Nullification Surgery - The Information Gap for AFAB Patients
In a space that's all about pushing the boundaries of gender and redefining how we think about sexual anatomy, I had expected (or at least hoped) that sexism wouldn't be an issue.
But... Here we are, I guess.
I didn't know this before starting my research and pursuing my consultations, but—the majority of patients pursuing nullification surgery start with what is generally considered "male" anatomy: phallus, scrotum and so on.
I've asked around as to why, but haven't yet found a good answer or even a good excuse. One suggestion was that "female" anatomy is less noticeable and obtrusive. I assume that the logic here is that it would be less dysphoria-inducing or easier to just "forget" about than the opposite anatomy.
It would be nice if that were true. Instead, it feels rather minimizing. Patronizing, even.
Out of all of the spaces I've spent time in that are dedicated to null surgery patients, I haven't found any that are openly hostile toward AFAB people, people with uteruses, femme-presenting people, insert your preferred term here... yet. But once I started paying attention, and thinking of these problems not as coincidences but as interconnected issues, I've realized that overall, spaces dedicated to patients of null surgery overwhelmingly assume male-as-default.
So, quite ironically, and I would argue paradoxically, being AFAB in null spaces is an alienating experience.
Lack of Relevant Information
The most striking obstacle I'm sharing is also the first one I encountered.
When I was scheduling a consultation with Align Surgical Institute in California, I was sent an information packet about the nullification surgery I was interested in. For being sent at the consultation stage, the packet was very detailed. For example, it listed what each stage of prep in the months working up to the surgery would be. One such step was hair removal. It had a diagram, with exact measurements, of where hair would need to be removed (through either electrolysis or laser treatments) before the surgery. However, the diagram only depicted an example of what would be expected on an AMAB patient.
I looked through the whole thing again. But there was no AFAB counterpart. I figured I had been sent the wrong packet, or there might have been an accidental omission. (Putting together and exporting PDFs can be a pain, as I know from working in book design.) So I asked the clinic if they could please provide one relevant to my anatomy.
The clinic's reply was that they do not have such a diagram readily available.
To say the least, it was strange. This very reputable gender-affirming surgery clinic, with multiple locations and doctors, at which numerous folks I've spoken with have gotten their surgery and have referred others to...was somehow not at all prepared to provide proper information of the surgery to an AFAB patient.
Now, though, I know that's not just an accident or a coincidence.
Lack of Awareness
As I've explained elsewhere, nullification is a very obscure surgery. Even Dr. Toby Meltzer, who has done hundreds of gender-affirming surgeries, has only done a handful of nullification procedures including mine.
This means that the information that is out there is even more easily skewed. And apparently, even on reputable websites, nullification is phrased as a procedure whose patients are mainly exclusively AMAB. This of course, may have a compounding effect where AFAB patients don't realize it's an option for them, and therefore don't seek it. Or, they may hesitate because there's less information readily available for them, leading them to feel underprepared and less confident. (I was naive in a good way early on—I had no awareness of this inequity to discourage me.)
Even among experts and reputable websites, this bias exists. One of the occurrences that spurred me the most to write this blog was an article from VICE that discussed nullification surgery. The article reads:
(The highlights are my own, from when I screenshotted and instantly shared this bit with my friends, incensed at its implications. The shoehorning of nullification as something "practiced among cisgender gay men" is... wow.)
There's no way I'm the only AFAB patient undergoing nullification. We must be out there. I know, we are because there's a few in one of the support groups I'm in. But we are decidedly a numerical minority, so our experiences often get overshadowed by those on which there's simply more, and more detailed, information out there. And I guess that leads even journalists to assume that, just because the information is not readily avaiable, it must not exist.
My question is: are the right people even asking? Is there anyone but ourselves to advocate and help spread our experiences, too?
Male-as-Default Community Resources
A member of a surgery support group I'm part of shared a project that their friend was working on. This project, rather like a wiki, would centralize information about null surgery, reviews of providers, a glossary of terms, etc. by several contributors in a single searchable site. At first, I was excited: I could write a few sentences of my experiences and have them seen somewhere, without having to go trouble with building my own site and driving traffic to it! (Haha...)
I quickly—perhaps too quickly—logged onto the wiki, got a brief understanding of its structure, and made an account. I looked for sections to edit, and...
They all defaulted to discussing the surgery from the point of view of an AMAB patient. There was no mention anywhere of the surgery from the perspective of an AFAB patient. On the contrary, some of the wording (as well as the site title) seemed to imply that it was dedicated exclusively to patients beginning with AMAB anatomy.
My eagerness deflated. I asked the group member who had shared the site: are they looking for contributions from AFAB members, or no?
It turns out: yes, they were. But it sure didn't seem like they were. I wouldn't have had even the faintest inkling if I didn't have someone in the group playing telephone to clarify that yes, that friend definitely wanted that information, actually!
The obstacle that I disproportionately faced, then, was that there was nowhere on the wiki to put said information. I would have had to, essentially, restructure parts of the site and add whole new sections on various pages, all to merely start to categorize my contributions. Let alone the actual writing.
When the project was shared, I had hoped that the opportunity was there, ready for the taking, and I just had to make myself known. I didn't realize that I would have to be the sole pioneer of that information.
In case you haven't heard already, having to be The One Spokesperson on behalf of an entire minority class within a majority space is exhausting. More exhausting than just saying "screw it" and making my own site, which at least comes with the freedom to structure things how I want, instead of having to eke out space within an already-sexist structure.
So, now we're here.
Microaggressions
Even if spaces are ostensibly welcoming to AFAB members (or members perceived as female, or what-have-you), the assumptions that existing members make about other members in that space, especially new ones, influence the character of the space as a whole.
I've been in one of my support groups for years now. And I still find that other members will assume I'm starting with male anatomy unless I specifically bring up what I am starting with.
The fact that people in a supposedly gender-progressive space will mentally project maleness onto you without questioning it at all unless you specifically identify yourself as otherwise is... kind of insidious, when I think about it. I know I'm a minority—but assuming that an unfamiliar conversation partner is a member of the majority group and proactively denying other possibilities is pretty much the definition of a microaggression. (Well, one of the definitions.) This is the last space I would think I'd need to generously qualify my responses with "Well, I have/had a vulva actually, so..." A penectomy doesn't apply to me. Or I won't have a scrotum afterwards. Or one of the numerous things that other members discuss about that side of the process.
I guess that just because we're moving beyond sex doesn't mean we're moving beyond sexism.