This post is based on a piece Lissa wrote in her capacity as the OB/GYN On Call at Betty Confidential earlier this month. Enjoy, Pinkies, and weigh in with your thoughts!



Word on the street is that Chastity Bono, the daughter of Cher and Sonny Bono, is getting a sex change so she can become Chaz. News like this makes big headlines - some might say it’s shocking, even.

And yet, if you truly understand what it means to be transgender, it wouldn’t shock you.

As an open-hearted OB/GYN physician, I have cared for many in the transgender community, both before and after surgery. In fact, one of my patients, Shania, who was genetically male but post-sex change, came to me for pap smears.

Shania used to be Shane. For many years, she wore the wrong hat. When her brothers expected her to play with Star Wars paraphernalia, she preferred dressing up like Sandy from Grease and belting “Summer Nights” in a poodle skirt. In junior high, when the Sadie Hawkin’s dance rolled around, she wanted to invite Donny, but her brother told her it was girl’s choice, and she was a boy. Plus, why the hell would she want to invite another boy anyway? Secretly, when she was home alone, she stripped off her button down shirts and thick leather belts and khaki paints and dressed up in her mother’s panties and high heels. Only then did she feel like herself.

Not until she moved to the big city did she discover she was not alone. Others who looked like men felt like women on the inside. Some even had surgery to rectify the error in nature, which kept them from feeling authentic and whole. Shane saw a doctor right away and began saving up her pennies. Five years and tens of thousands of dollars later, Shane became Shania, inside and out.

Every year, on the dot, Shania took time off from her job and showed up at my office for a pap smear. I prescribed Shania’s estrogen therapy, which helped her look and feel more feminine, but that’s not why she came to see me. Every year, she requested a pelvic examination. The first time, I found myself dumbstruck. I read her chart, which said, “Genetic Male- XY chromosomes.” I’m a gynecologist- I don’t do men- so I had no idea why this patient was scheduled to see me. I asked flat out, and Shania said, “Dr. Rankin, I’m here for my pap smear. It’s been a year.”

I flipped through her chart and, sure enough, I found a pap smear report from exactly one year ago, to the date. I read last year’s pap smear. The pathologist reported, “No endocervical or ectocervical cells detected. No pathologic findings.” In other words, there was no cervix to pap, so no cervical cancer was detected.

I had no problem with taking care of a transsexual, but why would she want to waste her money on a pap smear when she didn’t have a cervix and couldn’t get cervical cancer? I said, “Shania, you don’t need a pap smear. You don’t have a cervix.”

She said, “I know, but I want it anyway. That’s what we women do.”

After I had done her pap smear for the third year, I couldn’t contain my curiosity, so I asked Shania how it felt to come to the gynecologist’s office, to get a pap smear?

She told me that every time she walked into my office, she saw other women sitting around the waiting room, reading magazines, holding babies, putting on lipstick. She saw the women behind our front desk, laughing and whispering to each other and talking about their weekends. She saw my art, filled with imagery of vaginas and eggs and giving birth. And I see all the women, pregnant and breastfeeding and doing lady things.

Shania went on. “I see life and camaraderie and beauty.” She closed her eyes and sighed. “I know I will never give birth or breast-feed or be quite like the other women in your waiting room, and these doubts about who I am haunt me sometimes. I wonder whether I am really a woman or whether I am only pretending to be. I think maybe everyone else can see right through me, and that they’re laughing, at work, at the mall, in the grocery store. Maybe they know I was born a man. Maybe they think that defines me. I get very sad, because inside, I know I am a woman. I always have been. I try to say, ‘To hell with the rest of them,’ but deep down, it still hurts. So I get unsteady sometimes, wondering.” A tear smeared mascara down her cheek, and she opened her eyes and looked right at me.

“Then I come here, to see my gynecologist, and I get a pap smear, just like all the other women of the world.” She reached out and held my hand. “And that makes me feel like I’m really a woman.” She smiled a crooked grin. “No man would be caught dead in a gynecologist’s stirrups.”

I learned so much from Shania’s Yoni. Which hat or tuxedo or white coat or evening gown we wear does not define us, not really. Shania’s body revealed a woman, who was really a man, who was authentically a woman on the inside. Appearances can be deceiving.

If Chastity Bono undergoes the types of procedures that are typical for those having gender reassignment surgery, she will likely undergo multiple surgeries to change her body into one that appears male, including genital reconstruction to create a penis, removing her breasts via mastectomy and removing her ovaries to reduce her body’s circulating estrogen levels. Genital reconstruction for transmen (female-to-male) requires fusing the labia to form a scrotum and inserting prosthetic testicles. Skin grafts are then used to create a neo-penis, and an erectile prosthesis or other implant can then be inserted to give the penis its rigidity. Sensation is maintained via the clitoris, and the urethra is reconstructed so urination occurs via the penis. Hormone replacement with testosterone helps change the physical appearance into a more male body. This way, transmen can urinate, enjoy sexual intercourse and feel comfortable in the skin they’re in. And don’t we all want that?

Shania made me rethink the old adage I often quoted to my patients considering plastic surgery. I always said, “Learn to live in your own skin” and discouraged them from changing their bodies. But what if your skin betrays you? It’s easy for me to quote cliché’s, since, aside from the post-pregnancy muffin-top hanging over my low-rider jeans, I look on the outside the way I feel on the inside. But what if there’s a massive discrepancy? What if how you look fails to merge with your inner identity? How many people can get past the exterior to see the real you? Mostly, I learned how very much I don’t know.

From Shania’s Yoni, I learned that it’s possible to clear away a pathway that allows your true identity to express itself to the world. Like clearing away the rocks that damn up a river and stop the flow of water, unveiling a mask and removing your hats can open the path for the free flow of self. With all the barriers removed, your heart can shine through, like a beacon, shedding light all around you.

I find that most people who are repulsed by the idea of sex change simply don’t understand it. What does it mean to get a sex change? Most individuals undergoing what we call “gender reassignment surgery” experience “gender identity disorders” or “gender dysphoria,” meaning that they don’t identify with their genetic gender. Chances are that Chastity Bono feels male, even though she was born into a female body. Gender reassignment surgery seeks to help these individuals inhabit a body that better fits their sense of self.

It’s easy for those of us who were fortunate to be born into the right gender skin to judge those who aren’t. But I admire you, Chaz. What you’re doing takes courage - and BALLS! It’s a struggle for most of us to learn to Own Our Bodies. But imagine how hard it is when you look in the mirror and see the wrong gender. Let’s send love and blessings to Chaz Bono as she faces this difficult, painful and life-changing decision. She doesn’t need our judgments. She needs our support, as we would want if we were in her transgender shoes. I feel grateful that I love being female, but I feel for those who don’t. I’m a big fan of living authentically and if it takes gender reassignment surgery to let your essential self shine through, I say more power to you.

Tell me what you think, Pinkies. Has Chaz lost it, or is he simply doing what he needs to do to get his Mojo back? How would you feel if it was you- or your child? Do tell…