Surgeons have tried before to harvest other parts of the body to make more vagina-like vaginas for trans women. About 10 years ago some doctors attempted the procedure with small portions of patients’ colons. That didn’t work out. “No one wants a vagina that smells like a stool,” says Ting.
Today, more and more transgender men and women are scrambling to schedule gender affirmation surgeries, scared that the Trump administration is sliding shut their recently opened window to accessible healthcare. In May, Health and Human Services Secretary Tom Price told a federal court that he’s reworking a provision in the Affordable Care Act that requires states to cover transgender care through their Medicaid programs. The rewrite is likely to free states to refuse coverage for hormones, counseling, and surgeries for transgender men and women. Not that they have to wait; Price said he’s declining to enforce the rule in the meantime.
Like many other surgery patients, Hayley Anthony has a daily physical therapy regimen. But unlike other post-ops, the 30-year-old marketing consultant is recovering from a procedure she helped invent. Five months ago, she became one of the first people in the world to have a piece of tissue incised from the cavity of her abdomen and turned into a vagina. A surgeon in New York City may have pioneered and performed Anthony’s procedure—but the idea to try it in the first place was all hers.
But a vaginal cavity made out of skin doesn’t do some things the inside of vagina should (like get wet when aroused) and does others it really shouldn’t (like grow hair, even after electrolysis). For trans women with genital dysphoria, it’s been the only real option for bottom surgery, and it’s been a pretty good one. But the procedure can still leave many disappointed.
With only about a dozen doctors in the US who specialize in gender affirmation surgery, it’s nearly impossible to keep up with demand, let alone innovate new ways of doing things. But that’s what Jess Ting, director of surgery at the Center for Transgender Medicine and Surgery at Mount Sinai, has been up to for the last two years. What started as a Google search on Anthony’s computer is now the most sought-after surgery Ting performs. In the last six months he’s given 22 trans women something that they weren’t sure they’d ever have—a vagina that looks and feels and secretes like the real thing.
The peritoneum, it turns out. After Anthony first brought his attention to the Indian research, Ting started doing some research of his own. The peritoneum, he found out, regenerates naturally after just a couple days. He was even more intrigued. Then he shadowed a colleague at Mount Sinai who was a laproscopic surgeon, watching him remove gallbladders from a tiny incision in a patient’s abdomen. And he watched videos of surgeries that gave him a better look at the tissue to see how much of it he could harvest with the same technique. “It’s just like taking a tool you’re well acquainted with from a toolbox and using it in a new way,” he says.
Anthony had known her whole life that she was female, but she didn’t begin transitioning until about four years ago. Then, in the fall of 2015, after months of working with a therapist to better understand herself and her options, she accepted that she had to do whatever it took to have the right body for her mind. She scheduled a consultation with Ting and they made a date to make her a new vagina. Then she went home and down a deep internet hole. “I had gone into the process, eyes wide open, understanding all the compromises and willing to accept them,” Anthony says. The procedure she was mentally preparing for involved slicing open the penis, removing most of the inside parts, and then folding the penile skin into the space between the urethra and the rectum (kind of like turning a sock inside out). In what has become the standard surgery for a male to female bottom transition, the outside of the penis then becomes the inside of the vagina.
During her research though, Anthony came across a paper describing the work of some doctors in India who were building vaginas a bit differently. They were performing surgeries on women with a rare disorder that causes the organ to develop abnormally or not at all. So they had to start from scratch, which requires a lot of material. 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. She brought the paper into her next consultation and showed Ting. “At first he was like, ‘What is this girl doing?’” Anthony says, laughing. “I have no medical training. I’m not a scientist. But then he looked at it and said, ‘Oh, there might be something here.’”
Patients that live in left-leaning states that have passed their own protections for trans health care, like New York and California, will have a better chance of retaining access. About 70 percent of the transgender patients at Mount Sinai have insurance through the state’s Medicaid program. But many still have to fight to get the coverage they need. For those living in other parts of the country, the situation is even more dire. “There are few populations for whom if you started to play games with people’s access to health care it would be more detrimental.” says Anthony. “Trans people’s attachments to stable sources of income and legal protections are as precarious as they come. The progress we have made has been very limited, very contingent, and very easily lost.”
Hayley Anthony recently became one of the first people in the world to have tissue incised from the cavity of her abdomen and turned into a vagina.
In cases where both a penis and vagina are present, this individual is considered a true hermaphrodite. But it isn’t that simple, DSDs can be classified into three groups:
One study out of Brazil found that for making the male to female transition, feminizing genitoplasty consisting of vulvoplasty, clitoroplasty, and Y-V perineal flap produced good cosmetic and functional results in virilized girls with congenital adrenal hyperplasia, with few complications. In addition, this surgical approach prevented the need for neovaginaplasty.
There have been case studies that conclude that a true hermaphrodite is a normal male phenotype, who has been diagnosed with Sertoli Cell Only Syndrome (SCOS), which is a condition that prevents the sufferer from creating sperm and that has a testicular mass. Examination of the testes may show that ovarian, fallopian tube, myometrial, endometrial, and epididymal tissue is present. This combination of findings is found in approximately one-third of true hermaphrodites.
When it comes to the long-term results of procedures that help treat DSD the science is still in its infancy. There are debates about when treatment or gender confirmation should occur. There have been some studies trying to sort this out, though.
Scott Sundick, MD, is a board-certified vascular and endovascular surgeon. He currently practices in Westfield, New Jersey.
The terms, intersex, third sex, third gender, ambiguous genitalia, pseudohermaphrodite, false hermaphrodite, true hermaphrodite, male pseudohermaphrodite, female pseudohermaphrodite, are also used to describe this condition. Each tends to describe different aspects of this condition.
For instance, if an individual is born with genitalia that cannot quite be categorized as male or female, but lies somewhere in between, it is known as ambiguous genitalia. However, this person is also considered a false hermaphrodite or pseudohermaphrodite. These last two terms are considered offensive and even confusing. Therefore, the use of the term disorders of sexual development (DSD) is sometimes preferred.
Usually, the sex of an individual is determined by the internal and external sexual organs, the gonads, and the secondary sexual characteristics that appear at puberty. Intersex conditions occur when there is a defect in the normal process of sexual maturation that results in abnormalities. How the medical establishment manages these conditions is continually in flux, from how and when to diagnose, and how and when to treat. In addition, why these conditions occur is still unknown.
A hermaphrodite is someone who is born with a discrepancy between their internal genitalia and external genitalia. The term hermaphrodite came from combining the names of the Greek god and goddess Hermes and Aphrodite. For many, the term hermaphrodite is offensive. Instead, the term intersex is preferred.
What is a hermaphrodite and is it an offensive word to use? How and when should gender assignment occur? Learn about these issues of intersex.