Newswise — A prominent gynecologic cancer surgeon is urging her fellow physicians to reconsider their views about a medical procedure for transsexual patients making the transition from female to male. Dr. Kate O'Hanlan, MD, a surgeon in private practice in Portola Valley, California, provided evidence that total laparoscopic hysterectomy can be the best approach for many of these patients.
O'Hanlan, former associate Director of Gynecologic Cancer Surgery at Stanford University and member of the Scientific Advisory Board of Rockway Institute, believes gynecologic surgeons should learn about the procedure as part of an effort to better meet the needs of transsexual patients. "Transsexual patients face enormous barriers in life, and those continue into their medical treatment. They endure stigma and misunderstanding even when they go to their physicians for medical care," O'Hanlan said.
Most hysterectomies, or removal of the uterus, are performed through large abdominal incisions or through the vagina, O'Hanlan explained. She has observed in her practice that patients making the transition from female to male, who have not had children and are taking testosterone to assist the transition, have vaginal walls that are too thin to safely perform the procedure through the vagina. Laparoscopic hysterectomy, in which the uterus is removed through several small incisions in the abdomen, rather than through a large abdominal incision or through the vagina, is an option for these patients. O'Hanlan published her findings in an article in the Journal of Obstetrics & Gynecology (Vol. 110, No. 5, November 2007) that described the outcomes for 41 transsexual patients during an eleven-year period. They were compared to 552 other patients who underwent total laparoscopic surgery.
However, O'Hanlan noted, total laparoscopic surgery is underutilized and few gynecologic surgeons know how to perform it. She reported that about 15 percent of hysterectomies are performed laparoscopically, and only five percent are total laparoscopies. "Transsexual patients are being denied the optimal care they need because doctors are unfamiliar with this procedure," O'Hanlan said. "The pain and complications of traditional large incisional surgery are simply unacceptable given that laparascopic surgery can be used in so many cases."
In the paper, O'Hanlan and her co-authors, Suzanne L. Dibble, DNSc and RN, and Mindy Young-Spint, MD, noted that "culturally appropriate gynecologic care of transsexual patients has been identified as an important goal by the American College of Obstetricians and Gynecologists in Special Issues in Women's Health." Standards for care have been well-established by The World Professional Association for Transgender Health, the article said.
"Transgendered persons frequently experience social and economic marginalization once they begin transition, but after their transition, most transsexuals typically establish and maintain partnerships and have a stable socioeconomic status," the article said. However, O'Hanlan added, the process is quite expensive, and cannot be covered by medical insurance due to an "unfortunate and baseless" amendment to the Americans with Disabilities Act (ADA). Transitioning within World Professional Association for Transgender Health (WPATH) standards requires ongoing psychotherapy, which can be costly. Similarly, the hormone injections essential to quality of life for these patients are not covered by most insurances because of the ADA. "Because of that amendment to the ADA, the surgeries and medicines used for gender identity disorder are specifically excluded from most insurance policies. It's a crying shame that Americans citizens are marginalized by this policy and are prevented from getting the medical care they need," said O'Hanlan. "The transgender diagnosis is a very serious medical reality, and patients deserve compassionate treatment that will carry them forward toward their deserved future as an accepted, valued member of our society."
An expert on health issues facing lesbians and gay men, O'Hanlan was president of the Gay and Lesbian Medical Association and wrote the group's report "Homophobia as a Health Hazard." She has been active in urging professional organizations to confront discrimination in medicine against lesbians, gay men, and transsexuals.
About Rockway Institute: The nonpartisan Rockway Institute promotes scientific and professional expertise to counter antigay prejudice and improve public policies affecting lesbian, gay, bisexual, and transgender (LGBT) people. The Institute's view is that public opinion, policies, and programs should be shaped by the facts about LGBT lives, not by political ideology. A primary goal is to organize the most knowledgeable social scientists, mental health professionals, and physicians in the United States to provide accurate information about LGBT issues to the media, legislatures, and the courts. The Institute also conducts targeted research projects to address the nation's most pressing LGBT public policy concerns.