(Hello, Its Mistress Eva! I know many of my sluts feel that they are a woman trapped in a man’s body. Some have thought of having sex change operation. Sometimes fantasy is better than reality.)
http://www.bilerico.com/2010/06/sex_reassignment_surgery_when_things_go_wrong.php?utm_source=tbpfront&utm_medium=bestof&utm_campaign=best_of_b
Sex Reassignment Surgery: When things go wrong
Filed by: Amy Hunter
Sometimes, things go wrong with the surgery.
It has many names and many acronyms, SRS, GRS, GCS-Sex Reassignment
Surgery. Whatever you call it, it is an irrevocable commitment and
irreversible step should you choose to take it.
Male to female (MtF) transpeople talk about it a lot. You know: Are
you, or aren’t you? Is she pre-op, or post-op? Who did yours? Whom are
you going to have do yours? We talk about it a lot, except…when
things go wrong. Then–we don’t say much at all. In fact, we won’t
talk about it publicly, but it happens. We cover it up as if we should
be ashamed. We feel damaged.
Something odd ensues, much like forty or fifty years ago. Back then,
people spoke in hushed tones, if at all about the family member,
colleague, or friend who had certain illnesses-the “C word”-only
whispered. Many times this lack of openness about such matters led
directly to preventable consequences–even deaths.
We need to talk about healthcare for the transgender individual and I
want to talk–openly about my experience–about what can happen when
things go wrong with SRS.
I Knew There Were Risks
While death is an unlikely result of complications from sex
reassignment surgery, things can and do go wrong with the procedure.
Even the most skilled of surgeons are, after all, human and as with
any surgery, there are risks.
The information packet sent to me from my surgeon’s office listed the
possible things that could go wrong. I had read extensively about what
my body would have done to it after Propofol sent me to a dreamless
sleep. Everything I found on the internet listed possible
complications. One was a worst-case scenario, but the websites always
mentioned it last and even then, it happened so seldom, most said,
that it was a risk hardly worth mentioning.
My pre-operative appointment, a scant two hours before I signed the
waiver, was brief. The surgeon asked a few questions, looked me over,
pronounced me suitable for surgery and added that I had enough tissue
for good depth. Almost as an afterthought, she said we needed to go
over “this stuff”. We got to that last, not worth mentioning but still
possible, worst-case scenario thing. Of course, it needed to be
brought up but in almost four hundred surgeries “it had only happened
just once, so we don’t worry about it”. I didn’t.
Just before I walked into the surgical suite, I signed the waiver.
I slumped to the floor of the shower that morning in Trinidad
Colorado, water and reality raining down on me. Bewilderment and
terror replaced hope, which swirled toward the drain along with the
feces and the blood. Emergency surgeries there, four more at home in
Kalamazoo and another in Denver have all failed.
Chronic pain, heavy narcotics addiction, and bouts of deep depression
are the hushed legacies I have battled. Left with a possibly permanent
colostomy and a painful, fibrous lump between my legs where a vagina
should be, it is nearly impossible not to revisit the devastation
daily. It is now two and a half years later.
The infrastructure of a natal male body is not the same as a natal
female. The male pubic bone is lower and in my body, tipped somewhat,
making it hard for my surgeon to get the geometry just right. In my
case, there probably wasn’t really quite enough space to allow for the
proper thickness of septum between the new vaginal wall and the rectal
wall.
A slight tear in my colon from a retractor, was all that was necessary
to compromise an otherwise flawless procedure. I had developed a
rectal-vaginal fistula. This problem happens to natal women too, often
as a complication from difficult childbirth or certain cancers.
Frankly, the success rate for repairing the defect in natal women is
not good either. It often takes multiple surgeries for them too. What
makes it even harder for the transwoman?
The Endemic Problems In Transsexual Healthcare
My story–and my surgeon’s– illuminate important problems endemic to
healthcare for the transgender and specifically, the transsexual person.
Lack of access- Discrimination by doctors and hospitals and inability
to get insurance or pay outright makes it difficult, if not
impossible, for many transgender people to access care - primary or
specialized.
Lack of knowledge- Documentation of protocols for care of patients
undergoing transition is severely limited. Additionally, techniques
for remedial care of complications are not well developed; instead,
procedures designed for amelioration of fistulae in natal females are
used.
Lack of training- There exist no specialized courses of study or
teaching hospitals for SRS surgeons.
Lack of experience- While some surgeons learn techniques from other
doctors already performing SRS, there are no residencies for those
wishing to become SRS surgeons.
Lack of inter-disciplinary collaboration- Ignorance, discrimination
and arrogance on the part of specialists often block those needing
specialized post-SRS care.
In 2008 both the American Medical Association and the American
Psychological Association issued white papers - policy statements
calling for equal and fair access to healthcare for the transgender
community. Both organizations recognized lack of access to health care
as a growing crisis among transgender people.
Significantly, however, while both bodies asked the insurance industry
to remove discriminatory blocks for transpeople, neither the APA nor
the AMA asked for better training and documentation of skills. Neither
organization called for unilateral coverage of transition related care
and procedures. The APA resolution reads thus (emphasis mine):
THEREFORE, BE IT FURTHER RESOLVED THAT APA recognizes the efficacy,
benefit and medical necessity of gender transition treatments for
appropriately evaluated individuals and calls upon public and private
insurers to cover these medically necessary treatments;
And the AMA:
RESOLVED, That our American Medical Association support public and
private health insurance coverage for treatment of gender identity
disorder as recommended by the patient’s physician.)
Ok, pretty strong statements, right? Look again and in particular,
consider the italics. The APA resolution makes one BIG assumption-that
you will be able to be “appropriately evaluated” , this requires you
to have found and be able to pay for a psychologist, assuming of
course, that you want to be evaluated. The AMA resolution assumes much
the same thing; that you have a physician and that he or she is
willing to make such recommendations, if, in fact, they are so
qualified.
Whom Should I Go See When No One Will See Me?
I am associated with a LGBT resource center so, I get calls for things
like, “Who is a trans-friendly electrologist” but the most frequent
call I get is “My family doctor won’t prescribe me hormones. Whom
should I see?”
To my knowledge, there are only two therapists in this area who take
transgender clients, neither is a clinical psychologist who can render
a surgical readiness opinion for SRS. There are one or two primary
care physicians in the area who will prescribe hormones but, after
hearing stories of one of them prescribing the exact same regimen for
every patient, I am more than reluctant to send people to him. The
nearest endocrinologist who takes transgender patients is ninety
minutes from here. My own primary care doctor, admittedly, has no
knowledge of how to dose a transwoman either pre-operatively or, post-
operatively. He has left it up to me to tell him.
There is no curriculum, no specialization, no residency, and no board
certification for SRS surgeons. No medical texts detail the
procedures. Most SRS surgeons have followed in the footsteps of
pioneers.
In my doctor’s case, the pioneer was legendary Colorado surgeon,
Stanley Biber M.D. whose compassion for a social worker led him to
develop the most celebrated sex reassignment practice in the States.
The surgeon who did my SRS learned from him and took over his practice
when he retired. Soon, she began refining his technique and developing
and teaching her own. Today, she routinely performs SRS as many as two
hundred times a year.
There are surgeons who want to do SRS-who have trained under doctors
as mine did, but find it difficult, if not impossible, to find a
facility that will grant privileges for SRS. Often, these surgeons may
have the technical skills for SRS-urology, gynecological and plastic
surgery, but hospitals will not grant access because there is no
accredited course of specialization or board certification.
This may not be all bad. While there are a few new surgeons doing SRS
every year, are they really getting the training necessary to
accomplish not just the surgery itself but, adequate follow-up care
too? Again, no curriculum, no specialized course of study, no board
certification, but perhaps more significantly, certainly for the
patient, there is no roadmap for what to do when things go wrong.
My Surgeon Doesn’t Know How to Fix It
Then, seemingly, neither does anyone else. My SRS surgeon attempted to
fix the two-inch tear in my colon while I was still there, the repair
failed in less than twelve hours. Next, a colon-rectal surgeon was
found in the nearest large city and brought in to look at me. He
aborted his attempt to repair the defect and instead, performed a full
colostomy.
I flew home to Michigan with a bag attached to my abdomen and thick
pads between my legs to soak up the blood.
A local colon-rectal surgeon, persuaded to see me by my primary care
physician, was upbeat. Each time I went into surgery with him he would
encourage me, saying “this time we’ll get it”. Coming out of surgery,
my spouse Cindy would hear from him how well it went and that he was
“optimistic this time” the closure would take and a new defect would
not open up.
Another surgeon who has had some success with other fistula patients
seemed promising, but eight months later, under the pressure of a
barium test, that repair too, failed.
I have had stitch-overs, mucosal flap advancements, and pelvic floor
muscle mobilization; each new approach diminishes what viable tissue I
have for another attempt. I have tried to go into every surgery with a
realistic outlook; multiple failures however, become difficult to bear.
Still, I am one of the fortunate ones with this complication; I stand
a chance, albeit small, for an eventually favorable outcome. Many
transwoman are not able to find a colon-rectal surgeon who is willing
to work on a transperson, much less “someone else’s problem”, nor do
all of us have the means.
Even if you are fortunate enough to locate a doctor–and in my case,
privileged to have insurance and financial means to cover remedial
procedures, then there is still only a slim chance for alleviation of
this humiliating and debilitating condition. One surgeon, out of
frustration no doubt, finally washed his hands of me saying, “well,
you did this to yourself”.
Losing the Patient
I am not writing this to slam the physician who did my SRS. Far from
it, she is a dear friend. We have shared much together, laughing, and
holding each other; the two of us have grappled for footing. We have
cried together, and yes, yelled at each other. She is an icon in the
transgender community and heroine to many transsexuals. She is also
perhaps the most accomplished of the few surgeons doing primary SRS in
the United States.
However, even a surgeon as accomplished as mine cannot overcome
obstacles that she has no training for and little experience
resolving. There are unseen and unsaid barriers that come into play
when someone with complications from SRS must seek treatment aside
from their original surgeon.
As I mentioned before, most surgeons just do not want to deal with
what they may perceive to be another doctor’s mistakes, if they are
willing to look at you at all. A person would be hard pressed to get a
doctor to admit that they are closed-minded, yet there are many
doctors who simply will not work on-or treat a transsexual.
My surgeon has told me, and has repeated often, that she would see me
through this. I believe she has tried, but somewhere in the mix of
discrimination, ego, and fear, the patient has been lost.
