right at the body site where they would be sculpted. no depth means no internal surgeries, dilation, open wounds, rearranging.

surface level plastic surgery on soft tissues. less risky than even nose jobs, there's no cartilage to rearrange, no bones to break.

penectomy and orchiectomy are time tested procedures, men can need them for a variety of medical reasons. (same with mastectomy).'

This was in response to this question from a poster called HalfPint.

'I am not a medical professional, but is this really not experimental still specifically for men? I know women can get labiaplasty, but the butchering/rearranging of a penis into a vulva still seems far from safe.'

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

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

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

It’s also very hard to measure outcomes in such a pressured, ideological context. You can assess if it’s not grafting properly, the “urethra” part is blocked or the arm gets an infection. But how can you assess if the phalloplasty is achieving its purpose of “affirming” a male gender identity, when no female can know what it’s like to have real male anatomy, and people in this situation are under huge pressure to believe and say this “affirmation” is lifesavingly wonderful and ostracised if they say they made a mistake.

I'd want to see long term studies. Like, maybe the faux penis eventually heals after revision surgeries, say after five years it's settled down.

But what is the state of the urinary tract and the surgical sites and the motility of the degloved arm or thigh after 10, 15, 20 years? How often does the person have UTIs? How are thier kidneys coping?

I can't see how it would do anything other than shorten your life expectancy.

It's not like doing phalloplasty on a soldier who got his bits blown off by a land mine in Afghanistan, for example. That will I presume have decent success rates because he's already got all the internal plumbing in place. But a woman's urinary tract system is totally different from a man's, so I just don't see how it could work. How the hell do you lengthen a urethra anyway? You can stretch it I guess but then you risk tears and fistulas - sepsis - UTIs - kidney failure.

I just don't get it.

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

This only occurred to me a couple of days ago. No ligaments or muscle, just scar tissue attaching it to skin. Very superficial.

Yes, men have a complex structure of muscle and ligature there, you can feel it especially when they start to get hard (an interesting experiment although it does tend to kill the vibe somewhat lol).

Women don't, so over time, you've just got this heavy flesh tube, won't it end up stretching out, like ear lobes in people who have those huge 'flesh tunnel' earrings?

Wouldn't you get stretch marks and skin tearing? Can't be good for one's gender dysphoria.

Can't be good for one's gender dysphoria

I don’t know. None of these interventions are about addressing gender dysphoria, they are all about indulging it. Like with OCD where accommodating compulsions may initially feel good but just worsens the OCD.

There is a method where they basically cut your belly flesh like 3 sides of a square, then inch it down you in stages, and you end up with your belly button on your 'penis'. Spoiler alert: it doesn't work. The KF thread is for strong stomachs only, both in terms of the photos and of the language the farmers like to use, but it's extremely informative.

The cells of the urethra are unique, they have to deal with being in contact with urine (of course), all the alternatives I have seen are completely inferior in terms of this basic function. Veins, skin, skin from inside the mouth etc. None have evolved to cope with repeated urine exposure.

Urethral lengthening and the 'stand-to-pee' desire that many FTM people have is fundamentally flawed, especially if you want whatever bodged together structure that the surgeon has constructed from repositioned/repurposed flesh to last 40 years plus.

There are limits as to what can be done with a live human body using their own flesh. This is pushing the edge, no, it is pushing past the edge of what is possible.

The cells of the urethra are unique, they have to deal with being in contact with urine (of course), all the alternatives I have seen are completely inferior in terms of this basic function.

Well quite, there's that too. So I just don't see how you can have one of these things without also ending up with near permanent UTIs and eventual kidney failure.

Same with neovaginas, as I understand it, transwomen struggle a lot with infection and odour - because actual vaginal cells have a certain pH level and are evolved to stay healthy even though it's a dark, damp place. But an inverted penis doesn't have those same cells and don't do well in an enclosed environment so get infected.

Urethral lengthening and the 'stand-to-pee' desire that many FTM people have is fundamentally flawed, especially if you want whatever bodged together structure that the surgeon has constructed from repositioned/repurposed flesh to last 40 years plus.

I've been on exulansic videos last night and am struck by how much these girls valorise the idea of standing to pee - it matters more to them than being able to get erect and feel sensation (which is what an actual man would care most about of course).

They seem to have a fear of squatting to pee and I can't help wondering if some of them have trauma from past sexual abuse/assault and equate disrobing and squatting with physical vulnerability, thus they are seeking to resolve their trauma by obsessing over being able to stand.

From the images I have seen, the stumpy looking result also doesn’t look to be something that would be usable for PIV sex.

And if it was, surely the join would be at risk of rupture?

I have never understood why this operation was allowed. It is barbaric.

And yes, of course life is shortened considering the constant issues that the surgery and testosterone have with excretory system infections. I cannot imagine the body fighting off the infections we get as we age for as long as an unmodified female body could.

A shewee or even a 'packer' that functions as a shewee but is shaped like a penis (which do exist) would be a much better solution.

From the images I have seen, the stumpy looking result also doesn’t look to be something that would be usable for PIV sex.

And if it was, surely the join would be at risk of rupture?

As I understand it they can have a plastic erectile device implanted and they can make it 'hard' by pulling some kind of implanted lever. Very few seem to go for this option and of course it just means more surgeries and more points of failure.

There was a young woman on tik tok who dealt with the erection issue by wrapping her faux penis in lots and lots of duct tape and then popping a condom on it to achieve stiffness for PIV sex.

Aaaand my vagina just dried out and clambered up somewhere near my throat at the thought of it.

And yes, of course life is shortened considering the constant issues that the surgery and testosterone have with excretory system infections. I cannot imagine the body fighting off the infections we get as we age for as long as an unmodified female body could.

This also comes back to ‘a hysterectomy is low risk’ which ignores the lifelong impact of a hysterectomy. It considers the surgery in isolation from the rest of the body systems.

Oh I know about the inflation devices. But usage of it surely must cause issue with the joining...

WTAF - duct tape? surely that would be over the top of a condom and then another condom over the top?

I can't read these details without wincing. Dear god the thought

I don't think so, sadly many of these young ladies seem quite alienated from their own bodies and have no problem with harming it

Hope no-one minds me posting actually footage of my vagina after reading that

How romantique.

😢 I suspect you are right there.

I can’t imagine they have much sensation there either. Wouldn’t it mostly just be numb?