Most all of us have read studies reporting what male-to-female transsexual women tell their caregivers about their lives after surgery.
What do transsexual women say about themselves when they "let their hair down", so to speak? What do they talk about when they gather together in an atmosphere of trust, with no non-transsexuals present? What do they report when they can answer questions anonymously? And what questions are asked when transsexual women themselves are doing the asking? Some of the answers surprised me, and may surprise you. This will be the topic of my presentation today: "Life After Surgery: Questions and Answers from the 1996 New Woman Conference."
Each fall, beginning in 1991, a group of "new women", post-operative male-to female transsexuals, from all over the United States, have gathered together to talk about their lives. This annual retreat is the New Woman Conference, sometimes known as "Rite of Passage." Initially sponsored by the Outreach Institute, the event has subsequently been organized and managed by transsexual women themselves.
The 1996 conference, NWC 6, was held on Ocracoke Island in North Carolina. At the conference, I participated in, and recorded, an exercise in which anyone might pose a question to the entire group, with the answers obtained through an anonymous polling method. These are the data I am presenting today. The recording was done openly, and it was understood that the results might be made public.
The question-and answer exercise was called "Pass the Bowl", after the method used to solicit replies. In response to a yes-or-no question posed by a member of the group, we passed an opaque bowl around to everyone. Each attendee could discretely drop into the bowl a colored chip, which were provided in three colors.
Red signified a "yes" answer, white a "no" answer, and blue "uncertain" or "don't know". After all the women had deposited their chips, we spilled out the contents and tallied the results. Everyone was then free to talk about the results, and some women even volunteered what their answers had been. Then someone posed another question, and we passed the bowl again.
Data gathered in this way have some obvious limitations, and also some desirable characteristics. Only 13 women attended NWC 6, so the sample size is small. And women occasionally left the exercise briefly, so a few questions received only 11 or 12 replies. Moreover, the composition of the group was such that results many not be generalizable to other populations of transsexual women. We did not take a formal demographic survey of the participants, but most appeared to be in their 30's, 40's, or 50's. All participants were caucasian or asian. Dates of surgery were, with one exception, relatively recent, from 1988 to 1996. Most participants probably had surgery in their 30's or 40's. Nearly half of the participants identified as lesbian, a higher percentage than in many clinical samples. Although NWC does offer partial scholarships, all the women were of sufficient means to pay for most or all of their travel and registration fees. NWC is not widely publicized, and most attendees learn of it by word of mouth, or from occasional advertisements in publications that attract transsexual readership. Therefore, attendees are more likely to be those transsexual women who have maintained ties to the transsexual community following transition. Overall, then, we might expect the women at NWC to be older, wealthier, more gynephilic (i.e., more sexually attracted to women), and less representative of ethnic minorities than the theoretical population of post-operative transsexual women at large.
Another limitation of these data is that the answers to the various questions cannot be correlated, since all questions were answered anonymously and independently. Finally, since the questions were formulated by the participants themselves, the phrasing of some items may not be as precise and unambiguous as would be true in an academic questionaire.
Balancing these limitations, the data have some unique and desirable characteristics. The questions were asked and answered in an atmosphere of unusual intimacy and trust, and the answers were obtained by a "guilt-free" sampling method: not only were the replies anonymous, there was also no pattern of answers that that might be used to identify a particular individual, as might be true of a written questionaire. It is therefore quite likely that the responses were extremely candid, perhaps more so than with other survey methods.
Moreover, the questions were posed by the participants themselves. This allows us to use the questions, as well as the answers given, to better understand the issues that are of importance to post-surgical transsexual women: what has their attention, what they're struggling to understand, what unfinished pre-surgical business they still carry with them. In this way, the questions may sometimes be as interesting as the answers.
Some of the topics raised at NWC 6 were novel, or have been examined only rarely. As we go along, I will pause to comment in some detail on these "uncommon" threads. Some of the other topics raised have been studied more commonly; and in these cases, I will try to highlight areas of agreement or disagreement with previous reports. When the answers given by these new women differ from prior results, we may wonder: Are these just a very odd group of transsexual women -- an unrepresentative sample? Or could it be that the NWC women are fairly representative, and are simply being unusually candid? Because of this uncertainty, I present these results as "thought-provoking", rather than as definitive. I do invite you to ask yourselves, when you hear these new women saying something you haven't heard before, whether it might be true that these women are just being unusually honest; and what implications that might have for your understanding of transsexual women's lives.
To begin, the participants posed several questions about identity. Three participants said that they were neither men nor women, but transsexuals. Ten, quite likely the other ten, thought that the term "transsexual woman"described them well, implying that both terms were necessary for an accurate description.
There are few reports of new women either doubting their womanhood, or holding onto a transsexual sub-identity. Kuiper and Cohen-Kettenis reported that none of their 55 post-operative MTF transsexual subjects felt even occasional doubts about being women, and only 3 of their 50 pre-operative subjects had such doubts. Their data were collected in face-to face interviews. Maryann Schroder reported in her 1995 dissertation that all but two of her 17 post-operative patients always felt like complete women; her data were collected through interviews and a questionaire. Anne Bolin interviewed about 17 transsexual women, many of whom were pre-operative, in the early 1980's. She noted that all of her subjects emphatically rejected transsexual identity following transition. Indeed, this is one of the central theses of her influential book, "In Search of Eve": that transsexual identity is a temporary step in the process of becoming a "new woman". She wrote that her subjects: (quote)
"not only expressed their primary identities as women, but rejected the label transsexual as stigmatizing. Being a transsexual is therefore an identity phase to be outgrown as one becomes a woman and seeks normalcy."
Most, if not all, the participants in NWC 6 would reject this formulation. Obviously much has changed since the 1980's. Bolin herself acknowledged the trend toward diversity in transgender identity in a 1994 essay. Ironically, she specifically pointed to the New Woman Conference as an example of a "conservative trend that discourages variant gender identity" . The willingness of the "conservative" women of the NWC to embrace a transsexual sub-identity thus seems like either a remarkable turnabout, or perhaps an example of unusual honesty.
Six of the thirteen NWC participants identified as lesbian, and four of the thirteen as bisexual. As I mentioned earlier, this evidence of widespread gynephilia -- sexual interest in other women -- may seem unusual, and may suggest that the NWC women are quite unrepresentative. While this may be somewhat true, the tendency of transsexual women to be gynephilic may also have been underestimated.
Traditionally, sexual interest in men has been seen as evidence that one is a "true transsexual"; whereas sexual interest in women has been seen as a contraindication to surgery, or at least as a poor prognostic factor. For this reason, many transsexual women have simply lied about their gynephilia. Janet Walworth reported that 6 of her 52 post-operative subjects admitted lying to their therapists about their sexual attraction to women. She obtained her results through an anonymous questionaire. Nearly half of her respondents expressed more sexual interest in women than in men, and another quarter reported being equally interested in women and in men. Only 11 of her 52 subjects were more interested in men than in women. Bolin found, among 17 subjects she surveyed, that 7 were exclusively or preferentially lesbian, and 7 were bisexual -- although we should be cautious with these data, since not all of her subjects had had surgery. I believe the NWC data can be seen as merely more evidence that gynephilia, whether presenting as bisexuality or as lesbianism, is much more common in transsexual women than is often supposed.
Turning to sexual issues, only 4 of the 13 women reported having sex regularly, while three had given up on sex. Neither of these results is particularly remarkable. Although most follow-up studies have reported high levels of sexual satisfaction in new women, rates of sexual dissatisfaction in the range of 15-25% are not unusual.
About half the women were capable of vaginal penetration, with a quarter incapable, and a quarter unsure. These figures, too, are not unusual. Blanchard and colleagues, in one of the better sexological studies of transsexual women, reported in 1987 that about a quarter of their respondents self-rated their vaginas as inadequate for coitus with "most or all partners." 21% of the patients reported by Stein and colleagues in 1990 had vaginal stenosis. Schroder found that nearly half of her subjects had vaginal stenosis, using an objective measure.
Although a bare majority of the new women reported having had at least one orgasm since surgery, only one could definitely report achieving orgasm regularly. This is an astonishingly low figure, even allowing that two of the women had had surgery less than a year before -- perhaps too recently to know what their pattern would be. In response to this disappointing result, one participant remarked, (quote): "This confirms what we've known all along - that surgeons lie." (unquote)
Another interpretation, of course, is that perhaps all the orgasmic transsexual women are busy having orgasms, while the non-orgasmic ones go to NWC to bemoan their fates.
We can compare the present results with some historical ones. The results from both NWC surveys show unusually low orgasm rates. Do the NWC women comprise a different population? Or are they perhaps just unusually honest?
As Blanchard stated, "orgasm is undoubtedly difficult to describe in the first place, and one has little idea what to seek as evidence of authenticity in self-reports." He thought that at least some of his subjects, especially those who described "multiple" orgasms, were probably describing something else. He also noted that self-reports are: "almost certainly colored, in many instances, by the transsexual's need to see herself, and be regarded by others, as a normal female." This factor might well explain why several non-"guilt-free" studies report orgasm rates of 30-60%. Both the 1993 and 1996 NWC studies, using "guilt-free" data collection, yield lower numbers, and I would tentatively suggest, more accurate numbers.
I'd like to share some personal experience on this subject, which is consistent with the factors noted above. I am one of the lucky transsexual women who is orgasmic; but I did not become orgasmic until seven months after surgery -- after I attended NWC 6. During those months, I had some sensations that I believed might have been orgasms --and, indeed, that I desperately wanted to believe were orgasms. For that reason, in the exercise, I dropped a blue "not sure" chip when answering whether I had ever been orgasmic after surgery. Knowing what I know now, I should have dropped a white "no" chip. If I had been asked, in a face-to-face interview, whether I was orgasmic, I would quite possibly have answered "yes", an answer that I now know would have been incorrect. I can testify to the powerful desire to portray oneself as "normal" after surgery. I believe that this must be considered in interpreting studies which have not used anonymous data collection.
The NWC women considered issues of eroticism as well. One topic raised was whether we experience autogynephilia -- erotic interest in, or arousal by, the idea of ourselves as female, or feminized. I'd like to discuss this concept briefly before presenting the results.
The term "autogynephilia" was coined in 1989 by Ray Blanchard; he defined it as "the propensity to be sexually aroused by the thought or image of oneself as a woman". In a series of papers published between 1985 and 1993, Blanchard explored the role of autogynephilia in the erotic life of male gender dysphoric patients. His clinical sample included many cross-dressers, as well as some persons who would subsequently be diagnosed as transsexual.
He advanced the hypothesis that there are two fundamentally different types of male gender-dysphorics: those who are exclusively or almost exclusively aroused by men, i.e., who are androphilic; and all the rest, who, as it turns out, are primarily aroused by the idea of being women, i.e., who are autogynephilic.
Blanchard found, in his large but diverse clinical population, that those gender dysphoric males who were primarily attracted to men: presented at an early age, reported more childhood femininity, were aroused very little by autogynephilic fantasy, and displayed little cross-gender fetishism. The other gender dysphoric males, whether attracted to women, to both women and men, or to neither, presented at a later age, reported less childhood femininity, were almost always aroused by autogynephilic fantasy, and displayed considerably more cross-gender fetishism. He concluded that the gender dysphoria of this latter group is in most cases a paraphilia.
Although Blanchard's ideas are intriguing, they have rarely, if ever, been examined in postoperative transsexual women. His ideas have also been widely ignored -- perhaps because they are so divergent from conventional notions about transsexuality. Both of these factors led me to pose three questions regarding autogynephilic eroticism at NWC 6; a fourth question was asked by another participant.
And, perhaps not surprisingly, 10 of the 13 women, fully three-quarters, reported that self-feminization was erotic for them. Incidentally, this is exactly the number who identified as either lesbian or bisexual. This is by far the largest sample of new women I know of who acknowledge autogynephilic sexual fantasies. Over half the women said that self-feminization had been their primary erotic fantasy prior to transition. 3 of the 13 said that they had lost sexual function after SRS because their sexual fantasy of self-feminization had become reality. Although there are undoubtedly many reasons why individuals lose sexual function after SRS, at least 3 women believed that losing this sexual fantasy had played a part. 4 women reported that they were sexually aroused immediately prior to genital surgery.
Reports of autogynephilic arousal in post-operative transsexual women have been rare. 5 of Schroder's 17 subjects described arousal to autogynephilic fantasy prior to surgery, but only 1 reported this after surgery.
Why is it that autogynephilia, so readily reported by the NWC women, has received so little attention? I believe it's because admitting to autogynephilic eroticism, and especially to autogynephilic motivations, can be very difficult for many transsexual women. They may fear that if they admit to paraphilic arousal, they will encounter disapproval, and may not be seen as genuine women -- or even as genuine transsexuals. Their therapists, accustomed to to more traditional, gender-based formulations, like "a woman trapped in a man's body", may regard autogynephilic eroticism as rare and aberrant -- and who can blame them, if their clients often don't tell them the truth? Surgeons especially would find it difficult to acknowledge that when they perform sexual reassignment surgery, they are sometimes simply helping a transsexual woman act out her own paraphilic sexual script.
Recently, some transsexual women themselves have called for more honesty about the role of sexual motivation in our life paths. Jessica Xavier wrote this in her article "Reality Check", published in 1995:
"To become fully cognizant of our realities, we must first acknowledge our fantasies. The eroticism of ... transsexuality for many of us is based upon a powerful sexual fantasy of becoming someone else, either temporarily or permanently. Sex is a powerful but seldom-discussed influence in our transgendered lives.... We should ... embrace our sexual power, and in so doing ... put it in proper perspective with the rest of our lives."
I plan to ask additional and more explicit questions about autogynephilia at NWC 7.
Next, the women considered their sexual feelings for other transsexuals. 5 of the women reported that they were strongly attracted to other male-to-female transsexual women. 9 of the 13 women said that they would like to engage in sex with someone present at the conference. This is almost double the number who found other transsexual women strongly attractive. 6 of the women had previously had sex with someone present at the conference, and 3 of the women had had sex with someone present, other than at a prior NWC.
I know of no other survey that reports this extent of sexual attraction to, and sexual behavior with, other transsexuals. This may in part reflect a self-selection process -- transsexual women who find other transsexual women attractive may have been aware of NWC's reputation for sexual freedom, and may have attended partly for that reason. Or it may be that the atmosphere of intimacy and trust at NWC promotes sexual feelings and behaviors that would not be acknowledged or acted upon in other circumstances.
Reports of sexual relations between transsexual women have been rare. Anne Bolin found that 2 of her 17 transsexual women were involved in a sexual relationship with each other; we do not know if they were pre- or post-operative. Among Schroder's 17 subjects, 1 reported sexual involvement with a pre-operative transsexual woman, and one with another post-operative transsexual woman. Recently, a few other observers have noted this phenomenon, without commenting on its prevalence, e.g., Mildred Brown in her 1996 book, "True Selves", and Holly Boswell in her article "When TGs Love TGs" in this year's Transgender/Tapestry #76. I will return to this topic in some concluding remarks.
Turning to compliance with the Standards of Care, a less than half the women said that their own transitions had adhered to the Benjamin Standards. I know of no other survey that has asked this question. Nearly half the women said their transitions had involved some deception of their therapists or healthcare providers. In the other survey I know that posed this question, Janet Walworth found that "only" one quarter of her respondents admitted to deceiving or lying to their therapists. 3 of the 13 NWC women had not lived full-time in-role for one year prior to having SRS -- something clearly not condoned by the Standards of Care. At least in this sample, both deviation from the Standards of Care and deceit of caregivers were widespread.
My interpretation of these results is that transsexual women often believe that the existing Standards do not meet their needs. The Standards of Care are being rewritten this year -- the first revision in 7 years. I was one of eight outside consultants invited to review the final draft. While the proposed revision contains many valuable improvements, it still includes provisions which, in my opinion, will be seen by some transsexual women as failing to realistically address their needs. Perhaps the membership of HBIGDA will someday enact Standards that facilitate the care of transsexual persons without erecting barriers to that care. Until then, disregard of the Standards and deceit of caregivers are likely to remain widespread.
The final data I'll present concern abuse issues. I'll admit that both the questions and the answers surprised me. About half the participants reported childhood abuse, either physical or psychological, with the definition of abuse open to individual interpretation. 5 of the women had been abused by an adult because of gender issues. By the way, this abuse was virtually all by parents, according to a follow-up question. 6 of the women had been in an abusive relationship as an adult, 5 of these in an abusive relationship with another transsexual. I was unable to find prior reports of the prevalence of abuse in transsexual women. However, there are comparable data for other sexual minorities. In one study, a majority of lesbian women reported childhood abuse; and Holly Devore reported this in a group of female-to-male transsexuals as well. Partner abuse in adult relationships is also widespread among lesbians and gay men. The dimensions of childhood abuse and partner abuse in transsexual women deserve further study.
I'd like to close by pulling together a few pieces of data, combined with a bit of speculation, to focus on a topic that has received little attention: transsexual women partnering with each other. In my experience, such partnerships are extremely common -- I've encountered at least half a dozen just in Seattle, and many more elsewhere. But such relationships have scarcely been mentioned, much less documented and studied, in the professional literature. Recall, however, that about 40% of the NWC women report a strong attraction to other transsexual women in general; half had had actual sexual experience with another transsexual; nearly half had had a past abusive relationship with another transsexual; and about 70 percent would have liked to have sex with someone present at the conference. If these women are at all representative of the broader transsexual community, or even of its non-androphilic component, then it is no wonder that partnerships between transsexuals are commonplace. This is an area ripe for investigation -- especially since abusive relationships are apparently not uncommon.
Why do so many transsexual women choose each other as sexual partners? Opportunity, and the prospect of finding tolerance and understanding, are likely part of the reason; but I speculate that these are not the only motivations. Could it be that some of us find other transsexuals especially desirable as partners, because they exemplify the autogynephilia at the core of our desire? Because they mirror our own minds; are our own fantasies made flesh? Attending to our internal autogynephilic imagery, many of us metaphorically "make love to ourselves", whether we are by ourselves or with another. And when this feels too lonely, what partner could be better, and less distracting, than one who is essentially a clone of ourselves?
If the sexologists ever turn their attention to our community of new women, perhaps that question will be examined. Scientific study of our sexuality is long overdue, as is sociologic study of our relationships. Those of us who attend the New Woman Conference do so because we believe that the truth of our lives has not yet been well understood by any but ourselves. We gather to ask the questions that the researchers haven't thought of, or won't touch; and to share the answers we only dare disclose when we are among our own -- or that we only discover we know when we are among our own. What we learn is of great value to us -- and I hope it has also been of some benefit to you today, in understanding the realities of life after surgery.