Thursday, 14 August 2014

Back from the Grave 8

The penultimate resurrection. A post called Genital surgery - fear and regret, or joy and happiness?, published on 3 January 2013. I wrote when feeling angry about men's attitudes. I soon came to think the post needed a major rewrite. And I wondered what alert redfems would make of it.

It seemed best to deny anyone ammunition for comments. It was time, anyway, to lower my profile and write much less of this kind of thing. So it had to go.

By the end of February, three more trans people that I know of, two of them local friends, will have undergone 'male-to-female' genital surgery. There are now few in my circle of personal friends who have not reached this stage in their transition.

It's a complicated procedure, with several difficult preliminary hurdles to overcome before you can enter the operating theatre. Plus, of course, all the ordinary risks of any major operation that goes on for hours. Every patient presents a different challenge for the surgeon, and although the desired outcome is broadly predictable, in the detail it may not go quite as intended. I myself developed a haematoma (a blood-filled sac) that was swollen and unsightly until it dissipated. Actually, I was abnormally swollen all over at the surgical site, and for longer than usual. It was my body's reaction to all the work done. But it was my only complication. Quite a few trans women find themselves stuck with internal stitching that stubbornly refuses to heal up quickly, causing bleeding, and leaving them prone to post-op infection. I had none of that.

With surgery like this, there's a trade-off. The simpler the operation, the plainer the result, the less there is to go wrong, and the faster it all heals up. But if you want the full monty, an artistic recreation of complex labial folds and flaps, a pronounced clitoral hood, and a really deep vagina stitched together from heavily-scraped scrotal skin, then the things that could go wrong add up and the risks of complications grow. I suppose I'm talking about the standard job offered by the NHS at Charing Cross and the Brighton Nuffield versus the very finest work you can get in America, Thailand, and other places around the world. But no question, even the most straightforward procedure means three hours in the theatre, and rigorous aftercare that will go on for a long, long time. It's an invasive operation, not lightly faced, that will put the body through trauma. It simply can't be compared to a weekend boob or lipo job. And any supposition that the patient is ready for sex within a month is just a very bad joke.

Most people are (quite sensibly) wary of operations. But the thought of this one seems to generate a massive adverse reaction in some quarters, not only from men. Men do however seem to squirm the most. Perhaps they imagine themselves with their willy removed, and how that would impact on their self-image and self-esteem, and how their mates would laugh at them, and how women would spurn them with mocking sneers. To the conventional man, it's horrific, and suicide might be better. They project that horror onto the trans woman who is going to have the operation. This results in fear and loathing, the trans woman ridiculed and rejected because she is suddenly an object of lurid fear and disgust. And afterwards, after the deed is done, another feeling arises: the conventional man's fear of being thought gay. Because the trans woman not only has a ruined body, but is now firmly in the female camp. She is a potential bed-partner: an exotic and dangerous vampire who might spell ruin to her victims.

I'm sorry for such wobbly men. They are so wrong-thinking. They miss the point entirely, which is this: that trans women are women, not men, and although a man might recoil at the thought of having female genitalia, a woman does not. They are exactly what she wants. They are right and proper for her. Being told that she is gross, dirty-minded and masochistic to long for such surgery is a hurtful error. And a man putting obstacles in the way of this surgery, or actually denying it to the trans woman - for whatever reason - is guilty of an act of dire cruelty.

But some natal women object violently to it as well. Here the passions are based mainly on the status of the trans woman's body. Arguments will be brought out to 'prove' that a male body remains a male body regardless of how its appearance changes. That 'all men' have XY chromosomes, the 'mark of a man', and that surgery can't alter this 'fact'. That male meat remains male meat after being cut up and stitched back together. That the surgery only alters the outward appearance, creating fabricated organs, and doesn't put in a womb, ovaries, nor any of the special features and functions possessed by a natal woman's body. And so on. In other words, men can't be made women, no matter what you spend on your surgery.

I've listened to a lot of this. It didn't alter what I felt inside. It still doesn't. Because I simply wanted the surgery to alter my appearance, not to lead me down the road to motherhood. I was too old for that anyway.

I've also heard a lot of comment from men and natal women who are used to trans women, and comfortable in their company, and believe what we say about ourselves. These people were all grown-up adults, confident of themselves, and wanting to see other human beings succeed in what matters to them.

What about post-op regret? None of my post-op friends have mentioned any, and I haven't experienced a single moment of wishing to be as I used to be. I suppose the immediate post-op stage might seem difficult, with tiredness and discomfort to cope with, and dilation ruling your day. But this will end, you know it will; and unless complications are significant and ongoing, there is nothing medical to get despondent about.

The real source of potential regret kicks in long before surgery. By the time anyone gets to the operating theatre, there will be at least a year of full-time female living. And the moment that begins, it is too late to go back to the former life. Coming out, starting to live full-time in a female role, permanently alters everything - other people's perceptions and attitudes, the dynamics of a close relationship, career prospects, where one now lives, who are now one's friends. Coming out is the decisive act, not the surgery. The surgery is just the eventual extra, much wanted no doubt, but not the key reason why you might regret anything. Coming out is the moment that really fixes your new status in the minds of everyone else, and makes them throw away the old familiar you, and embrace the you that they haven't seen before. If they manage to move forward, they won't be able to step backwards later on. They won't forget the woman that you revealed. Once that has happened, you can only move onwards. Cancelling the operation won't restore anything, nor wind the clock back. It will just deprive you of what you should have.

Speaking for myself, I could not have endured a life of knowing I was trans, and yet not having surgery to make me look right. I did think a lot about post-op life in the months before surgery. But I was already living with the consequences of coming out in 2008. It seemed to me that my life was, already, utterly altered - and that surgery would actually improve my chances of living a full and useful life in the future. This has proved to be true.

And besides, the positive benefits of authentic appearance are truly substantial. Yes, it's a fact that nobody can view the surgical site, because it's covered up by what you wear, and undetectable unless you deliberately wear tight-fitting clothing to show your smooth shape off. But you know. And that knowledge, which you can share if need be, is the most marvellous boost to your confidence. It's astonishing what this really means in ordinary daily life. But you can also face any strip search at the airport, and pass through any airport X-ray machine. So much potential bother avoided because you look right. A priceless gain.

One thing I can't personally go on to discuss is the happiness that might flow from a sex life. I'm taking it on trust that sex with the proper physical equipment is better than sex with the wrong equipment. It seems like a reasonable proposition.

Posted by Lucy Melford at 13:04

There were just two comments, one of them mine:

1. Jenny 3 January 2013 23:14

The 'XY' brigade would be shocked to meet an XY androgen insensitive natal woman. They probably already have in fact, without realising it.

2. Lucy Melford 4 January 2013 00:51

Absolutely. Abnormalities are not that rare, are they - although I'm willing to bet £5 on being a plain, predictable XY, and would be staggered to find that I was anything else (which indeed might have health consequences). Besides, who'd want to be a medical oddity. The Sun isn't going to hound an XY trans woman for her story (i.e. the 'XY man'), but would make life impossible for the 'XX man'. I'm assuming that Leveson gets forgotten, of course.


Post-mortem in 2014
I was nearly two years post-op, and my experience wasn't generally applicable anyway. Why then harp on about the surgery? I could have said more about the significance of coming out, and how that seems to be the really decisive event. Yes, a re-write should have been attempted.

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