Visible Man
Jamison Green offers a man's POV on life in the trans lane. Opinion,
advice, and information from an internationally respected leader of the
FTM community.
Under the Knife -- Part 2
FTM genital reconstruction is a controversial topic, even among
transmen. Everyone seems to have an opinion about what is acceptable,
what is
abominable, which technique is the "right" one to achieve the "best"
results. And, yes, there are FTM people who are completely opposed
to
surgery and who think it should not be necessary to have our parts
rearranged
in order to be legally male. I believe the important thing is to
make real
information available so that transmen can make informed decisions,
and none
of us should be judgmental against people who make decisions about
their
bodies that do not conform to our own: our own decisions or
bodies. We can
certainly have opinions, but there is no need to express them in a
way that
invalidates the opinions of others.
We may never know how long and hard someone worked to save the money to
get surgery, how many complications they endured, how hard they have
struggled to come to terms with the results of their decisions, or
conversely, how pleased they are with them. The genital surgical
reconstruction options
available to transmen today leave much to be desired. If genital
reconstruction is what you need in order to feel at home in
your body,
you will have to learn to want less. Sometimes
surgery is necessary for us in order to feel like we can leave
transition
behind and get on with our lives, or in order to attain legal status
as a male.
One reason for having surgery may be sexual satisfaction or
other complex, erotically driven desires. The factors that drive
those of us
who do to have genital surgery are as different as one person's
genitals are
from another's.
There are two basic ways to surgically make a penis: phalloplasty and
metaoidioplasty. Modern phalloplasty techniques came into use
around 100
years ago, driven by the need to replace penises on men who lost them
in wars
and industrial accidents. The techniques were applied to
male-identified
female-bodied people as early as the 1930s, with the first documented
procedure in peer-reviewed surgery journals appearing in England in
1948.
The last significant advance occurred about 25 years ago with the
advent of
microsurgery, which enabled surgeons to connect nerves to make
the penis sensate. Prior to that, phalloplasty could result in a
possibly
good-sized and occasionally realistically shaped penis that had no
erotic
sensation.
The skin to make the penis was (and still is, in the classical
phalloplasty technique) usually taken from the abdomen or hip and
grafted into the groin area, sometimes above the mons pubis,
sometimes
directly on it. The ability to urinate through the penis has been
technically problematic until relatively recently, and urethral
extension is
still not always successful. Erections are achieved with either a
stent or
rod implanted permanently or inserted temporarily in the penis, or
with an
implanted hydraulic pump like those used to assist some men who have
lost
erectile capability.
The type of phalloplasty that can be erotically sensate usually employs
the skin and muscle from the forearm, though sometimes thigh or
deltoid
muscle is used. The muscle makes a denser phallus, and nerves in the
tissue
can be connected with existing nerves in the genital area, most
importantly
the pudendal nerve that enervates the penis (and clitoris). The
scrotum can
be constructed from the labia majora (better for sensation, but
possibly not
forward enough on the body) or from tissue from the lower abdomen,
depending
on the surgeon's technique. These procedures can range in cost from
around
$15,000 to well over $100,000, depending on technique, complications,
etc.
Usually more than one trip to the operating room is required, as the
procedure is rarely successful when done in one stage, though
exceptions do
occur.
Metaoidioplasty (commonly spelled metoidioplasty), meaning
"a surgical
change toward the male," is a term coined by one of the surgeons who
developed the technique in the 1970s. It results in a small penis,
but one that
is erotically sensate and capable of unassisted erection. Derided by
some as
not masculine enough, for many transmen it is an acceptable
alternative
because it does not leave scars on other parts of the body, and
because of
the promise of erotic sensation. Not all transmen are good
candidates for
this procedure because acceptable results require a significant
amount of
testosterone-induced growth in the clitoris (usually discernable
after about
one year of testosterone treatment). And not all transmen are
capable of
accepting themselves with a small penis.
Metoidioplasty techniques can be compatible with urethral extension, and
with the proper placement of the penis and scrotum forward on the
body (which
sometimes doesn't happen, due to the transman's original physical
construction
or the surgeon's technique), a very natural-looking, natural-feeling
package is achievable. This procedure may be done as an outpatient
in a
clinic, though, as with phalloplasty, a general anesthetic is
required. It
can be done in one stage, though some surgeons prefer to construct
the penis
and scrotum first, then place testicular implants in the scrotum in a
second procedure using local anesthetic and a sedative rather than a
second
general anesthesia. Costs for this procedure range from roughly
$10,000 to
$20,000.
For more information on FTM genital reconstruction, as well as photos of
surgical results, readers should consult surgery journals such as
Annals of
Plastic Surgery, Plastic Reconstructive Surgery, or Journal of
Reconstructive Microsurgery, which are usually available in the
libraries of
universities with medical schools. Ask the librarian to show you how
to
do a search on the topic of penis reconstruction or male genital
surgery, and you'll be amazed at how much there is to read!
Online, you can start with my article "Getting Real About FTM Surgery,"
available at www.gender.org, then comb the archives of the
International Journal of Transgenderism
for more medical articles
and other
references. You can also see some results of surgery on photographer
Loren
Cameron's Web site, at www.lorencameron.com.
We're not done yet! Next month, further surgical considerations for
transmen.
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