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    Surgery

    Radical New Method Offers Fulfilling Gender-Affirmation Surgery for Trans People

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    At Mount Sinai Hospital in New York a surgeon is training a new generation of practitioners in a new procedure for vaginal construction that came from an unlikely source: a marketing consultant who did some at-home research in anticipation of her own gender-affirmation surgery.

    Hayley Anthony, a 30 year old trans woman, was in consultation with Jess Ting, director of surgery at the Center for Transgender Medicine and Surgery at Mount Sinai, when she presented him with a novel idea she'd discovered during online research at home. It promised to create a far more realistic vagina than present surgical methods in the United States could offer; Ting was intrigued, and set to work verifying and perfecting the technique.

    The method Anthony discovered had been pioneered by doctors in India to treat an extremely rare disorder that caused the vagina to develop abnormally or not at all. It involves crafting a new vaginal cavity using a piece of 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.

    When Ting heard Anthony's suggestion, he was immediately interested. "At first he was like, ‘What is this girl doing?" Anthony recalled in an interview with Wired. Ting quickly saw that Anthony was onto something and that the procedure promised a far more satisfying "bottom surgery," as genital gender-affirmation surgery is colloquially known, than the prevailing method.

    Before Anthony and Ting, the best that trans women or non-binary people desiring vaginas could hope for was a crude procedure that involved slicing open the penis and inverting it into the space between the urethra and rectum in a manner similar to how one inverts a sock. Unfortunately this still carried a host of problems: 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), according to Wired.

    Using the peritoneum offers a way around all of these problems. Anthony, who herself went under the knife about 5 months ago, told Wired that her new body " does all the things she wants it to."

    Fear and Hope for the Future

    As director of surgery at the Center for Transgender Medicine and Surgery at Mount Sinai and one of only a dozen gender-affirmation surgeons in the United States, Ting is training a new generation of surgeons in the new procedure at a rate of one fellow per year. He's already performed 22 operations in the last 6 months, and he hopes that that number will continue to rise as the new fellows will hopefully stay on the staff at Mount Sinai.

    More and more trans people are scrambling to schedule gender-affirmation surgeries as the Trump administration brings central parts of the Affordable Care Act under its targeting sights.

    In May, Department of Health and Human Services Secretary Tom Price said that he was in the process of reworking Section 1557 of the Affordable Care Act, which "prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities," according to the Department's website. The administration aims to allow states to refuse coverage for hormones, counseling, and surgeries for trans people.

    According to the Center for American Progress, transgender people are four times more likely than the general population to be living below the poverty line. At Mount Sinai Hospital, 70 percent of the transgender patients get their insurance through the state's Medicaid program.

    The Affordable Care Act, passed in 2010, forced states to expand their Medicaid coverage to up to 138% of the poverty level, and as of July 2016 31 states and Washington DC had complied.

    If the Trump Administration is successful at changing the law it would mean a loss of health care access for a large portion of the country's estimated 1.4 million transgender people, even if Trump' and his Republican allies in Congress were unable to completely destroy the ACA, as they have repeatedly attempted to do since Trump was inaugurated in January.

    "There are few populations for whom if you started to play games with people's access to healthcare it would be more detrimental." Anthony said to Wired. "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."

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    Tags:
    Affordable Care Act, Sex Reassignment Surgery, LGBT, Medicaid
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