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Carly achangodzokera kuLouisiana kunoona bhaisikopo nemusikana wake ndokugara kumashure.Maive muchirimo cha2017, uye angangoita mavhiki maviri apfuura, Carly, ane makore makumi matatu nemana trans mukadzi, akange aitwa vaginoplasty: maitiro dzimwe nguva aiitwa mushure mekukuvara kana kenza, asi kazhinji nekuda kwekutarisira kunoenderana neshanduko.Carly akasarudza chiremba anovhiya, Dr. Kathy Rumer, uyo anonyanya kugadzirisa maitiro ekusimbisa zvepabonde munharaunda yePhiladelphia.
Ivo Skyped mumwedzi inotungamira kuvhiyiwa, asi havana kumbosangana mumunhu pamberi pekuvhiyiwa.Carly akati akashanyira chiremba kwenguva pfupi asati asundirwa muimba yekuvhiya, asi haana kuona Dr. Rumer zvakare mumazuva matatu ekupora muchipatara.Papera vhiki avhiyiwa, mukoti akamubhuka kuti auye kuzomuona.
Mushure mokudzoka kumba kubva kufirimu "Louisiana", Carly akanyatsotarisisa vulva yake itsva.Nepo mavhinga akawanda evhiki mbiri okuberekwa achiratidzika kuva asingataridziki, Carly akakatyamadzwa apo akawana “dehwe guru rakafa saizi yechigunwe chikuru,” akadaro.Mangwana acho akachaya nharembozha yainge yapiwa achibva atumira email kuhofisi yaDr. Rumer.NeMuvhuro, hofisi yakayambira Carly kuti atumire email mapikicha enzvimbo dzine dambudziko kuti vavhiyi vaongororwe.Mazuva mashomanana gare gare, Carly naamai vake vakati vakanzwa kubva kuna chiremba akanga ari pazororo ndokuudza Carly kuti akanga asina chinhu chokunetseka nacho.Dr. Rumer vakati amai vake, chiremba wokuvhiya akarega basa, vaigona kuvhura ganda rakarembera kana rikaramba richirwadza.
Kurudziro iyi yakashamisa Carly naamai vake.Akataura kuti nhengo yake yesikarudzi yainhuwa “zvakashata” uye matinji ake akarembera neganda nhete.Vhiki mushure mekutaura naDr. Rumer, Carly akati akaenda kuna gynecologist yeko, uyo akatya ndokutora Carly kuOshner Baptist Hospital muNew Orleans kunovhiyiwa nechimbichimbi.Chikamu cheCarly's vagina chakakanganiswa necrotizing fasciitis, hutachiona hune ngozi mune chero kuvhiyiwa.Izvi zvinowanzokonzera kurasikirwa kwenyama munzvimbo ine utachiona.
Carly akavhiyiwa neboka revanachiremba, hapana aive neruzivo ne post-op vulva kana vagina-post-op genitals akasiyana zvishoma kubva kune cisgender.Akapedza mazuva maviri ari muwadhi yevanorwara zvakanyanya uye mamwe mazuva mashanu ari muchipatara.Vose iye naamai vake vakataura kuti mafoni akawanda kubva kuna amai vaCarly uye OB / GYN yake kuhofisi yaDkt Rumer haana kupindurwa panguva ino.
Pavakawana mhinduro kubva kuhofisi yaDr. Rumer - mhirizhonga yehutungamiri ine zvinyorwa zveCarly - chiremba anovhiya akagumbuka kuti Carly akanga asina kuronga ndege kuenda kuPhiladelphia kuti vanachiremba vagadzirise dambudziko racho.Maererano naCarly naamai vake, Dr. Rumer akavabvutira parunhare naamai vaCarly: “Ndinonyatsoyeuka ndichizvinzwa zuva iroro,” akadaro Carly, uyo angadai akanzwa hurukuro yacho.“Dr.Rumer akati, "Ndakatevera mirairo yeWPATH yekurapa murwere wangu.Kana uchifunga kuti unogona kuita zviri nani, wadii kumupa chibereko?”
Dr. Rumer aitaura nezveWorld Professional Association yeTransgender Health (WPATH), iyo inovandudza mazano uye maitiro akanaka ehutano hwe transgender pasi rose.Sangano rinoshanda semuchengeti wemagedhi anoshingaira ane mitemo yakasimba inobvumira varwere kuti vavhiyiwe kushanduka-shanduka, asi haisi kudzora zvakajeka maitiro ekuita maitiro aya.Vanogona varwere vakaita saCarly vari vega kana zvasvika pakutsvaga chiremba wekuvhiyiwa.
Dr. Rumer chiremba anovhiya ane ruzivo: akamhanyisa maitiro ake kubvira 2007, ave achirapa varwere vetransgender kubvira 2016, uye anoita maitiro anosvika mazana mana ekusimbisa hutano hwevakadzi gore negore, kusanganisira kutaridzika kwechiso, kuwedzera mazamu uye GRS.Muna 2018, Dr. Rumer akaonekwa muNBC documentary pamusoro pekushandurwa kwemudzidzi wepakoreji.Sekureva kwesaiti yake, ndiye mumwe wevashoma-vane chibvumirano chevakadzi vanovhiya mapurasitiki munzvimbo yePhiladelphia, nhengo yeAmerican Academy yeOrthopedic Surgery, uye director wekuvhiya kwepurasitiki kuPhiladelphia College yeOsteopathic Medicine (PCOM) .uye Fellowship muKuvhiya Kunovaka.Anga ari nhengo yeWPATH kubvira 2010. (Kubuditsa pachena: Ndakaita hurukuro yekuvhiya naDr. Rumer kuburikidza neSkype pakupera kwaSeptember 2017, asi pakupedzisira ndakasarudza kuona mumwe chiremba wekuvhiya.)
Varwere vakawanda vanouya kuna Dr. Rumer nokuda kwekuvhiyiwa kwehudyu vanogutsikana nemigumisiro.Asi kune avo vasingagutsikane nemafambisirwo avanoitwa na Dr. Rumer kana vamwewo, zvakaoma kupindura zvine musoro kuzvichemo zvavo.Munyika ine zvematongerwo enyika yekuvhiyiwa kunosimbisa kuti murume nemukadzi, zvinogona kunetsa kuwana mhinduro dzemibvunzo pamusoro pekutarisirwa kwakajairika.Vatsigiri vanotsanangura maitiro akasiyana-siyana ekuvhiya uye "transgender nzvimbo dzepamusoro" dzinotarisirwa nezvipatara zvemunharaunda uye mabhodhi ehurumende ezvokurapa.Mahofisi anogona kusiyanisa zvakanyanya kana zvasvika kune murwere-kuna-chiremba ratios uye kuti ndeapi kudzidziswa kwaanoitwa nachiremba anovhiya.
Kana izvi zvikaitika, zvinogona kuva zvakaoma kutaura pamusoro penyaya yakavanzika yakadaro - Carly akakumbira pseudonym nekutya kutsiva uye akaratidza pachena nyaya yakadaro yega kune vezvenhau.Kutaura panguva iyo vanhu vashoma vanogona kuwana rubatsiro rwekurapa mushure mechiitiko chinoshungurudza chinogona kushandiswa nevanorwisa-transgender activists kana kududzirwa nevamiriri senhanho yekudzokera kumashure.
Mashoko aCarly akaiswa pa-anti-transgender forums paakanyora nezvezvakaitika kwaari naDkt Rumer pabhodhi remashoko kuti anyevere vamwe vangangove varwere.Kunyunyuta kwake kuPennsylvania Dhipatimendi reProfessional and Vocational Affairs hakuna kuunza chero chiito chepamutemo.Jezebheri akabvunzurudza vamwe vanhu vana vakati vane matambudziko nemaitirwo akaitwa naDr. Rumer, kubva pakupomerwa kusachengetwa zvakanaka kwemashure kusvika kunhengo dzesikarudzi dzemukadzi dzakavakonzera kurwadziwa kwakanyanya, kana kuti vulvas isingataridzike zvakanaka.Dambudziko.Mukuwedzera, kubva muna 2016, kwave kune masutu mana asina kunaka anopesana nevarapi panyaya dzakafanana, iyo yose yakaguma kunze kwekupokana kwedare.Muna 2018, Medical Board yePennsylvania yakabata chiremba wekuvhiya mushure mekunge rimwe boka revanhu vakambomuona achitaura pamusangano wetransgender mushonga vakamhan'ara vachiti chiremba uyu akanyepera budiriro, asi hapana chirango chakaitwa.
Sekunyora kwakaita Dr. Rumer padandemutande ravo uye vakakakavadzana mudare, zvinoita sekunge matambudziko aya akakonzerwa nekusatevedzera mirairo yehofisi yake mushure mekuvhiyiwa, kana chikamu chenjodzi dzinonzwisisika dzechero nzira yakadaro.Asi Jezebheri paakaenda kuna Dr. Rumer nerondedzero yemibvunzo nemashoko evarwere, takawana mhinduro kubva kugweta.Muna Kubvumbi, magweta aDr. Rumer akaedza kundidaidza mumhaka isina hukama, vachida kuti ndipe "zvose zvinyorwa, maemail, zvinyorwa, uye tsvakiridzo" zvine chekuita nenyaya.Nguva pfupi isati yaburitswa, Dr. Rumer vakaramba zvakare kutaura uye, kuburikidza nemagweta ake, vakatyisidzira kuwedzera Jezebheri kudare rake rekusvibisa zita rake.
Izvi zviitiko zvevarwere uye matambudziko ekutsvaga rubatsiro hazvina kubatanidzwa nachiremba mumwe chete.Sezvo kudiwa kweGRS kuchikura, panogona kuve nekunetseka kwakanyanya: Pasina nzira yakatsaurirwa yekuzivisa kune varwere vakakanganisika kana agency ine basa rekudzora ruzivo rwetransaffirmative care, varwere vari kutsvaga nzira idzi vanovharirwa.hapana chivimbiso chehutano hwebasa pacheki-in, uye hazvisi pachena nzira yekufambira mberi kana vasina kufara nemigumisiro.
Nepo chero kuvhiyiwa, kunyanya panhengo dzinonetsa dzemuviri, kunouya nenjodzi, GRS haiise njodzi kune vakadzi vetransgender.Maererano neongororo ye2018, chikamu chevanhu ve transgender vanopedzisira vachidemba vaginoplasty inenge 1 muzana, pasi pevhareji yekuvhiyiwa kwemabvi.Kutaura zvazviri, chikonzero chakajairika chekudemba kuvhiyiwa mhedzisiro yakaipa.
Iyo nzira yemazuva ano yevaginoplasty yakagadziridzwa muEurope makore anopfuura zana apfuura uye yave ichiitwa muUSA kweanodarika makore makumi mashanu apfuura.Muna 1979, Johns Hopkins University yakamira kupa GRS nekuda kwezvikonzero zvezvematongerwo enyika, kunyangwe yaive imwe yezvipatara zvinotungamira muUnited States kugadzira tsika iyi.Zvimwe zvipatara zvakawanda zvakateverawo, uye Dhipatimendi rehutano neHuman Services rakarambidza Medicare kubva pakuvhara maitiro muna 1981, zvichiita kuti makambani einishuwarenzi arege kuburitsa pachena kuvharwa kwakabatana netransgender kubva kuzvirongwa zveinishuwarenzi yakazvimirira nguva pfupi yadarika.
Nekuda kweizvozvo, nyanzvi shoma muUS dzinopa kuvhiyiwa kwemuviri wakaderera zvachose, kushandira boka diki revarwere vanokwanisa chaizvo kuvhiya.Vanhu vazhinji vakachinja-chinja vakamanikidzwa kubhadhara mari yekuvhiyiwa kunze kwehomwe kusvika 2014, apo hutungamiriri hwaObama hwakadzoreredza Medicare kuvharwa kwekuvhiyiwa kwekusimbisa murume nemukadzi uye kurambidza inishuwarenzi yekuvhiyiwa kwe transgender muna 2016. Kamwe mitemo yenguva yaObama yapfuura, vanhu vakawanda vanochinja kukwanisa kubhadhara maitiro aya kuburikidza neinishuwarenzi kana Medicaid, uye zvimwe zvipatara zviri kumhanya-mhanya kuzadzisa zvinodiwa.
Zvisinei, maitiro akadaro anodhura: vaginoplasty inodhura madhora makumi maviri nemashanu.Ongororo yakaitwa muna 2018 nevatsvakurudzi vepaHarvard University neJohns Hopkins University yakaona kuti pakati pa2000 na2014, huwandu hwekuvhiyiwa kwetransgender verification hwakawedzera zvakanyanya, nenhamba iri kuwedzera yavo vachipihwa inishuwarenzi yega kana kubhadharwa neMedicaid."Sezvo kufukidzwa kwemaitiro aya kunowedzera, ndizvo zvichaitawo kudiwa kwevanovhiya vane hunyanzvi," vaongorori vakapedzisa.Asi pane mitemo mishoma yakamisikidzwa pamusoro pezvinoreva "vanokwanisa", uye mamwe matunhu ebasa rekurapa anokanganisa shanduko yevakadzi.padambudziko.Vanachiremba vanovhiya vanoshuma kumasangano akasiyana siyana uye kudzidziswa kweGRS kunogona kubva pakuona kwevhiki nachiremba ane mukurumbira kusvika pachirongwa chemakore akawanda ekudzidzira basa.Iko hakuna zviwanikwa zvakazvimiririra zviripo kune varwere kuti vawane data pamusoro pekuvhiya complication rates.Kazhinji, varwere vanovimba chete nedata rinopihwa nevanovhiya ivo pachavo.
Kunyange zvazvo vanhu vasingaverengeki vakabatsirwa nekuvharwa kweGRS, chimwe chiitiko chisingatarisirwi chave icho San Francisco-based gender surgeon Dr. Marcy Bowers anodana tsika ye "goodbye".chipatara mukati menguva yakatarwa, uye kuti tisafe nedambudziko rakaipisisa, kana kuendeswazve kuchipatara kakawanda,” akadaro, “ndiwo mayera avanoyera budiriro.”kuva "vanofarirwa vanopa" nekukwevera zvinobudirira varwere vatsva kumaitiro avo zvichienderana nemametric aya.
Muna Chivabvu 2018, 192 postoperative transgender varwere vakanyora tsamba yakavhurika kuWPATH ichitaura zvimwe zvinonetsa nezvehurongwa hwazvino umo vanachiremba vanovhiya vanopa varwere vane zviwanikwa "mahara kana akaderera kuvhiyiwa kuti vawane complication rate ne preoperative kuraira".zvinyorwa zvedzidzo uye kutaura pachena pamusoro pechiitiko chekuvhiyiwa, kuvhiyiwa kwekuedza pasina kubvumirwa, ruzivo rwezvokurapa rusina chokwadi rwunopiwa kuvarwere, uye kusava nehanya kwakakwana kwevarwere.
"Pachine kusaenzana pakati pezvinodiwa uye nhamba yevanhu vakadzidziswa mumaitiro aya," akadaro Dr. Lauren Schechter, purezidhendi akasarudzwa weAmerican Society of Gender Surgeons.“Chokwadi chinangwa chedu ndechekudzidzisa vanhu vakawanda kuitira kuti vanhu vasafambe, kunyanya munzvimbo dzakakosha… Saka pane kunonoka zvakare pakati pekudzidzisa vanhu nemazvo uye kutanga zvipatara [ne] zvipatara.”
Kuderedza kunonoka kuzadzisa kudiwa kuri kukura kwemaitiro ekusimbisa varume kunowanzoreva kuderedza mikana yakakosha yekudzidziswa kuzvipatara nevarapi."Chaizvoizvo, nhanho mbiri kumberi uye nhanho imwe kumashure," akadaro Jamison Green, aimbova purezidhendi weWPATH uye iye zvino director wezvekutaurirana, wekuvhiya mukuvhiya.Achidzokera kumashure, akadaro, vamwe vanachiremba vanovhiya vangasarudza kurovedza mumamiriro ezvinhu akaoma zvikuru: “Havajoini neWPATH.Havazvibvumiri kudzidziswa.Ipapo Vanoti, "Ehe, ikozvino ndave kuziva zvekuita."Semumwe chiremba wekuvhiya asingazivikanwe akataurwa muongororo ya2017: “Mumwe munhu anoenda kune vanhu vane mazita ane mukurumbira;vanodzidza kwevhiki uye vobva vatanga kuzviita.zvisina kunaka zvachose!”
Kuchinja zvirongwa zveinishuwarenzi nemitemo inotonga makambani einishuwarenzi eUS zvinoreva kuti vanhu vanochinja hunhu vanowanzo tsvaga maitiro akadai vachityira kuti mainishuwarenzi anogona kushandura mitemo yavo yekuvhara kana vachiongorora vanogona kuvhiya.Kuvharirwa inishuwarenzi kunowanzo taura kuti varwere vanochengetwa kupi, saDanielle, mukadzi ane makore makumi mana nemaviri ekuberekwa anogara muPortland, Oregon uye anovimba neMedicaid.Mudunhu rake, kumwe kuvhiyiwa kwekusimbisa murume kana mukadzi kunovharwa nechirongwa chehurumende cheMedicaid, asi muna 2015, Danielle akanzwa kukosha kwekuzviita nekukurumidza sezvo kurapwa kwevanhu vanochinja kwakava chinangwa chezvematongerwo enyika cheRepublican.
"Ini ndafunga tisati tave nemutungamiri weRepublican, ndinofanira kuve nesikarudzi," akaudza Jezebel mubvunzurudzo yechirimo 2018.Apo Medicaid yakamutumira kuPortland kunoona Dr. Daniel Dougie, akamuudza kuti akanga ari murwere wake wechi12 we transvaginoplasty.Paakazopepuka kubva kwaainge avhiyiwa akaudzwa kuti oparesheni yacho yaizotora nguva yakapetwa kaviri nekuti nhengo dzake dzesikarudzi dzainetsa kuvhura.
Kunyange zvazvo akataura kuti maonero aaiita uye manzwisisiro ake akanga akanaka, zvakaitika kuna Danielle ari muchipatara zvakasiya zvakawanda.“Muwadhi ino hapana aiziva maitirwo ekukuvara kwevanhu,” vakadaro.Akataura kuti akanzwa kusiiwa uye akamhanyira kunobatsira mushure mekuita kwenguva refu uye kupindira.Jezebel akataura nevamwe varwere vaDr Dougie vakati wandei, uye pamwe chete vakazomhan'ara kuchipatara.Kunyange zvazvo kunyunyuta kwaDaniella kwaiva pamusoro pezvakaitika kwaari pakuchengetwa kwepashure-op muchipatara, vamwe vakatambura nezvinetso zvakakomba, zvinosanganisira fistula uye incontinence weti mushure mekuvhiyiwa.Sekureva kweanoziva nhaurirano dzeboka iri nechipatara, boka iri rinotenda kuti chipatara ichi chine dambudziko rakanyanya kudarika zvimwe zvipatara zvinopa maitiro akafanana.
Mukupindura mibvunzo yakawanda yeJezebel, Dr. Dougie akati chipatara hachibatanidzi mukudyidzana kwakananga nevarwere nekuda kwemitemo yekuvanzika, asi vakabvuma kuti vashandi vakataura zvakanyanya nevarwere vetransgender.“Takapinda mumisangano yakati wandei takatarisana nevanhu nemapoka nekufamba kwenguva.Iyi misangano yakaramba ichienderera mberi kusvikira kubvumirana kwasvika pamusoro pezvinonetsa zvevarwere, zvinangwa zvekukurukurirana zvakasvika, uye chirongwa chekudzivirira kudzoka kwakagadzirwa, "Dr. Dugi akanyora mune email.
Kunyanya, chipatara chakagadzira Community Advisory Committee yemuno transgender uye vanhukadzi vasingaenderane nevanhu vanobvunza nevashandi uye manejimendi eOHSU Transgender Health Chirongwa, Patient Affairs, nevamwe vane chekuita.
Dr. Dougie akaudza Jesabel kuti matambudziko ekuvhiya pachipatara akatariswa uye akashandiswa kuvandudza migumisiro, nekunetseka kwehuwandu hunofananidzwa kana kudarika zvakabudiswa kubva kune dzimwe nyanzvi dzekuvhiya."Vanachiremba vedu vanoedza kuita zvakanaka, asi dzimwe nguva pane zvinonetsa," akadaro."Vese varapi veOHSU vanoita ongororo yemukati nguva dzose yezvekurapa kwavo nekuvhiya mhedzisiro kuburikidza nehurwere nemisangano yekufa inorongeka nemukuru wedhipatimendi remhando."
Dr Dugi akacherechedza kuti kunetseka kwevashandi pamusoro pehutano hwehutano uye migumisiro yakasimudzwa kune imwe nzira yekuongorora nevezera iyo inogona kuendeswa kumabhodhi ekuongorora masangano."Nzvimbo dzese dzekurapa dzinotevedzera mwero uyu uye dzinotemerwa nemasangano anotenderwa enyika," akadaro.
Kunyange zvazvo varwere veOSHU vakakurukura zvinogona kugadziriswa nehutungamiri hwechipatara, vamwe vekare vaDr. Rumer vaimbove varwere vakaenda kune zvakanyanyisa.Muna 2018, vana vaimbove varwere vechiremba uyu vakamhan'ara matare edzimhosva kuEastern District yePennsylvania.Mumwe nomumwe aimiririrwa nekambani imwe cheteyo yezvemitemo uye vakataura kuti basa raDr. Rumer rakanga raitwa zvakaipa kwazvo mumhaka dzavo zvokuti vamhan’ari (vose vomuNew York) vaida kuvhiyiwazve paGomo reSinai.
Mumwe nemumwe wevamhan'ari akatsanangura kupfupika uye kukuvadzwa kune yavo urethra, vaginal canal, uye labia, pamwe nebulging kana kuremara clitoral hoods, nyaya dzinozivikanwa se "kukuvadza zvachose" zvekuti vamhan'ari "havagone kuita zvepabonde zvakare."
Mhosva, iyo inotsanangura "kunyadziswa" uye "kushungurudzika kwakanyanya kwepfungwa" kwakakonzerwa nebasa raDr. Rumer, pakutanga vakadana kutongwa kwevatongi, asi vakazoendeswa kune voluntary private arbitration.Mune imwe nyaya, magweta ane chinangwa chekumhan'arira Dr. Jess Ting, chiremba anovhiya uye purofesa wemishonga anonyanya kukoshesa GRS paGomo reSinai, maererano nememo yepretrial.Anotarisirwa kupupurira kuti kunyange mushure mekuvhiyiwa katatu, basa raDr. Rumer harina kubvumira vamhan'ari "kuwana orgasm kana kugutsikana kwepabonde pasina kurwadziwa", pamwe nekugadzirisa mamwe matambudziko anokosha, kusanganisira "kunyanya clitoris pasina clitoral shield" uye bvudzi. hapana clitoris.kubviswa zvakanaka.
“Sachiremba wokuvhiya, ndinogona kukuudza kuti chiremba wokuvhiya ari wose ane miuyo yakaipa,” akadaro Dr. Ding Jezebel.“Tese tine matambudziko uye zvinhu hazviwanzofamba nenzira yatinoda kuti zviitike.Paunoona maitiro ezvinobuda anoratidza kuti chiremba anovhiya angave asiri kusvika pachiyero chekutarisira, unonzwa kudikanwa kwekutaura. ”
Muchidimbu chisati chatongwa chakaiswa mukupera kwaFebruary, nyaya yacho isati yaenda kunopokana, magweta aDr. Rumer akapokana kuti chiremba anovhiya haana kuregeredza, haana kutsauka kubva pachiyero chekutarisira, uye kuti dambudziko remurwere raive "kunetswa kunozivikanwa. ”"[c] Vaginoplasty.Kunyunyuta kunotaurawo kuti murwere "haana kushanda paairapwa naDkt. Rumer" uye kuti ane makore 47 okukura haana kurondedzera matambudziko makuru kutozosvikira gore rinopfuura pashure pokuvhiyiwa.Details of the arbitration process and its results were released not made public, v. Rumer Hapana mumwe wevamhan'ari munyaya yechiremba akapindura kune zvikumbiro zvakawanda zvebvunzurudzo.
“Sachiremba, hapana anofarira masutu akashata,” akadaro Dr. Dean.“Iyi inyaya isingafadzi kwandiri semupomeri wekukanganisa.Ndataura izvozvo, ndinonzwa kuti sevashandi venzvimbo itsva iyi duku, tinofanira kuzvitarisira uye kuchengeta mipimo.”
Jezabel akabatana nevakawanda vanozivikanwa vekuvhiya vakadzi kuti vabvunze vangani vevaimbove varwere vaRumer vakavhiyiwazve kuti vagadzirise zvaakawana.Zvinonzwisisika zvakaramba kutaura, asi vanhu vatatu ava, vakakumbira kusazivikanwa, vakatevera varwere vanopfuura makumi mashanu vakatanga kubata Dr. Rumer veGRS kubva 2016.
"Tese tinoda kuti vanhu vane transgender vave nezvimwe zvingasarudzwa zvekuvhiyiwa, uye tiri kuita zvose zvatinogona kudzidzisa nekusimudzira zvibereko zviri nani," akadaro Dr. Bowers, chiremba wekuvhiya wepabonde kuSan Francisco.matambudziko ekuvhiya, kutsamwa uye ruvengo kune vanonyunyuta, kushaikwa kwekuwanikwa kana kuzvidavirira.Akawedzera kuti Dr. Rumer “anonzwisisawo kuti varwere vanoda chaizvo kuvhiyiwa nevavhiyi vashomanana.””
Hannah Simpson, mukadzi ane makore makumi matatu nemana anonzi transgender anobva kuNew York, akati mavhiki maviri mushure mekuita GRS naDr. Rumer muzhizha ra2014, akaona kuti vulva yake yakatanga kuita seasymmetrical uye zvikamu zvayo zvakatsvuka kwazvo.uye kuzvimba.Pasinei nekuvimbiswa kwaDr. Rumer kuti zvinhu zvose zvakanga zvakanaka, Simpson akatanga necrosis yevulva.
Simpson, uyo aidzidzira zvokurapa panguva iyoyo, akatsanangura mbongoro yake itsva: clitoris yakaremara iyo yakanga “ine divi rimwe chete” uye mboro “yairatidzika sebundu kupfuura kuputika kuviri.”Simpson aivewo nezvimwe zvinonetsa, kusanganisira bvudzi remukati memukadzi iro vanachiremba vekuvhiya vakavimbisa kubvisa uye kuiswa kusinganzwisisike kweurethra yake.Mukuwedzera, Dr. Rumer akasiya mamwe matishu akatenderedza pamusuwo wemukadzi, izvo zvakaita kuti dilation isanyanya kugadzikana, Simpson akadaro.Pazuva rakatevera, uye zvakare mune yakatevera email iyo Simpson akagovana naJezebheri, Dr. Rumer akapomera ganda rakafa pane Depends Simpson pair iyo Simpson yakanga yapfekwa yakasimba muchipatara, iyo Simpson akafunga kuti dambudziko rekunzvenga.Dr. Rumer vakaramba kupindura mibvunzo yaJezebheri pamusoro pemabatiro aakaita murwere uyu kana mumwe murwere.
Necrosis senge Simpson's necrosis injodzi nechero vaginoplasty uye inogona kukonzerwa nekupfeka zvipfeko zvemukati zvakanyanyisa mumatanho ekutanga ekupora mushure mekuvhiyiwa, kunyangwe zvingave zvakaoma kudoma chaicho chikonzero mumamiriro ezvinhu aya, Schechter akadaro.zvirwere mumurwere."Kutapukira, tishu necrosis, suture dehiscence - zvese izvi zvinoitika nekuvhiya kupi," akadaro.Schecter akacherekedza kuti kufamba kwepashure uye nzvimbo yakasviba kana isina kuchengetedzeka yemumba inogonawo kutungamirira kumatambudziko, asi pakupedzisira chiremba anovhiya anofanira kuraira murwere uye kuona kuti izvi zvinokonzera njodzi zvinoderedzwa.
Kuvhiyiwa kwechipiri nachiremba akasiyana hakuna kubudirira mukudzorera basa rekutanga raDr. Rumer uye zvakatotungamirira kune mamwe matambudziko, uye Simpson akanga asina clitoris.Nekuverenga kwake, iye zvino abvunza vana chiremba vanovhiya makumi matatu nevatanhatu kuti vamugadzirirezve mitezo yake.Chiitiko ichi chakamuodza mwoyo mubasa rezvokurapa uye akarega kutevera dhigirii rake rezvokurapa.Haana kushandisa nzira dzipi nedzipi dzokumhan'ara, achityira kuti izvi zvaizoderedza mukana wokuti mumwe chiremba aizotora nyaya yake.
Kunyunyuta kwaSimpson pamusoro pebasa raDr. Rumer kwakafanana nekwevamwe vaichimbova varwere vakataura naJezebheri."Ndagara ndichiyambira vanhu kuti vasiyane naRumer," akadaro Amber Rose, ane makore makumi maviri nemasere asiri bhanari wekuBoston.Muna 2014, vakaenda kuna Dr. Rumer nokuda kwekuvhiyiwa kwehudyu nekuda kwezvisarudzo zvose zvakapiwa neurongwa hweinishuwarenzi yevabereki vavo, chiremba anovhiya aiva nenguva shoma yekumirira.
Operation yaRose haina kufamba sezvaainge aronga."Rumer akasiya akawanda erectile tissue pasi pelabia minora yangu, inogona kuva dambudziko," Ross akadaro."Yaisaita senge vulva."Kunyange vamwe vanachiremba, vakati, “vakamboedza kupinza munwe muurethra yangu nekuti zvaisaoneka.”
Ross akati Dr. Rumer havana kuvaka clitoral hood, vachisiya clitoris yavo yakavhurika zvachose kuti isimudzire.Zvakare, nzira yaRumer yekubvisa bvudzi yakatadza uye yakasiya rimwe vhudzi mukati memarabhi asi kwete mugero remukadzi.“Akaramba achiunganidza mvura uye weti, uye ainhuwa zvokuti ndakazvitya kwegore rokutanga,” vakadaro, “kusvikira ndaziva kuti maisafanira kuva nebvudzi imomo.
Maererano naRoss, makore matanhatu gare gare, havasati vachifara nekushanda kwavo uye vari kunetseka kuti Dr. Rumer anoshanda kune vanhu vane transgender.Asi vanoti kushushikana kwavo kunobvawo mumatambudziko ehurongwa nemaitirwo aya: kushomeka kwevarapi veGRS uye runyoro rwakamirira rurefu, zvichireva kuti vanhu vakaita saivo vane sarudzo shoma dzekusarudza kubva uye kwete ruzivo rwakakwana kuna chiremba anovhiya.
Kuvhiya buttock kune transgender uye transgender vanhu kune multidisciplinary uye kunoda hunyanzvi mukuvhiya kwepurasitiki, urology uye gynecology.Imwe neimwe yedzidziso idzi ine komiti yakazvimirira ine basa rekubvumidzwa.Kuedza kwazvino kuyera vaginoplasty yekudzidza curve inoratidza kuti makumi mana maitiro anodiwa kuti udzidze zvizere maitiro.Pasina kuyanana kwakatenderwa kana nhungamiro yekudzidzira basa kubva kuWPATH kana chero rimwe boka rehunyanzvi, varwere vanozofanirwa kuvhiya kwakasiyana siyana kwehupenyu hwavo hwese.
Zvipatara zvega zvega zvine basa rekuona kuti ndiani ane mvumo yekuita mamwe maitiro muzvivakwa zvavo.Dr. Schechter akaudza Jezabel kuti mabhodhi echipatara anowanzoda kuti vavhiyi vabvumidzwe neimwe yeanopfuura 30 mabhodhi ezvokurapa munyika yose, uye angave ane akasiyana madiki ekudzidziswa kwevanovhiya vangangoita.Asi maererano neWPATH's Greene, hapana bhodhi rezvokurapa rinonyatso bvumidza vavhiyi vega kuti vavhiyiwe zvinoenderana nevarume. kudzidzisa.sechikamu chebvunzo dzebhodhi kuti ugopihwa zvitupa,” vakadaro."Nekuti izvozvi, sekutaura, havana kupihwa zvitupa."
Parizvino, iyo American Society of Plastic Surgeons inobata general board certification asi haina kunyanya kubata mune zvine chekuita nebonde, zvichireva kuti vanovhiya vanobatana havafanirwe kusangana nemimwe miitiro yekudzidzira kuita kuvhiyiwa kwenhengo dzepabonde kune varwere ve transgender.Green akataura kuti ichi chimiro chemasangano chisina kukodzera mabasa aripo.“Iye zvino tatova navanachiremba vezveurologist, gynecologists uye ma microsurgeon akasiyana siyana anoita basa rekuvakazve nhengo dzesikarudzi.Saka zvatooma kupfuura kare,” akadaro."Asi hapana bhodhi rakagadzirira kugamuchira izvo."
Kuti vazadze chishamiso, vanachiremba vakadai saDr. Schechter nevamwe vanoita basa rekusimbisa hutano hwevakadzi vakabatana pamwe chete kuti varwire hurongwa hwedzidzo hwepamusoro hwezvipatara zvinotarisa kupinda mumunda.Muna 2017, Dr. Schechter akanyora imwe nyaya mu Journal of Sexual Medicine inotsanangura zvimwe zvezvishoma zvekudzidziswa zvinodiwa kune vanovhiya ramangwana.
Sekureva kwemushumo, vanachiremba vanovhiya vanovhiya-kusimbisa pabonde vanofanirwa kudzidziswa zvakanyanya, kusanganisira masemina, masemina emu-office, maoko-on uye post-operative care sessions, pamwe nekuenderera mberi kwehunyanzvi.Kunyange kurudziro idzi dzichizovandudza mhando yedzidzo munyika yose, dzinoramba dzichizvipira kuzvipatara zvega zvega nevarapi.Masangano asina purofiti akadai seWPATH agara achiedza kuita zvinodiwa pakudzidziswa asi akatadza kuita shanduko ega.Sangano rinoita kudzidzira kwayo kwekuvhiya, kwakatanga panguva yehutungamiri hweGreen kubva ku2014 kusvika ku2016. Asi kune sangano rakafanana neWPATH, mari yekudzidzira inogona kurambidzwa, uye inoramba iine sarudzo uye yakasununguka kune vanovhiya vanoda chaizvo kuita basa ravo.
Vamwe, sevanachipangamazano vanoshanda mu LGBT primary care centers, vanobatsira varwere vane kuvhiyiwa kwevakadzi, uye muna 2018 vakaronga tsamba yakavhurika yeWPATH ichikurudzira "center of excellence" modhi umo mainishuwarenzi nemasangano anoshanda pamwe chete, kuvimbisa inobhadharwa inishuwarenzi chete. .vanachiremba vanovhiya vakadzidziswa zvirongwa zvehunyanzvi.(Muenzaniso, anoti, wakagadzirisa matambudziko akafanana mukuvhiyiwa kwebhaatric mukutanga kwe2000s, kupa ruzivo rwakakwana ruzivo uye kusimbisa zvirambidzo pakuvhiyiwa pavanenge vatarisana nezvinetso zvakafanana.) Blasdel anotaura kuti kunyange zvazvo mamwe masangano ezvokurapa achangotanga kuzviti "transgender". centre of excellence”, “Parizvino hapana maitiro anofanirwa kusangana nachiremba anovhiya kuti agamuchire zita iri.