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15 May 2018

penile-inversion vaginoplasty in 1903

The official history of penile-inversion vaginoplasty is that Harold Gillies & Ralph Millard pioneered the use of of penile skin-flap in 1951, but that their method was not penile-inversion vaginoplasty as we later knew it.   Poul Fogh-Andersen in Copenhagen, who had operated on Christine Jorgensen, continued to innovate, and in 1956 he reported that he had successfully used a full-thickness skin graft harvested from the penile skin to line the neovagina. This was taken further by Georges Burou in Casablanca, also in 1956, who set the standard for future surgeons.   His method was quickly adopted by Jose Jesus Barbosa in Tijuana and Milton Edgerton at Johns Hopkins in Baltimore.   It was Edgerton who passed on details of Burou's method to Stanley Biber in Trinidad, Colorado.

This was the 1950s.

Let us turn back the clock to 1903.

________________

E.C. had been raised as a girl in New York, and identified as a woman. At age 20 she was referred by her family physician to the gynaecology professor, J. Riddle Goffe, in that she wanted to get rid of a growth between her legs. She also had a partial vagina and facial hair. Goffe examined her, and also asked her whether she wanted to be a man or a woman. She decidedly wanted the latter.

In March 1903, he operated on her at the Polyclinic Hospital (later called the Stuyvesant Polyclinic) in the presence of his class and some invited guests. He used the skin of the penis/enlarged clitoris to form the inside of the vagina. Three months later she returned and was very happy about the success of the operation.

Goffe describes the case: “The case of pseudo-hermaphroditism which I have to present is of special interest on account of the operative procedure which I instituted and performed, and which effectually eradicated all semblance of duality of sex and placed the young patient safely in the ranks of womankind, where she desired to be”. The editorial caption under the surgical photographs reads: “operation for removal of the penis and the utilization of the skin covering it for the formation of a vaginal canal”. E.C. also undertook treatment three times a week for removal of facial hair by electric depilation.  Goffe wrote up the case in the American Journal of Obstetrics and Diseases of Women and Children.

Goffe's describes the operation: "The skin adjacent to the vulva was so harsh and bristled so with hair that it was not available for filling in the lateral gaps in the mucous membrane of the vagina. The only apparent resource was to allow them to fill up by granulation, when suddenly the thought occurred to me, Why not use the skin covering the clitoris? This was soft and delicate and free from hair. It
was therefore decided upon." (p760 in Goffe, quoted p76 in Mak, 2005.  Mak comments: "As far as I know, this was the first case in which the skin of a clitoris/penis was used to construct a vagina.")

Apparently the editor of the journal altered the title of Goffe's paper to say “for removal of the penis”, despite Goffe referring to the organ as a clitoris throughout. Goffe’s comment “where she desired to be” caused controversy among surgeons and gynaecologists in that the consensus at the time was that only gonads truly define sex – a position that Goffe himself had set forth in his introduction, but to which he did not in fact adhere.

A few other doctors in the very early 20th century did as Goffe did, and considered the patients wishes in deciding what surgery to do (see Mak 2011) rather than insisting on gonadal determinism, but there does not seem to be any record of any other surgeon using the skin of the penis/clitoris until 50 years later.
  • J. Roddle Goffe. “A pseudohermaphrodite, in which the female characteristics predominated: Operation for removal of the penis and the utilization of the skin covering it for formation of a vaginal canal”. American Journal of Obstetrics and Diseases of Women and Children, 48:6, 1903: 755-763.
  • Geertje Mak. ‘ "So We Must Go Behind Even What the Microscope can Reveal". The Hermaphrodite’s “Self” in Medical Discourse at the Start of the Twentieth Century.’ GLQ A Journal of lesbian and Gay Studies, 1,1, January 2005: 66-7, 71-8, 80-4
  • Christina Matta. “Ambiguous Bodies and Deviant Sexualities: hermaphrodites, homosexuality, and surgery in the United Sattes, 1850-1904”. Biology and Medicine, 48,1, winter 2005: 75, 80-1.
  • Geertje Mak. Doubting Sex: Inscriptions, Bodies and Selves in Nineteenth-Century Hermaphrodite Case Histories. Manchester University Press, 2011: 176-82, 258-9n32.
  • Elizabeth Reis,. Bodies in Doubt: An American History of Intersex.: Johns Hopkins University Press, 2012: 78-80. .

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