The Future of Sex Is Non-binary Genital Surgery That Advances Bodily Agency
Transgender medical advancements permit a tertium quid – a third option for genital surgery
Gender confirmation surgery that sculpts functional vaginas and penises for trans people is fairly well-known, but ongoing medical advancements now permit new options.
Some trans people are opting for genital reconstruction that does not match the gender binary.
Tertium Quid – A third option
If there are such things as mainstream gender confirmation surgeries, they would be the vaginoplasty and phalloplasty, which construct working vaginas and penises for transgender people.
These surgeries are performed by multidisciplinary teams that combine the expertise of urology, gynecology and cosmetic surgery to create sexually functional organs. As the pool of expertise for gender confirmation surgery grows, newer surgical options like uterine transplants are being explored. These advances are also paving the way for non-binary gender confirmation surgeries – a proverbial third option beyond the vagina/penis dichotomy.
Non-binary gender confirmation surgeries are relatively uncommon, and many are pioneer procedures. They offer a solution for people who feel that aligning their body to cisgender norms is inadequate. This includes intersex people who do not wish to erase their intersex characteristics by conforming to the norm.
Transcending gender norms
Non-binary gender confirmation surgeries can include modifications to existing binary procedures. Such modifications can be personal twists on existing procedures – even those frequently performed on cisgender people.
Examples include (but aren’t limited to) vulvoplasties, orchiectomies, and nipple excisions.
Vulvoplasty is a procedure which constructs an external vulva identical to a cisgender vulva, but does not create a vaginal canal. This procedure is sought out by those who want the appearance of a vulva without a vaginal canal. It is also an option for high-risk patients who cannot safely undergo a standard vaginoplasty.
Orchiectomies remove one or both testes, and are primarily chosen by trans people who wish to retain a penis, but eliminate their natural fertility and testosterone production. They can also be undertaken in preparation for a full vaginoplasty.
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Nipple excisions remove the nipples and are often performed on cisgender patients as part of double mastectomies. Some trans people undergoing a double-mastectomy also opt for nipple removal as a cosmetic option, leaving an essentially ‘bare’ chest.
These are only a few examples of non-binary surgeries that can modify people’s bodily functions and aesthetics to match their desires. In fact, some of these procedures are not substantially more complex than ‘conventional’ procedures. The vulvoplasty is safer and simpler than a full vaginoplasty, and a nipple excision can be performed as part of a mastectomy with only slightly more risk. However, these are far from the most complex procedures.
‘Salmacians’ and mixed genital surgeries
A small group of altersex/transgender people have taken on the identity of salmacian, from the Greek myth of Salmacis and Hermaphroditus. The salmacian identity is mainly characterized by the desire to have both masculine and feminine genitalia. Advances in the knowledge and willingness to perform transgender surgery has allowed salmacians to realize their dream bodies.
Salmacians include people who were assigned to binary genders (men, women) at birth, and intersex people. Irrespective of their origins, they typically want to preserve their birth genitals while adding opposite-sex genitalia.
The most common types of salmacian surgery are a phallus-preserving vaginoplasty and vagina-preserving phalloplasty. As their names imply, they preserve a patient’s birth genitals while creating a new set of the opposite sex. These surgeries are more customized to each patient’s anatomy than typical genital surgeries, due to the large surface area affected. As with other bottom surgeries, patients can request specifics like the presence and shape of external labia, penis size, and vaginal depth.
Although these surgeries are profoundly expensive and can bear significant complications, they are still pursued by the people who want them. The willingness to embark on such complex surgery is testament to the extraordinary desire for bodily harmony that trans people of all kinds experience.
Present and future of surgical options
Non-binary surgeries are the result of extraordinary advances in surgical augmentation. Binary vaginoplasties and phalloplasties have been cornerstones of reconstructive surgery and transgender surgery for decades. It stands to reason that non-binary patients would demand fittingly non-binary alternatives.
Advances in non-binary surgery also extend to cisgender people, as they greatly improve surgeon expertise. This benefits the most common recipients of vaginoplasties and phalloplasties: cisgender people seeking cosmetic alterations or reconstruction. The pioneering patients and surgeons of non-binary surgery are living proof that medical knowledge is not a closed fortress, but a cycle of learning that benefits everyone.
