How to change how things are done (GRS)

How to change how things are done, which can be also resumed as fighting inertia, is quite a general topic, but we’re going to focus on gender transition treatment, and more particularly surgery for transgender women (i.e. gender reassignment surgery a.k.a. vaginoplasty). So here I am, talking about transition after saying in my first post that I wouldn’t do it so often. But this one will be rather long, and I don’t want to be banned from twitter for spamming. So here we go.

A few weeks ago, I stumbled upon this article in Wired that talks about a “new” vaginoplasty technique that is better than the current one. It says a bit what it does, who does it and… that’s it. The problem, I find, is that it cruelly lacks sources, because, let’s see:

  1. They say it’s Dr Ting who performs it, and he is director of surgery at Mount Sinai (NYC). Ok, this one is easy, here is Dr Jess Ting, although they only say he does hand surgery and plastic and reconstruction surgery. Well, reconstruction surgery matches with vaginoplasty, so I guess we nailed that one. But is he the only one in the USA?
  2. a paper describing the work of some doctors in India who were building vaginas a bit differently.” So apparently, there is somewhere a paper that describes a technique used in India (only?) that’s better than what is generally used now. Nice, can you tell us more about the paper? Not the paper itself, I’m sure it’s under strict copyright, but the authors, the publication? A DOI maybe? Well, no, apparently, it’s not interesting enough to have more information for people who might be interested in such topic, like, other transgender women.
  3. They were performing surgeries on women with a rare disorder that causes the organ to develop abnormally or not at all.” This one is just lazy. Seriously, not even the name of the disease?

So in the end, we literally can’t find actual useful information about this without putting extra effort. This article smells purely like a hidden advertisement for the Mount Sinai so they don’t get competition. They don’t even talk about it on their website, like it’s a Research and Development project and they don’t want anyone else to do what they do. This is obviously not in the interest of transgender women who want to access what’s best for them without having to travel thousands of kilometers away or pay more than they should (which is zero or close to that figure in many countries). It’s always better to find a solution in your local area, or at least in your country, especially when your country has a relevant health care system that will cover it.

Enough said about this badly sourced article, now how do we get to have this kind of procedure?

First, we need to know what we’re talking about. This is why yours truly went above and beyond to find that information. So I started by contacting the Mount Sinai hospital about this matter and never got an answer. So either they’re too busy to answer a transgender woman they claim they want to help, or they just didn’t want to answer. Either way, they weren’t helpful at all, so I moved on to my second step: finding about the procedure.

The good thing, despite the lack of information in the article, is that they felt compelled to give out a minimum of technical information so they actually look like they know what they’re talking about. “They found a way to do that with tissue from the peritoneum, which is basically a bag of loose tissue that encircles the inside of your abdomen and holds your guts in place.” The fact that they actually name the organ they use (the peritoneum) helped a lot, because, after research, I managed to find more information about the procedure (which is called “Davydov’s colpopoeisis”). I won’t explain it in much detail, but if you’re curious, The Beverly Hills Center for Laparoscopic Urogynecology explains it very well, with pictures. And you learn about the condition of the women born without a functional vagina (Mayer-Rokitansky-Kuster-Hauser, MRKH), since that’s what the surgery was designed for in the first place. That also means that the Mount Sinai isn’t the only place to get that surgery.

If you want more detailed information about the procedure, there is an article (Ward et al., 1998(1)) for that. And you read right. It has been written in 1998, so obviously, this technique has been around for some time, and not only in India (I didn’t find the Indian article, though, which makes me wonder how this woman found it in the first place and not the article from Ward et al.).

Then, they are talking about the outcomes of the surgery: “while the new procedure is showing superior results so far, it will be important to monitor to see how it holds up long term“. They’re right, we need to know how the surgery holds up in the long run. Or do we? It turns out, there is already an article detailing that (Zhou et al., 2010(2)). And it’s neither in the USA or in India. Now it’s in China. Looks like this procedure is done all over the place after all. And don’t get me wrong. We definitely need more study, especially regarding transgender women. But the article is seriously misleading, and honestly the procedure is exactly the same for trans and cis women since it only involves body organs that are shared in both male and female bodies. And they can start from there.

Now the big question: how do we get to have more surgeons performing this surgery for transgender women. As I said in introduction, changing things is about fighting inertia, and the strongest inertia is, the more energy we need. In this case we need an insane amount of energy, first to be heard, then to be listened to, and that’s where we need to do something together. I can go only as far as people are listening to me, and I don’t have a big notoriety or charisma that helps the subject to be brought forward. I tried to talk to my doctor, but she said it wasn’t her place to tell surgeons what they have to do, which is sound. I told the PHSA (health care system in Canada) in my local branch, in Vancouver; the person I have in contact said it was very interesting, and basically told me that they are currently training surgeons to provide surgery services in British Colombia, so we don’t have to go to Québec, but I don’t know what they are trained on.

Now I’m on a stand still. I really don’t know what to do since I have almost no useful contact in that regard. My only is that the information I salvaged gets to be shared the most widely possible.

So, please share, and talk about it to your practitioner, your health care representative, your pharmacist, your Shoppers clerk (who’s also your pharmacist), your mom, your dog, anyone who listen to you. Maybe together, we can do something about it.

 

(1) Current Obstetrics & Gynaecology (1998) 8, 224~226© 1998 Harcourt Brace & Co. Ltd

(2) Fertility and Sterility Vol. 94, No. 6, November 2010  Copyright© 2010 American Society for Reproductive Medicine, Published by Elsevier Inc.

4 thoughts on “How to change how things are done (GRS)

  1. Here is a link to a Dec 10, 2017 interview with Dr Ting:

    http://www.slate.com/articles/podcasts/working/2017/12/how_does_gender_reassignment_surgeon_jess_ting_work.html

    in which he talks in some detail about the technique you are referencing, that of using peritoneum tissue to partially create the vagina. The entire 45 minute interview is well worth the listen but the pertinent section starts at 9:59 where he talks about how peritoneum tissue is harvested form the abdomen laparoscopically.

    Very recently I spoke firsthand to a member of Dr. Ting’s surgical team who explained that the procedure has been further refined and developed to make the laparoscopic surgery step unnecessary. Very similar tissue can be harvested from the tunica vaginalis, which is the pouch of serous membrane that covers the testes. It is derived from the vaginal process (how fitting!) of the peritoneum, which in the fetus precedes the descent of the testes from the abdomen into the scrotum. [https://en.wikipedia.org/wiki/Tunica_vaginalis]

    In the interview Dr Ting also speaks about how a new era in transgender surgery is being made possible (12:10) by surgeons sharing their techniques through symposia and teaching programs, in direct contrast to the secretive and proprietary approach that the top surgeons in the field have long exhibited. There are currently two major transgender academic medical programs in New York (Mt. Sinai and NYU Langone) with two more soon to follow (Montefiore and Northwell). [https://www.politico.com/states/new-york/albany/story/2017/12/12/transgender-programs-flourish-following-new-york-medicaid-coverage-140750]

    Liked by 1 person

  2. The Davydov Method has been used for decades. A long term study of patient follow ups was published by Dr. Mhatre from Mumbia, India. He is one of the leading University professors in urogynocological surgery in the world.

    Liked by 1 person

    1. Do you have a link to this study? That’s the thing I was looking for and never found. If I want to bring the issue to a surgeon, I need to know what I’m talking about.

      Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s