The first-ever systematic review and meta-analysis of pelvic floor dysfunctions among transgender people who have had genital gender-transition surgery found that rates varied widely between studies.
I have suffered many complications from the vaginal birth of one of my daughters, which left me with many of these same complications. I have had multiple surgeries, , have an implanted nuerostimulator, and am thankful to live in a time with better medical care so that I have a good quality of life now. But honestly, I’m not the same as I was before the damage. It’s mind blowing to me that our medical system is out here currently disabling people in order to achieve solely a cosmetic result that’s a very poor copy of the original . The FTM phalloplasty surgeries especially have sky high complications . All of this takes up limited health care resources such as uro-gynecologists, OB-GYN’s, pelvic floor therapists. Theres a shortage of these specialists as is, and now there’s another population of people vying for them for cosmetic purposes only. It’s infuriating.
Hello Sarah, I just wrote a very similar comment to yours. Yes, there is a shortage of uro-gynecologists who can perform these corrective surgeries. Most women with pelvic floor prolapse never get access to these surgeries. HMO policies won't pay for them. It is shocking to me that we will now have a cohort of very young people who have never given birth that will now be struggling with pelvic floor prolapse.
Not surprising at all that women can't ejaculate after "gender affirmative care," given that women don't have testicles, penises or any other male equipment to ejaculate with.
Regarding the Johns Hopkins study on trans women [male to female transitioners] who received a vaginoplasty:
"Pelvic organ prolapse: According to Johns Hopkins, this is “descent of the uterus, vagina, bladder and/or rectum resulting in a "bulging" sensation within the vagina.” 1% to 7.5% experienced this complication. Six studies found rates ranging between 1% and 4% and another found a rate of 7.5%. "
I am confused. As far as I know, male to female transition surgery of the genitals involves building a vagina from a penis. Unless there is some new form of male to female transition surgery in which they also try to construct a uterus, I am not sure why they discuss prolapse of the "uterus, vagina and bladder."
Of course, in women, after giving birth, many actual women do experience prolapse of the uterus, vagina and bladder. In women who have given birth by vaginal delivery, prolapse is very common. Yet, its surgical correction is usually not covered by HMO health insurance policies. This is one of the things that irks me about trans advocacy . . . it seems like trans advocates are unaware that many of the surgical procedures they are politically advocating for, and pressuring health insurance companies for, are not available to most biological women.
Can anyone really be surprised by these results? If you were considering transgender surgery wouldn’t you expect problems like those described a priori?
If the so-called "doctors" who cut up the healthy sex organs of patients actually and frankly discussed the possible (and likely) negative outcomes, they would be out of a lucrative business. Most of these genital mutilating "doctors" brush off the possible (and likely) negative outcomes by claiming they are rare, or have never happened to their patients.
Hanna Barnes book, Time To Think, shows clearly that even in the UK, which has made a greater effort than in the US to council teens about the longer term realities of gender transition, few female to male trans adolescents understand that they will become infertile; and that, if they chose genital trans surgery, they will have a very high risk of urinary incontinence and sexual dysfunction. One female to male transitioner in the original Dutch study died from an infection as a result of genital trans surgery.
Even though WPATH limits phalloplasty to those 18 or over, hormones and mastectomies are often available at a much earlier age. The effect of hormones, especially the masculinization of the female voice, is irreversible.
So younger adolescents are often led down a path where they think there is a well worn path toward full transition, but find out at some point that full transition isn't available, or not available without considerable risk to their sexual health. At this point, many of the changes they have undergone are not reversible, so they are left in an intermediate state between male and female.
In general, in biological women, pelvic floor prolapse can appear shortly after giving birth due a birth injury. But more often in women, the combination of having incurred some sort of weakening of the pelvic floor, combined with menopause, eventually leads to more serious pelvic floor issues. Menopause in most women does not occur until approximately age 50. So the majority of more serious pelvic floor prolapse issues in women do not occur until after age 50.
The issue of pelvic floor prolapse in older women is a longstanding women's health issue. Depending on the type of prolapse, there are surgical methods to correct it, but it is complex. There are a limited number of surgeons that know how to correctly perform pelvic floor repair surgeries. (Dr. Eric Sokol at Stanford is one of these surgeons. https://stanfordhealthcare.org/doctors/s/eric-sokol.html)
Most women never find their way to Dr. Sokol or the small number of other experts on pelvic floor prolapse repair. Many primary care physicians will recommend that women get a hysterectomy (removal of the uterus) to correct the pelvic floor prolapse. This generally doesn't work. There are a huge number of older women which end up with chronic pelvic floor issues and associated urinary incontinence issues.
While this is a major women's health issue, again, it generally doesn't occur until after age 50.
When it comes to transgender "medicine" and testosterone, we are putting teens onto a trajectory where they will likely be struggling with pelvic floor prolapse half a lifetime before it might otherwise occur.
I am surprised that there isn't more outrage about this.
Benjamin, unfortunately I don't have time to read the systematic review (though I want to). Can you address the two questions posed in the comments, which also leapt out for me: did the researchers actually list the uterus in their description of prolapses after MtF surgeries, and lack of ejaculation in FtM surgeries? Can you elaborate on what they meant? Were these just textbook descriptions of the conditions, and they didn't bother to modify them for the population at hand? Very confusing.
I have suffered many complications from the vaginal birth of one of my daughters, which left me with many of these same complications. I have had multiple surgeries, , have an implanted nuerostimulator, and am thankful to live in a time with better medical care so that I have a good quality of life now. But honestly, I’m not the same as I was before the damage. It’s mind blowing to me that our medical system is out here currently disabling people in order to achieve solely a cosmetic result that’s a very poor copy of the original . The FTM phalloplasty surgeries especially have sky high complications . All of this takes up limited health care resources such as uro-gynecologists, OB-GYN’s, pelvic floor therapists. Theres a shortage of these specialists as is, and now there’s another population of people vying for them for cosmetic purposes only. It’s infuriating.
Hello Sarah, I just wrote a very similar comment to yours. Yes, there is a shortage of uro-gynecologists who can perform these corrective surgeries. Most women with pelvic floor prolapse never get access to these surgeries. HMO policies won't pay for them. It is shocking to me that we will now have a cohort of very young people who have never given birth that will now be struggling with pelvic floor prolapse.
Not surprising at all that women can't ejaculate after "gender affirmative care," given that women don't have testicles, penises or any other male equipment to ejaculate with.
Regarding the Johns Hopkins study on trans women [male to female transitioners] who received a vaginoplasty:
"Pelvic organ prolapse: According to Johns Hopkins, this is “descent of the uterus, vagina, bladder and/or rectum resulting in a "bulging" sensation within the vagina.” 1% to 7.5% experienced this complication. Six studies found rates ranging between 1% and 4% and another found a rate of 7.5%. "
I am confused. As far as I know, male to female transition surgery of the genitals involves building a vagina from a penis. Unless there is some new form of male to female transition surgery in which they also try to construct a uterus, I am not sure why they discuss prolapse of the "uterus, vagina and bladder."
Of course, in women, after giving birth, many actual women do experience prolapse of the uterus, vagina and bladder. In women who have given birth by vaginal delivery, prolapse is very common. Yet, its surgical correction is usually not covered by HMO health insurance policies. This is one of the things that irks me about trans advocacy . . . it seems like trans advocates are unaware that many of the surgical procedures they are politically advocating for, and pressuring health insurance companies for, are not available to most biological women.
Can anyone really be surprised by these results? If you were considering transgender surgery wouldn’t you expect problems like those described a priori?
Part of the point of this analysis is to encourage doctors to provide patients informed consent about the possible negative outcomes.
If the so-called "doctors" who cut up the healthy sex organs of patients actually and frankly discussed the possible (and likely) negative outcomes, they would be out of a lucrative business. Most of these genital mutilating "doctors" brush off the possible (and likely) negative outcomes by claiming they are rare, or have never happened to their patients.
Hanna Barnes book, Time To Think, shows clearly that even in the UK, which has made a greater effort than in the US to council teens about the longer term realities of gender transition, few female to male trans adolescents understand that they will become infertile; and that, if they chose genital trans surgery, they will have a very high risk of urinary incontinence and sexual dysfunction. One female to male transitioner in the original Dutch study died from an infection as a result of genital trans surgery.
Even though WPATH limits phalloplasty to those 18 or over, hormones and mastectomies are often available at a much earlier age. The effect of hormones, especially the masculinization of the female voice, is irreversible.
So younger adolescents are often led down a path where they think there is a well worn path toward full transition, but find out at some point that full transition isn't available, or not available without considerable risk to their sexual health. At this point, many of the changes they have undergone are not reversible, so they are left in an intermediate state between male and female.
Thanks!
According to this study published April of this year, the pelvic floor issues in females on T begin well before surgery:
https://link.springer.com/article/10.1007/s00192-024-05779-3
Yeah, the SR said that. I didn't end up putting it in my write-up.
In general, in biological women, pelvic floor prolapse can appear shortly after giving birth due a birth injury. But more often in women, the combination of having incurred some sort of weakening of the pelvic floor, combined with menopause, eventually leads to more serious pelvic floor issues. Menopause in most women does not occur until approximately age 50. So the majority of more serious pelvic floor prolapse issues in women do not occur until after age 50.
The issue of pelvic floor prolapse in older women is a longstanding women's health issue. Depending on the type of prolapse, there are surgical methods to correct it, but it is complex. There are a limited number of surgeons that know how to correctly perform pelvic floor repair surgeries. (Dr. Eric Sokol at Stanford is one of these surgeons. https://stanfordhealthcare.org/doctors/s/eric-sokol.html)
Most women never find their way to Dr. Sokol or the small number of other experts on pelvic floor prolapse repair. Many primary care physicians will recommend that women get a hysterectomy (removal of the uterus) to correct the pelvic floor prolapse. This generally doesn't work. There are a huge number of older women which end up with chronic pelvic floor issues and associated urinary incontinence issues.
While this is a major women's health issue, again, it generally doesn't occur until after age 50.
When it comes to transgender "medicine" and testosterone, we are putting teens onto a trajectory where they will likely be struggling with pelvic floor prolapse half a lifetime before it might otherwise occur.
I am surprised that there isn't more outrage about this.
Benjamin, unfortunately I don't have time to read the systematic review (though I want to). Can you address the two questions posed in the comments, which also leapt out for me: did the researchers actually list the uterus in their description of prolapses after MtF surgeries, and lack of ejaculation in FtM surgeries? Can you elaborate on what they meant? Were these just textbook descriptions of the conditions, and they didn't bother to modify them for the population at hand? Very confusing.
1. No. 2. See: https://x.com/benryanwriter/status/1858645050588025014?s=46