Piet Hoebeke - Members Club: A Users guide to the PENIS

I dedicate this book to all my patients who have a penis
that differs from the norm, but who live
a life close to perfection.

You prove each and every day that it doesnt matter what
kind of penis you have. The most important thing
is how you live with it.

I admire you for that.

Contents

Writing this book was only possible thanks to the many patients Ive treated. Their stories allowed me to test my theoretical knowledge against reality and that usually means you have to revise the theory. It is thanks to them that I was able to tell it how it actually is in this book.

I would also like to thank the people who trained me and my many colleagues past and present they all helped form my insights.

My colleagues Bie Stockman, Charles Van Praet, Joz Motmans and Stefaan De Henauw provided me with specific feedback for this book.

Guy Bronselaer and Rik Pinxten read the entire manuscript with a critical eye and gave me valuable feedback.

My buddy-writer Tim Van der Mensbrugghe was able to work with me to get my insights written down in a way that completely suited me and in the language I speak.

Thank you to all my colleagues and friends, and of course my husband Roberto, who, on top of the many evenings spent away working, also took my absence due to writing this book in his stride and supported me throughout.

When I was younger, I actually wanted to be a vet. As a child, I dreamed of helping sick animals, but in the end I chose to train as a doctor. I found animals didnt have much to say.

During my first few years as a medical student, I never could have guessed that I would specialise in the urinary tract and genitalia. A body has so many fascinating organs and structures the penis didnt immediately stand out as the most interesting part. I knew I wanted to operate on people and that I wanted to be more than your average surgeon. Many surgeons work on behalf of a specialist and dont see the patients again after the surgery. An abdominal surgeon, for example, will often do a lot of treatment for diagnoses already made by the specialist gastroenterologist, and then not be involved with the patient again. That didnt appeal to me. I wanted to diagnose patients and then support them throughout their treatment, from start to finish.

Wanting to do something both surgical and diagnostic left me with relatively few options you either became a urologist (working on genitalia) or an otorhinolaryngologist (working on mouth, nose and ears). Urology fitted best with my ambitions. It was a wide-reaching field; it not only covered the penis, but also the kidneys and bladder. It even covered cancer.

Armed with much enthusiasm, but no definite career plan, I became a urologist in training at Ghent University Hospital. I followed my interests and by all kinds of chance occurrences, new worlds opened up to me.

In autumn 1992, the urology department at the hospital was going through a difficult time. I was still in training, but had operated on, or assisted in operations of, barely two hundred patients or so in a year. I felt I had far too little experience to become a specialist urologist, as the Programme Committee required. The then dean and chief physician at the University Hospital knew I was concerned. They advised me to do a year abroad. By the time you come back, well have sorted things out and you can continue your training position here, they promised.

I went to the Wilhelmina Childrens Hospital in Utrecht in the Netherlands and there I met a remarkable colleague in the paediatric urology department, Tom de Jong. He introduced me to the fascinating world of congenital disorders of the urinary tract and sex organs. This is what I specialised in. A year later, when I returned to Ghent, the dean and chief physician had kept their word a new department head, Wim Oosterlinck, had taken over the running of the department and things were far better organised. Wim immediately asked me to put paediatric urology on the map in Belgium.

A new wave of serendipity sent me in the direction of transgender patients people who feel like a man in the body of a woman, or vice versa. Or, from a urologists perspective, people who dont have a penis but want one, or vice versa.

Professor Guido Matton, a famous name in plastic surgery, was the first to perform the operation to turn a penis into a clitoris in a trans woman in Ghent in 1987. As chance would have it, I was on call, assisting in a prostate resection in a nearby theatre. I was suddenly called to help Professor Matton, who couldnt find the nerve leading to the tip of the penis. I showed the professor what he was looking for and he wouldnt let me leave. This is how, quite unexpectedly, I performed my first operation on a trans woman. Afterwards, the Professor said to me, Right, from now on, you can help me anytime.

I did transgender surgery from then on, and Ive been doing it for 25 years. For the first few years, I operated on trans women, but from 1996 onwards, my patients were mainly trans men biological women who wanted a male body.

Five years ago, I stopped doing these operations. Something had been bothering me about them for a while. Instead of sleeping, I would lie in bed worrying and didnt know why. During a holiday in Israel with my husband Roberto and our two best friends, overlooking the incredible view of the river valley in Beer Sheva, we chatted about my sleeplessness and my work. Suddenly, the pieces of the puzzle fitted together.

I treated trans people with heart and soul, but I was weighed down by the number of patients there were and, in particular, the complications which some of them were fighting with. I was a second victim , I realised. That is a typical phenomenon for doctors. It starts with trouble sleeping, and if you dont do anything about it, you start to get nightmares, lose your self-confidence and are overcome by severe startle responses. The next stage is burnout.

It was then that I knew I could no longer handle the complications. The patients coming to me were getting younger and younger, and the complications more and more painful. I made a decision: I would stop operating on trans people.

I stuck to that decision for a few years, until I felt I was free from my second victim problem. I have since started treating trans men again, albeit less than before and always together with two colleagues. That takes the pressure off my shoulders.

However, I continued to operate on biological men who, for one reason or another, were born without a penis or who had lost their penis in an accident. For these patients, we make a new penis, and that entails fewer complications than the genital reconstruction required in trans people.

There is also another kind of procedure that Im doing less and less, but for a very different reason than my psychological burden. In the course of my career, opinions have changed about some procedures and therefore so has the way in which I go about them. Im talking about children with both male and female sexual characteristics.

During my year in the Netherlands, I was not only fascinated by paediatric urology, but also by differences in sex development something we used to call intersexuality. This involves differences in the three levels of sex that someone has. First, there is genetic sex your DNA says whether you are a male or female. Then, there is gonadal sex you have testicles or ovaries. Finally, there is external sex a penis or vulva. The three levels of sex are usually the same in most people, but they can also vary in some people.