Between+XX+and+XY:+Intersexuality+and+the+myth+of+two+sexes

Only 16 percent were capable of sexual intercourse

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Unformatted text preview: numbers for the convenience of communication have met with only limited success. The beauty, the breadth, the width, the length, and the abnormality of it all remain largely in the eye of the beholder. But the presence of an incompletely developed urogenital sinus has led to some remarkable surgeries to reconstruct our children. One of these procedures, called total urogenital sinus mobilization (TUM), requires the dexterity of a puppeteer moving the strings on a dozen marionettes at once.16 To separate the urethra and the vagina in children with a retained urogenital sinus, one catheter is inserted into the bladder and another into the vagina. After that, the surgeon makes an incision just below the phallus (clitoris) to just above the anus. Then the whole urogenital sinus (including the uterus) is freed by dissecting it away from all of the surrounding tissues. Using these two catheters like the strings on marionettes, the surgeon then manipulates both bladder and vagina into their scripted spots on the stage and sutures them into place. It’s a technical miracle, and where there was doubt there is now a girl. But this surgery is not without risks. And even as complicated as all of this sounds, my description is a significant oversimplification of the actual procedures and all the decisions that the surgeon must make along the way as he or she uncovers the actual condition of the urogenital sinus and the relationship of vagina to urethra. Masculinizing Surgeries As complex as vaginoplasties are, building a functional penis is a nearly impossible task. According to the Consensus Statement on Intersex Disorders and Their Management: “The enormity of the undertaking and the complexity of phalloplasty must be considered during the initial counseling period. Care should be taken to avoid unrealistic expectations about penile reconstruction.” 125 After Bettochi et al BJU International 95 (1): 120–124 What We Do About the Ambiguous Child The phallus is formed from a flap of anterior abdominal wall skin that is rolled around a catheter to form the new urethra and sutured to complete the new penis. This is not especially encouraging for male expectations. But the few studies that have been done seem to bear this out. In one study of adults with gender dysphoria—meaning people in women’s bodies who wished to be in men’s bodies—penises were created using a flap of muscle from the abdominal wall immediately above the pubic area. This flap was left attached at the base to the abdominal wall and sewn into a tube that contained a new urethra made from a tube of labial skin. Patients were then offered both penile and testicular prostheses—artificial elements for achieving erections and to fill an otherwise empty scrotum. Of the eighty-five people treated and questioned between 1989 and 2000, most thought their constructed penis looked OK. But nearly everyone had problems including strictures (narrowing of the tubes) or fistulas (holes that form between two abutting tissues) involving the newly formed urethra. About 25 percent of them needed further surgery, sixteen had problems with urination, and three had some necrosis of the constructed phallus. Only 16 percent were capable of sexual intercourse without prostheses. However, sensation in the penis was possible in most, since the existing clitoris was incorporated into the new urethra.17 It is difficult to imagine the technical accomplishments involved in these surgeries. Working human flesh like clay to create, enhance, or define sex is truly one of the wonders of modern science. 7 Outcomes: Sex, Surgery, and Satisfaction But does it work? Do these surgeries make for happier people? As previously mentioned, it depends upon whom you ask. Doctors, parents, and patients are all likely to provide different answers to those questions. The aftermath of surgery is often complex, and long-term studies of patient satisfaction are few and frequently contradictory. Bruce, Brenda, and David: One Boy’s Tragedy During the summer of 1965—the same year Dr. Betty Suits Tibbs wrote her account of Lenore, the boy-made-girl (see chapter 1)—a pair of identical twin boys was born to Ron and Janet Reimer in Winnipeg, Manitoba—an old city built where the Red and Assiniboine Rivers come together in western Canada. In Winnipeg, the predominant faith is Roman Catholic, winters are harsh, and hard work is a way of life. Ron was twenty years old in 1965; Janet was eighteen. Janet was pregnant when they married. Ron took a job at the slaughterhouse, and Janet settled into her role as soon-to-be-mother. The pregnancy unfolded without incident, and, though born a little prematurely, both boys were healthy and completely normal. The Reimers named the twins Bruce and Brian. 127 128 Between XX and XY For the next seven months, Ron Reimer worked hard to earn enough money to provide for his new family. The boys did fine, and Janet was a good mother to them. But just as they were about to turn seven mont...
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This document was uploaded on 02/04/2014.

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