May 17, 2024

Fancy a vaginoplasty? Think again

Transgender surgery in the United States is a kind of Wild Wild West of medicine

The popular feminist website Jezebel has a blog called “Barf Bag”, which covers American politics in the age of Trump. But an investigative feature published this week, “When surgeons fail their trans patients” fits quite nicely under that rubric.

The focus of journalist Katelyn Burns’s article is a surgeon specialising in sex-reassignment about whom a number of patients have complained after unsatisfactory outcomes. The surgeon is quick to call in defamation lawyers – so BioEdge will not mention more details.

However, her larger point is that transgender surgery in the United States is a kind of Wild Wild West of medicine. In 2017 The Journal of Sexual Medicine published a survey of 20 American doctors who perform transgender vaginoplasty. Some comments about their colleagues were dismaying.

“I have seen horrific unethical practices by surgeons who lie about their experience and horrific results surgically as a result of that. We are using trans-gender people as guinea pigs and the medical profession allows this to happen,” said one doctor.

Transgender surgery is a new specialty which requires interdisciplinary skills – and some doctors who tout themselves as practitioners are incompetent. Burns writes that 192 post-operative trans patients wrote an open letter in 2018 to the World Professional Association for Transgender Health. They complained that:

surgeons were offering “free or low-cost surgeries to under-resourced patients in order to gain operating experience in procedures for which they have incomplete professional training,” falsifying complication rates in “preoperative counseling, academic publishing, and public presentations,” providing experimental surgeries without informed consent, presenting inaccurate medical information to patients, and providing insufficient aftercare for patients.

Burns highlighted the case of a transwoman, a 34-year-old medical student, who developed  necrosis of the vulva after surgery, together with other issues.

She has now consulted with, by her own count, 36 surgeons about fixing her genitalia. The experience has left her disillusioned with the medical profession and she is no longer pursuing a medical degree. She has not pursued any official avenues of complaint, worried that doing so would make it less likely that another surgeon would take on her case.

What recourse do unhappy patients have? At the moment, not much, says Burns:

Malpractice suits remain an expensive last resort, and can be difficult to litigate: the law and medicine haven’t yet found consensus on what constitutes malpractice in trans-affirming surgeries. With no central database for reviews or information of trans-related surgical providers, trans people often depend on word of mouth between friends, social media, or trans-related message boards for feedback. And even then, website administrators are sometimes nervous to host negative remarks against a specific surgeon, fearing a potential libel suit. On the trans-focused message board Susan’s Place, one of the only centralized repositories of reviews for surgeons, warnings against libel abound, particularly in the Facial Feminization Surgery sub-forum.

Michael Cook is editor of BioEdge

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