Nkhani

Carly adangobwerera ku Louisiana kuti akawonere kanema ndi chibwenzi chake ndikungokhala.Munali mchaka cha 2017, ndipo pafupifupi milungu iwiri m'mbuyomu, Carly, mayi wazaka 34 wazaka zakubadwa, adachitidwapo vaginoplasty: njira yomwe nthawi zina imachitidwa pambuyo pa kuvulala kapena khansa, koma nthawi zambiri chisamaliro chokhudzana ndi kusintha.Carly anasankha dokotala wa opaleshoni, Dr. Kathy Rumer, yemwe amagwira ntchito zovomerezeka za amuna ndi akazi m'dera la Philadelphia.
Iwo Skyped m'miyezi yotsogolera ku opaleshoni, koma sanakumanepo pamaso pa opareshoni.Carly adanena kuti adayendera dokotala mwachidule asanakankhidwe m'chipinda cha opaleshoni, koma sanawonenso Dr. Rumer m'masiku atatu akuchira kuchipatala.Patangotha ​​mlungu umodzi atachitidwa opaleshoniyo, nesiyo anamuika kuti apiteko kuti akakumanenso.
Atabwerera kunyumba kuchokera ku kanema "Louisiana", Carly adayang'anitsitsa vulva yake yatsopano.Ngakhale kuti maliseche a masabata awiri atatha opaleshoni amawoneka osawoneka bwino, Carly anadabwa pamene adapeza "chikopa chachikulu chakufa chofanana ndi chala chachikulu," adatero.M'mawa kutacha, adayimba nambala yangozi yomwe idaperekedwa ndikutumiza imelo kuofesi ya Dr. Rumer.Lolemba, ofesiyo idalangiza Carly kuti atumize imelo zithunzi za madera ovuta kuti maopaleshoni awonenso.Patapita masiku angapo, Carly ndi amayi ake anati anamva kwa dokotala amene anali patchuthi ndipo anauza Carly kuti analibe nkhawa.Dr. Rumer adati amayi ake, omwe ndi dotolo wopuma pantchito, amatha kudula khungu lomwe linali lokulirapo ngati likupitilizabe kuwawa.
Pempholi linadabwitsa Carly ndi amayi ake.Anati kumaliseche kwake kunkanunkha “zoipa” ndipo maliseche ake anathothoka ndi khungu lopyapyala.Patatha mlungu umodzi atalankhula ndi Dr. Rumer, Carly adanena kuti anapita kwa gynecologist wa m'deralo, yemwe anachita mantha ndipo anatenga Carly kupita ku Oshner Baptist Hospital ku New Orleans kuti akachite opaleshoni yachangu.Mbali ina ya nyini ya Carly inakhudzidwa ndi necrotizing fasciitis, matenda omwe ndi owopsa pa opaleshoni iliyonse.Izi nthawi zambiri zimayambitsa kutayika kwa minofu m'dera lomwe lili ndi kachilomboka.
Carly anachitidwa opareshoni ndi gulu la madokotala, palibe amene anali ndi chidziwitso ndi post-op vulva kapena vagina-post-op maliseche ndi osiyana pang'ono ndi cisgender.Anakhala masiku aŵiri m’chipinda cha odwala mwakayakaya ndi masiku asanu onse m’chipatala.Onse awiri ndi amayi ake adanena kuti mafoni ambiri ochokera kwa amayi a Carly ndi OB / GYN wake ku ofesi ya Dr. Rumer sanayankhidwe panthawiyi.
Pamene adalandira yankho kuchokera ku ofesi ya Dr. Rumer - chisokonezo choyang'anira ndi zolemba za Carly - dokotalayo adakhumudwa kuti Carly sanakonzekere ndege yopita ku Philadelphia kuti madokotala akonze vutoli.Malinga ndi zimene Carly ndi amayi ake ananena, Dr. Rumer anaimbira foni mayi ake a Carly kuti: “Ndikukumbukira kuti ndinamva zimenezi tsiku limenelo,” anatero Carly, yemwe akanamva zimene akukambirana.“Dr.Rumer adati, "Ndinatsatira malangizo a WPATH pochiza wodwala wanga.Ngati ukuganiza kuti ungachite bwino, bwanji osampatsa nyini?”
Dr. Rumer anali kunena za World Professional Association for Transgender Health (WPATH), yomwe imapanga malangizo ndi njira zabwino zopezera thanzi labwino padziko lonse lapansi.Bungwe lomwe limagwira ntchito ngati mlonda wa pakhomo logwira ntchito lili ndi malamulo okhwima omwe amalola odwala kuchitidwa opaleshoni yokhudzana ndi kusintha, koma silimawongolera momveka bwino mchitidwe wochita izi.Odwala omwe angakhale ngati Carly ali okha okha pankhani yopeza dokotala kuti achite opaleshoni.
Dr. Rumer ndi dokotala wa opaleshoni wodziwa bwino ntchito: wakhala akugwira ntchito yake kuyambira 2007, wakhala akuthandiza odwala transgender kuyambira 2016, ndipo amapanga njira zotsimikizira kuti amuna ndi akazi 400 pachaka, kuphatikizapo kuwonetsetsa kwa nkhope, kuwonjezeka kwa mabere ndi GRS.Mu 2018, Dr. Rumer adawonekera mu zolemba za NBC zokhudzana ndi kusintha kwa wophunzira waku koleji.Malinga ndi tsamba lake, iye ndi m'modzi mwa madokotala ochita opaleshoni apulasitiki ovomerezeka a board ku Philadelphia, membala wa American Academy of Orthopedic Surgery, komanso mkulu wa opaleshoni ya pulasitiki ku Philadelphia College of Osteopathic Medicine (PCOM) .ndi Fellowship in Reconstructive Surgery.Iye wakhala membala wa WPATH kuyambira 2010. (Kuwulura kwathunthu: Ndinakambirana ndi Dr. Rumer kudzera pa Skype kumapeto kwa September 2017, koma potsirizira pake ndinaganiza zowona dokotala wina wa opaleshoni.)
Odwala ambiri omwe amabwera kwa Dr. Rumer kuchitidwa opaleshoni ya m'chiuno amakhutira ndi zotsatira zake.Koma kwa iwo omwe sakukhutira ndi machitidwe awo m'manja mwa Dr. Rumer kapena ena, ndizovuta kuyankha momveka bwino ku madandaulo awo.M'dziko lazandale la maopaleshoni otsimikizira kuti ndi amuna kapena akazi, zimakhala zovuta kupeza mayankho a mafunso okhudza chisamaliro chokhazikika.Othandizira amalongosola machitidwe osiyanasiyana opangira opaleshoni ndi "transgender centers of excellence" omwe amayang'aniridwa ndi zipatala zam'deralo ndi mabungwe azachipatala aboma.Maofesi amatha kusiyana kwambiri pankhani ya odwala ndi dokotala komanso maphunziro apadera omwe dokotalayo ali nawo.
Izi zikachitika, zingakhale zovuta kulankhula za nkhani yachinsinsi yotereyi - Carly adapempha dzina lodziwika bwino chifukwa choopa kubwezera ndipo adawonetsa poyera nkhani yaumwini woterewu kwa atolankhani.Kulankhula panthawi yomwe anthu ochepa amatha kupeza chithandizo chamankhwala pambuyo pa zochitika zowawa zomwe zingagwiritsidwe ntchito ndi otsutsa-transgender kapena kutanthauziridwa ndi olimbikitsa ngati kubwerera m'mbuyo.
Mawu a Carly adayikidwa pamagulu otsutsana ndi transgender pamene adalemba za zomwe adakumana nazo ndi Dr. Rumer pa bolodi la mauthenga kuti achenjeze odwala ena omwe angakhale nawo.Kudandaula kwake ku dipatimenti ya Pennsylvania ya Professional and Vocational Affairs sikunapangitse kuti achitepo kanthu.Jezebeli adafunsa anthu ena anayi omwe adanena kuti anali ndi vuto ndi njira zomwe Dr. Rumer adachita, kuyambira pazifukwa zosasamalidwa bwino mpaka ku ziwalo za nyini zomwe zimawapweteka kwambiri, kapena maliseche omwe sanawoneke bwino.Vuto.Kuphatikiza apo, kuyambira 2016, pakhala milandu inayi yotsutsana ndi asing'anga pazinthu zofanana, zonse zomwe zidathera pakukangana kunja kwa khothi.Mu 2018, Medical Board of Pennsylvania idalumikizana ndi dotoloyo pambuyo poti gulu lina la anthu omwe adamuwona akulankhula pamsonkhano wokhudza transgender mankhwala adasumira madandaulo kuti dotoloyo adanama, koma palibe chilango chomwe adachita.
Monga momwe Dr. Rumer adalembera pa webusaiti yake ndikutsutsa kukhoti, zikuwoneka kuti zovutazi zidachitika chifukwa chosatsatira malangizo a ofesi yake pambuyo pa opaleshoni, kapena mbali ya ngozi zomveka za njira iliyonse yotereyi.Koma pamene Yezebeli anapita kwa Dr. Rumer ndi mndandanda wa mafunso ndi ndemanga za odwala, tinapeza yankho kuchokera kwa loya.M’mwezi wa April, maloya a Dr. Rumer anayesa kundiimba mlandu pamlandu wosagwirizana ndi zachipongwe, akumandikakamiza kuti ndipereke “zolemba zonse, maimelo, zolemba, ndi kafukufuku” wokhudzana ndi nkhaniyi.Kutatsala pang'ono kusindikizidwa, Dr. Rumer anakananso kuyankhapo ndipo, kudzera mwa maloya ake, adawopseza kuti awonjezera Yezebeli pa mlandu wake womunyoza.
Zomwe odwalawa adakumana nazo komanso zovuta zopeza chithandizo sizinagwirizane ndi dokotala m'modzi.Pamene kufunikira kwa GRS kukukulirakulira, pakhoza kukhala nkhawa yayikulu: Popanda njira yoperekera malipoti kwa odwala omwe akhudzidwa kapena bungwe lomwe lili ndi udindo wowongolera tsatanetsatane wa chisamaliro chopanda chithandizo, odwala omwe akufuna njirazi adzatsekeredwa.palibe chitsimikizo cha ubwino wa utumiki polowera, ndipo sizikuwonekeratu momwe angapitirire patsogolo ngati sakukondwera ndi zotsatira.
Ngakhale opaleshoni iliyonse, makamaka pazigawo zovutirapo kwambiri za thupi, imabwera ndi zoopsa, GRS siyiyika pachiwopsezo kwa azimayi osintha gender.Malinga ndi kafukufuku wa 2018, kuchuluka kwa anthu omwe amapita ku transgender omwe amanong'oneza bondo ndi vaginoplasty ndi pafupifupi 1 peresenti, pansi pa maopaleshoni a mawondo.Ndipotu, chifukwa chofala kwambiri chonong'oneza bondo opaleshoni ndi zotsatira zoipa.
Njira yamakono ya vaginoplasty idapangidwa ku Europe zaka 100 zapitazo ndipo yakhala ikuchitidwa ku USA kwa zaka 50 zapitazi.Mu 1979, yunivesite ya Johns Hopkins inasiya kupereka GRS pazifukwa zandale, ngakhale kuti chinali chimodzi mwa zipatala zotsogola ku United States kupanga mchitidwewu.Zipatala zina zambiri zidatsata zomwezo, ndipo dipatimenti ya Zaumoyo ndi Ntchito Zaumunthu idaletsa Medicare kuti isafotokozere ndondomekoyi mu 1981, zomwe zidapangitsa makampani ambiri a inshuwaransi kuti asachotseretu chithandizo chokhudzana ndi transgender pamapulani a inshuwaransi payekha posakhalitsa.
Chotsatira chake, akatswiri ochepa ku US amapereka opaleshoni yochepetsera thupi nkomwe, akutumikira kagulu kakang'ono ka odwala omwe angakwanitsedi opaleshoni.Anthu ambiri a transgender adakakamizika kulipira maopaleshoni akunja mpaka 2014, pomwe olamulira a Obama adabwezeretsanso chithandizo cha Medicare pakuchita maopaleshoni otsimikizira kuti amuna kapena akazi okhaokha komanso kuletsa inshuwaransi ya maopaleshoni a transgender mu 2016. Ndondomeko zanthawi ya Obama zikadzadutsa, anthu ambiri opitilira muyeso athe kulipirira njirazi kudzera mu inshuwaransi kapena Medicaid, ndipo zipatala zina zikuthamangira kuti zikwaniritse zofuna za pent-up.
Komabe, njira zoterezi ndizokwera mtengo: vaginoplasty imawononga pafupifupi $25,000.Kafukufuku wa 2018 wochitidwa ndi ofufuza a pa yunivesite ya Harvard ndi Johns Hopkins University adapeza kuti pakati pa 2000 ndi 2014, kuchuluka kwa maopaleshoni otsimikizira kuti ali ndi amuna kapena akazi okhaokha kudakula kwambiri, ndipo kuchuluka kwaiwo amakhala ndi inshuwaransi mwachinsinsi kapena kulipira ndi Medicaid."Pamene kufotokozedwa kwa njirazi kukukulirakulira, momwemonso kufunikira kwa maopaleshoni aluso," ofufuzawo adamaliza.Koma pali malamulo ochepa okhazikika pa zomwe "woyenerera" amatanthauza, ndipo mbali zina zachipatala zimakhudza kusintha kwa jenda.pavuto.Madokotala ochita opaleshoni amapita ku mabungwe osiyanasiyana ndipo maphunziro a GRS amatha kuyambira pakuwona kwa sabata limodzi ndi dokotala wodziwika bwino mpaka pulogalamu yophunzirira zaka zambiri.Palibe zodziyimira pawokha zomwe zilipo kwa odwala kuti apeze deta paziwopsezo zazovuta za opaleshoni.Nthawi zambiri, odwala amadalira kokha deta yoperekedwa ndi madokotala okha.
Ngakhale kuti anthu osawerengeka apindula ndi chithandizo cha GRS, zotsatira zina zosayembekezereka zakhala zomwe dokotala wa opaleshoni yochokera ku San Francisco Dr. Marcy Bowers amachitcha chikhalidwe "chabwino".chipatala mkati mwa nthawi yoperekedwa, osamwalira ndi vuto linalake, kapena kugonekedwanso kangapo,” adatero, “momwemo ndi momwe amawonera chipambano.”kukhala "othandizira okondedwa" pokopa odwala atsopano ku machitidwe awo pogwiritsa ntchito miyeso iyi.
Mu Meyi 2018, odwala 192 a transgender postoperative adalemba kalata yotseguka ku WPATH yofotokoza nkhawa zina za dongosolo lomwe liripoli momwe maopaleshoni amathandizira odwala omwe alibe "opaleshoni yaulere kapena yotsika mtengo kuti apeze zovuta ndi upangiri waupangiri".zofalitsa zamaphunziro ndi kuyankhula pagulu za zochitika za opaleshoni, opaleshoni yoyesera popanda chilolezo chodziwitsidwa, chidziwitso chachipatala cholakwika choperekedwa kwa odwala, ndi kusamalidwa kokwanira kwa odwala.
"Padakali kusiyana pakati pa zofuna ndi chiwerengero cha anthu ophunzitsidwa njirazi," anatero Dr. Lauren Schechter, pulezidenti wosankhidwa wa American Society of Gender Surgeons."Zowonadi cholinga chathu ndikuphunzitsa anthu ambiri kuti anthu asamayende, makamaka m'malo ofunikira… Ndiye palinso kuchedwa pakati pa kuphunzitsa anthu moyenera ndikukhazikitsa zipatala [ndi] zipatala.”
Kuchepetsa kuchedwa kukwaniritsa kufunikira komwe kukukulirakulira kwa njira zotsimikizira amuna kapena akazi nthawi zambiri kumatanthauza kuchepetsa mwayi wophunzitsira zipatala ndi maopaleshoni."Kwenikweni, masitepe awiri kutsogolo ndi sitepe imodzi," adatero Jamison Green, pulezidenti wakale wa WPATH ndi mkulu wamakono wa mauthenga, za opaleshoni ya opaleshoni.Pobwerera m'mbuyo, iye anati, madokotala ena opaleshoni angasankhe kuphunzitsa pansi pa zovuta kwambiri: "Salowa nawo WPATH.Salola kuphunzitsidwa.Kenako Amati, “Inde, tsopano ndikudziwa choti ndichite.”Monga dokotala wina wosadziwika dzina lake adatchulidwa mu kafukufuku wina wa 2017: "Wina amapita kwa anthu omwe ali ndi mayina otchuka;amaphunzira kwa mlungu umodzi ndiyeno amayamba kuchita zimenezo.zosayenera!
Kusintha mapulani a inshuwaransi ndi malamulo olamulira makampani a inshuwaransi aku US kumatanthauza kuti anthu omwe ali ndi transgender nthawi zambiri amafunafuna njira zotere powopa kuti ma inshuwaransi angasinthe malamulo awo akuwunikira powunika maopaleshoni omwe angakhale nawo.Inshuwaransi nthawi zambiri imayang'anira komwe odwala amasamaliridwa, monga Danielle, mayi wazaka 42 yemwe amakhala ku Portland, Oregon ndipo amadalira Medicaid.M'boma lake, maopaleshoni ena otsimikizira kuti amuna kapena akazi okhaokha amachitidwa ndi pulogalamu ya boma ya Medicaid, koma mu 2015, Danielle adawona kufunika kochita izi mwachangu popeza chithandizo chamankhwala kwa anthu osinthana ndi amuna chinakhala cholinga chandale ku Republican.
"Ndidaganiza tisanakhale ndi purezidenti waku Republican, ndiyenera kukhala ndi nyini," adauza Jezebel mu kuyankhulana kwa masika 2018.Medicaid itamutumiza ku Portland kuti akawone Dr. Daniel Dougie, adamuuza kuti anali wodwala wake wa 12th transvaginoplasty.Atadzuka chifukwa cha opaleshoniyo, anauzidwa kuti opaleshoniyo itenga nthawi yaitali kuwirikiza kawiri chifukwa kumaliseche kwake kunali kovuta kutsegula.
Ngakhale kuti ananena kuti zotsatira zake zooneka bwino komanso zogwira mtima zinali zabwino, zimene Danielle anakumana nazo ali m’chipatala zinali zosayenera.Iye anati: “Palibe amene ankadziwa mmene angathanirane ndi ngozi za anthu.Ananenanso kuti adamva kuti asiyidwa ndipo adathamangira kukathandiza pambuyo pa njira yayitali komanso yovuta.Jezebel analankhula ndi odwala ena angapo a Dr. Dougie, ndipo pamodzi adakasuma ku chipatala.Ngakhale kuti madandaulo a Daniella anali okhudza chithandizo cha post-op m’chipatala, ena anavutika ndi mavuto aakulu, monga fistula ndi kusadziletsa mkodzo pambuyo pa opaleshoni.Malinga ndi yemwe akudziwa bwino za zokambirana za gululi ndi chipatalachi, gululi likukhulupirira kuti chipatalachi chili ndi vuto lalikulu kuposa zipatala zina zomwe zimapereka njira zofananira.
Poyankha mafunso angapo a Jezebeli, Dr. Dougie adanena kuti chipatala sichichita nawo zochitika zapadera ndi odwala chifukwa cha malamulo achinsinsi, koma adavomereza kuti ogwira ntchitoyo amalankhula kwambiri ndi odwala transgender.“Tidachita nawo misonkhano ingapo ya maso ndi maso ndi anthu paokha komanso magulu pakapita nthawi.Misonkhanoyi inapitilira mpaka mgwirizano unafikiridwa pa zovuta zomwe zikuchitika panopa, zolinga za zokambiranazo zinakwaniritsidwa, ndipo ndondomeko yopewera kuyambiranso idapangidwa, "Dr. Dugi analemba mu imelo.
Mwachindunji, chipatalachi chakhazikitsa Komiti Yopereka Uphungu Wamagulu a anthu omwe ali ndi transgender ndi omwe sakugwirizana ndi amuna kapena akazi okhaokha omwe amakambirana ndi ogwira ntchito ndi oyang'anira OHSU Transgender Health Program, Odwala, ndi ena ogwira nawo ntchito.
Dr. Dougie anauza Jesabel kuti zovuta za opaleshoni pachipatala zimayang'aniridwa ndikugwiritsidwa ntchito kuti zitheke bwino, ndi zovuta zofanana kapena kupitirira zotsatira zofalitsidwa kuchokera kwa madokotala ena opaleshoni."Madokotala athu ochita opaleshoni amayesetsa kuchita bwino, koma nthawi zina pamakhala zovuta," adatero."Madokotala onse a OHSU amawunika pafupipafupi zachipatala ndi maopaleshoni awo kudzera pamisonkhano yazachipatala ndi yakufa yomwe imayendetsedwa ndi mkulu wa dipatimenti iliyonse yazaumoyo."
Dr Dugi adanena kuti nkhawa za ogwira ntchito zokhudzana ndi chisamaliro ndi zotsatira zake zakhala zikugwiritsidwa ntchito ku ndondomeko yowunikira anzawo omwe amatha kuperekedwa ku mabungwe owunikira mabungwe."Zipatala zonse zimatsata izi ndipo zimatsimikiziridwa ndi mabungwe ovomerezeka mdziko," adatero.
Ngakhale kuti odwala a OSHU adakambirana za kusintha komwe kungatheke ndi kayendetsedwe ka chipatala, ena mwa odwala omwe kale anali a Dr. Rumer anapita mopitirira malire.M'chaka cha 2018, odwala anayi omwe kale anali dokotalayo adapereka milandu yosiyana kukhothi ku Eastern District of Pennsylvania.Aliyense ankaimiridwa ndi bungwe lazamalamulo lomwelo ndipo ananena kuti ntchito ya Dr. Rumer inachitidwa moipa kwambiri m’milandu yawo moti odandaula (onse a ku New York) anafunika opaleshoni yokonzanso pa Phiri la Sinai.
Aliyense wa odandaulawo anafotokoza kuchepetsedwa ndi kuwonongeka kwa urethra, ngalande ya nyini, ndi labia, komanso kuphulika kapena kupunduka kwa ma clitoral hoods, zomwe zimadziwika kuti "kuwonongeka kosatha" kotero kuti odandaula "sangathenso kugonana."
Milandu, yomwe imalongosola za "chitonzo" ndi "kupwetekedwa mtima kwakukulu kwa maganizo" chifukwa cha ntchito ya Dr. Rumer, poyambirira inafuna kuti anthu azizengedwa mlandu, koma potsirizira pake adatumizidwa ku kutsutsana kwachinsinsi.Nthawi ina, maloya akufuna kutsutsa Dr. Jess Ting, dokotala wa opaleshoni komanso pulofesa wa zachipatala yemwe amagwira ntchito ku GRS pa Phiri la Sinai, malinga ndi zomwe adalemba kale.Akuyembekezeka kuchitira umboni kuti ngakhale atachitidwa maopaleshoni atatu, ntchito ya Dr. Rumer sinalole odandaulawo kuti "akwaniritse orgasm kapena kukhutitsidwa pogonana popanda kupweteka", komanso kuthetsa mavuto ena ofunikira, kuphatikiza "chombo chokulirapo popanda chishango" ndi tsitsi. palibe clitoris.kuchotsedwa molondola.
“Monga dokotala wa maopaleshoni, ndingakuuzeni kuti dokotala aliyense amakhala ndi zotsatira zoipa,” anatero Dr. Ding Jezebel.“Tonse timakumana ndi zovuta ndipo zinthu sizimayenda momwe timafunira.Mukawona zotsatira zomwe zikusonyeza kuti dokotala wa opaleshoni sangakhale woyenerera, mumaona kuti m’pofunika kulankhulapo.”
M'chidule cha chigamulo chomwe chinaperekedwa kumapeto kwa February, mlanduwo usanaperekedwe, maloya a Dr. Rumer adanena kuti dokotalayo sananyalanyaze, sanapatuke pamtundu wa chisamaliro, komanso kuti vuto la wodwalayo linali "vuto lodziwika bwino. ”"[c] Vaginoplasty.Chidandaulocho chimanenanso kuti wodwalayo "sanagwire ntchito pamene akuthandizidwa ndi Dr. Rumer" komanso kuti wazaka 47 sananene mavuto aakulu mpaka chaka chimodzi pambuyo pa opaleshoniyo.Tsatanetsatane wa ndondomeko yotsutsana ndi zotsatira zake zinatulutsidwa sizinatchulidwe poyera, v. Rumer Palibe aliyense wa odandaula pa mlandu wa udokotala adayankha zopempha zambiri za kuyankhulana.
“Monga dokotala, palibe amene amakonda masuti olakwika,” anatero Dr. Dean."Uwu ndi mutu wovuta kwambiri kwa ine monga wozengedwa mlandu wolakwa.Nditanena zimenezi, ndikuona kuti monga ogwira ntchito m’gawo latsopanoli laling’ono kwambiri, tifunika kudzisamalira komanso kukhala ndi makhalidwe abwino.”
Jezabel adalumikizana ndi maopaleshoni angapo odziwika bwino kuti afunse kuti ndi angati omwe anali odwala a Rumer omwe adathandizidwanso kuti akonze zomwe adapeza.Ambiri amakana kuyankhapo, koma anthu atatuwa, omwe adapempha kuti asadziwike, adatsatira odwala opitilira 50 omwe adalumikizana ndi Dr. Rumer kwa GRS kuyambira 2016.
"Tonsefe timafuna kuti anthu a transgender akhale ndi njira zambiri zopangira opaleshoni, ndipo tikuchita zonse zomwe tingathe kuti tiphunzitse ndi kulimbikitsa zotsatira zabwino," adatero Dr. Bowers, dokotala wa opaleshoni ya jenda ku San Francisco.zovuta za opaleshoni, mkwiyo ndi udani kwa odandaula, kusowa kupezeka kapena kuyankha mlandu.Ananenanso kuti Dr. Rumer “amamvetsetsanso za chiopsezo cha odwala omwe akufuna kuchitidwa opaleshoni ndi maopaleshoni ochepa.”
Hannah Simpson, mayi wazaka 34 wa ku New York, adanena kuti patatha milungu iwiri atadwala GRS ndi Dr. Rumer m'chilimwe cha 2014, adawona kuti vulva yake inayamba kuoneka ngati asymmetrical ndipo mbali zake zimakhala zofiira kwambiri.ndi kutupa.Ngakhale kuti Dr. Rumer anatsimikizira kuti zonse zinali bwino, Simpson anayamba necrosis ya vulva.
Simpson, yemwe anali kuphunzira za udokotala panthaŵiyo, anafotokoza maliseche ake atsopano: maliseche opunduka amene anali “mbali imodzi” ndi labia amene “ankawoneka ngati bampu kuposa zipsepse ziŵiri.”Simpson nayenso anali ndi zovuta zina, kuphatikizapo tsitsi la nyini lomwe madokotala ochita opaleshoni analonjeza kuti adzachotsa ndi kuyika kwachilendo kwa mkodzo wake.Kuonjezera apo, Dr. Rumer anasiya minofu yowonjezera pakhomo la nyini, zomwe zinapangitsa kuti dilation ikhale yovuta kwambiri, adatero Simpson.Pa tsiku lotsatira, ndiyeno mu imelo wotsatira kuti Simpson adagawana ndi Yezebeli, Dr. Rumer anadzudzula khungu lakufa pa Depends Simpson awiri omwe Simpson adavala kwambiri m'chipatala, omwe Simpson ankawona kuti ndi vuto lothawa.Dr. Rumer anakana kuyankha mafunso a Yezebeli okhudza mmene anachitira ndi wodwala ameneyu kapena wodwala wina aliyense.
Necrosis ngati Simpson's necrosis ndi chiopsezo ndi vaginoplasty iliyonse ndipo ikhoza kuyambitsidwa ndi kuvala zovala zamkati zolimba kwambiri kumayambiriro kwa kuchira pambuyo pa opaleshoni, ngakhale zingakhale zovuta kudziwa chomwe chimayambitsa vutoli, Schechter adati.matenda mwa wodwalayo."Matenda, minofu necrosis, suture dehiscence - zonsezi zimachitika ndi opaleshoni iliyonse," adatero.Schecter adanena kuti kuyenda pambuyo pa opaleshoni ndi malo odetsedwa kapena osatetezeka a kunyumba kungayambitsenso mavuto, koma pamapeto pake dokotala wa opaleshoni ayenera kulangiza wodwalayo ndikuonetsetsa kuti zinthu zowopsazi ndizochepa.
Opaleshoni yachiwiri ndi dokotala wina wa opaleshoni inalephera kubwezeretsa ntchito yoyambirira ya Dr. Rumer ndipo inayambitsa mavuto ena, ndipo Simpson analibe clitoris.Mwa kuwerengera kwake, tsopano waonana ndi maopaleshoni 36 kuti amukonzenso maliseche.Zimenezi zinam’khumudwitsa pa ntchito ya udokotala ndipo anasiya kutsatira digiri yake ya udokotala.Iye sanagwiritse ntchito njira iliyonse yodandaulira, powopa kuti zimenezi zingachepetse mwayi woti dokotala wina atengere mlandu wake.
Madandaulo a Simpson okhudza ntchito ya Dr. Rumer ndi ofanana ndi a odwala ena akale omwe adalankhula ndi Yezebeli."Nthawi zonse ndakhala ndikuchenjeza anthu kuti asachoke kwa Rumer," atero Amber Rose, wazaka 28 wa ku Boston yemwe si wa binary.Mu 2014, adapita kwa Dr. Rumer kuti akachite opaleshoni ya m'chiuno chifukwa cha zosankha zonse zoperekedwa ndi ndondomeko ya inshuwalansi ya makolo awo, dokotalayo anali ndi nthawi yochepa kwambiri yodikira.
Opaleshoni ya Rose sinayende monga momwe anakonzera."Rumer anasiya minofu yambiri ya erectile pansi pa labia minora yanga, yomwe ingakhale vuto," adatero Ross."Sizinkawoneka ngati vulva."Ngakhale madokotala ena, iwo anati, “kamodzi anayesera kulowetsa chala mu mkodzo wanga chifukwa sichinali chodziŵika.”
Ross ananena kuti Dr. Rumer sanapange clitoral hood, kusiya clitoris yawo yotseguka kuti ikopeke.Komanso, njira yochotsera tsitsi ya Rumer sinalephereke ndikusiya tsitsi lina mkati mwa labia koma osati mu ngalande ya maliseche.Iwo anati: “Anapitirizabe kutulutsa timikodzo ndi mkodzo, ndipo ankanunkha kwambiri moti kwa chaka choyamba ndinkachita mantha ndi zimenezi mpaka ndinazindikira kuti munalibe tsitsi mmenemo.
Malingana ndi Ross, zaka zisanu ndi chimodzi pambuyo pake, sakukondwerabe ndi ntchito yawo ndipo akuda nkhawa kuti Dr. Rumer akugwira ntchito kwa anthu omwe ali ndi transgender.Koma akuti kukhumudwa kwawo kumachokeranso ku zovuta zadongosolo ndi njira: kusowa kwa madotolo a GRS ndi mindandanda yayitali yodikirira, kutanthauza kuti anthu onga iwo ali ndi zosankha zochepa zomwe angasankhe komanso chidziwitso chokwanira kwa dokotala wa opaleshoni.
Opaleshoni ya m'matako kwa anthu a transgender ndi transgender ndi yamitundu yosiyanasiyana ndipo imafunikira ukadaulo wa opaleshoni ya pulasitiki, urology ndi gynecology.Iliyonse mwa maphunzirowa ili ndi komiti yodziyimira payokha yomwe ili ndi udindo wovomerezeka.Kuyesa kwaposachedwa kuwerengera mayendedwe ophunzirira a vaginoplasty kukuwonetsa kuti njira 40 zimafunikira kuti muphunzire bwino njirayi.Popanda chiyanjano chovomerezeka kapena malangizo ophunzirira ntchito kuchokera ku WPATH kapena bungwe lina lililonse la akatswiri, odwala adzayenera kuchitidwa opaleshoni yochuluka kwa moyo wawo wonse.
Zipatala zapayekha zili ndi udindo wodziwa yemwe ali ndi chilolezo chochita njira zina m'malo awo.Dr. Schechter anauza Jezabel kuti matabwa a chipatala nthawi zambiri amafuna kuti madokotala ochita opaleshoni avomerezedwe ndi osachepera 30 mabungwe azachipatala m'dziko lonselo, ndipo akhoza kukhala ndi miyezo yosiyana yophunzitsira maopaleshoni omwe angakhalepo.Koma malinga ndi WPATH's Greene, palibe bungwe lachipatala lomwe limatsimikizira kuti maopaleshoni aliyense payekha angachite opaleshoni yokhudzana ndi amuna kapena akazi: maphunziro.monga gawo la mayeso a board kuti upeze satifiketi,” adatero."Chifukwa tsopano, titero kunena kwake, alibe ziphaso zamatenda enieni."
Pakalipano, American Society of Plastic Surgeons ili ndi chiphaso cha certification koma sichimakhudza mwachindunji njira zokhudzana ndi kugonana, kutanthauza kuti madokotala ogwirizana nawo sayenera kukwaniritsa mfundo zina zophunzitsira kuti achite opaleshoni ya maliseche kwa odwala transgender.Green adati ili ndi dongosolo lomwe siliyenera kugwira ntchito zomwe zikuchitika pano.“Tsopano tili ndi madokotala ochita opaleshoni, madokotala achikazi ndi maopaleshoni ang’onoang’ono osiyanasiyana omwe amagwira ntchito yomanganso maliseche.Ndiye ndizovuta kwambiri kuposa kale, "adatero."Koma palibe gulu lomwe lakonzeka kuvomereza izi."
Kuti athetse vutoli, madokotala monga Dr. Schechter ndi ena omwe amagwira ntchito yotsimikizira kuti amuna kapena akazi okhaokha agwirizana kuti amenyane ndi maphunziro apamwamba a zipatala zomwe zikuyang'ana kulowa m'munda.Mu 2017, Dr. Schechter adalemba nawo nkhani mu Journal of Sexual Medicine kufotokoza zina mwazofunikira zochepa zophunzitsira opaleshoni yamtsogolo.
Malinga ndi lipotilo, madokotala ochita opaleshoni omwe amachita maopaleshoni okhudzana ndi kugonana ayenera kuphunzitsidwa mozama, kuphatikizapo masemina, magawo a muofesi, machitidwe osamalira manja ndi pambuyo pa opaleshoni, komanso chitukuko chokhazikika cha akatswiri.Ngakhale malingalirowa apititsa patsogolo maphunziro m'dziko lonselo, amakhalabe odzipereka kwa zipatala ndi maopaleshoni.Mabungwe osachita phindu monga WPATH akhala akuyesera kuti akwaniritse zosowa zamaphunziro koma sanathe kusintha pawokha.Bungweli limapanga maphunziro ake opangira opaleshoni, omwe adayamba panthawi ya utsogoleri wa Green kuyambira 2014 mpaka 2016. Koma kwa bungwe monga WPATH, mtengo wa maphunziro ukhoza kukhala woletsedwa, ndipo umakhala wosankha komanso waulere kwa madokotala opaleshoni omwe akufunadi kuchita ntchito yawo.
Ena, monga alangizi omwe amagwira ntchito m'malo osamalira odwala a LGBT, amathandizira odwala omwe ali ndi maopaleshoni otsimikizira kuti amuna kapena akazi okhaokha, ndipo mu 2018 adapanga kalata yotseguka ya WPATH yolimbikitsa "malo ochita bwino" momwe ma inshuwaransi ndi mabungwe amagwirira ntchito limodzi, kutsimikizira inshuwaransi yolipira kokha. .madokotala ochita opaleshoni ophunzitsidwa mapulogalamu apadera.(Chitsanzocho, akuti, chinathana ndi mavuto ofanana ndi opaleshoni ya bariatric kumayambiriro kwa zaka za 2000, kupereka deta yeniyeni ya zotsatira ndi zoletsa zoletsa opaleshoni pamene akukumana ndi mavuto ofanana.) Blasdel akunena kuti ngakhale mabungwe ena azachipatala posachedwapa anayamba kudzitcha "transgender". center of excellence”, “Pakadali pano palibe njira zomwe dokotala wa opaleshoni kapena bungwe liyenera kukwaniritsa kuti alandire mutuwu.