레포트 준비

젠더와 트랜스섹슈얼리즘

하지만 , 젠더 연구에서 사용되는 ‘ 젠더 ’ 라는 말이 그 기원에서부터 살펴보면 , 의료 관계자들의 동성애에 대한 편견과 성전환 기술의 발달 에서 시작되었음이 드러난다 . 트랜스섹슈얼리즘의 역사는 곧 젠더가 생산된 과정에 대한 역사이기도 하다 . ‘ 젠더 ’ 라는 용어는 1950년대 중반 존 모니 (John Money) 와 존스홉킨스 병원의 동료들의 트랜스섹슈얼 시술의 프로토콜에 처음 등장했다 . 자신이 동성애자가 될 것임을 부인하고 MTF(Man-to-Female) 시술을 했던 트랜스섹슈얼 아그네스(Agnes)의 사례를 계기로 외과의사와 임상의들은 ‘ 적절한 ’ 젠더 연행의 사회적 범주와 일치하는 경우에만 시술을 할 수 있도록 하는 동성애 혐오적인 치료 프로토콜을 작성했다 . 이로써 ‘ 젠더 ’ 는 내부의 성적 정체성에 상응하는 사회적 연행을 의미하는 의학적 담론으로 처음 소개되었다(Denzin 1990). 이 역사적 사실을 통해 주목해야 하는 것은 , 의학기술의 발달과 의료전문가의 지식 생산이 트랜스섹슈얼리즘을 가능하게 했고 , 그 필연적인 결과로 , 트랜스섹슈얼리즘의 기술이 섹스와 대비되는 ‘ 젠더 ’ 라는 단어의 현대적 사용을 가능하게 했다는 점이다 . 1970 년대 이르러 젠더는 페미니스트의 두 번째 물결을 통해 확산되고 앞에서 언급한 바처럼 젠더 연구자들에 의해서 훨씬 풍부한 의미를 갖게 되었다 . 이러한 역사적 사실은 , 섹스 - 양성자 - 기술 - 프로토콜 - 트랜스섹슈얼 - 병원 - 의학전문가 - 논문 - 페미니스트 - 미디어의 연합을 통해서 젠더가 섹스와 대비되는 현대의 용례에 이르게 되었다는 점을 말해준다 (Hubschman 1999; Meyerowitz 2002; Kane-Demaios & Bullough eds. 2006). ‘젠더’ 라는 용어의 용례가 구성되는 과정을 추적해 본다면 , 젠더의 구성에서 물질과 기술을 빼고 논의할 수 없다 . ‘ 젠더 ’ 의 역사는 젠더를 섹스로부터 분리시키려는 기획을 보여주는 동시에 그 한계를 보여준다 . 또한 젠더의 차이와 역동성이 더 이상 섹스의 ‘ 일반성 ’ 과 ‘ 선천성 ’ 과 대조될 수 없다는 점도 명확해 졌다.

(중략) 동성애 혐오적인 프로토콜을 만든 의료진 없이 ‘ 젠더 ’ 라는 말은 트랜스섹슈얼과 관련해서 존재할 수 없었다 . 여성주의 연구자들이 없었다면 ‘ 젠더 ’ 라는 말은 트랜스섹슈얼의 성정체성을 설명하는 용어로 활용될 수는 없었다 . 결국 , ‘ 젠더 ’ 는 전문가와 연구자의 발명품으로써 현대에 섹스를 연행하는 데 필요한 필수품으로 자리 잡게 되었음을 알 수 있다.

  • 피인용 문헌
    • Hubschman, Lynn (1999) Transsexuals: Life From Both Sides, Diane Publishing.
    • Meyerowitz, Joanne (2002) How Sex Changed: A History of Transsexuality in the United States, Cambridge, MS: Harvard Univ. Press.
    • Kane-Demios, J. and B. V. L. Ari (eds.) (2006) Crossing Sexual Boundaries: Transgender Journeys, Uncharted Paths, Amherst, N, Y: Prometheus Books.

수술실 스위트룸

  • Eric Plemons (2013), "The Surgical Suite", Journal of Medical Humanities, 34:245–247. DOI 10.1007/s10912-013-9227-7

The operating room is undoubtedly a place structured by routine. Methods, protocols, and procedures guide most everything that happens there. But despite the routinization and replication of costuming and other forms of depersonalization, the operating room is also animated by people who do more than merely occupy the roles of doctors, nurses and patients. The controversial and transformative nature of FFS makes its enactment a site in which the commitments and beliefs of individuals are made quite clear. Forms of relations and thoughts about what gender is and how it gets (re)made, create a dynamic interplay between the body on the table, the actors in the room and the technologies that mediate between them. Routine as it may be, FFS is always a deeply transformative procedure that enables conversations and reflections on what that transformation is about, what it does, and what it cannot do. In these moments, the OR can be both a forum for the reinscription of essentialist narratives of embodiment and a site for radical challenges to them, a space for transformations of many kinds.

성전환 수술에서 생식기 형태와 기능

  • Eric Plemons, "It Is As It Does: Genital Form and Function in Sex Reassignment Surgery", Journal of Medical Humanities, 2014 Mar;35(1):37-55. doi: 10.1007/s10912-013-9267-z.

Surgical literature about sex reassignment surgeries (SRS)3 defines surgical goals and evaluates outcomes in terms of two kinds of results: aesthetic and functional. This division of form and function as two distinct but related modes of apprehending the body is certainly not unique to sex reassignment surgeries, but its constitution in this case is a particularly fraught one. Since the neogenitals fashioned through sex reassignment surgeries do not enable reproductive function, surgeons must determine what the function of the genitals is or ought to be. When the genitals—the word itself derived from the Latin genitas meaning to beget—are not reproductive, the question of their function shifts away from the biological and into other registers: pleasure, intimacy, sociality.

Penetrative intercourse is presented in these texts as the self-evident constitution of natural sexual activity. As such, the function of the neovagina is in its ability to accommodate intercourse. It does so by having an unobstructed and elastic opening, being of “adequate size” and by being at least moist, but ideally self-lubricating. The quality of self-lubrication is sometimes enabled by transplanting tissue from the rectosigmoid colon to line the vaginal canal. This tissue is desirable because it provides added length and self-lubricating properties to the neovagina. Added length is considered an advantage (Karim, et al., 1996), though I have found no explicit discussion of why a deeper vagina is particularly advantageous or desirable. Here, one recalls the “stud” factor (Shimizu 2007, 179) that may be invoked in a vagina that is able to—and in fact built to—accommodate penetration by an unusually large phallus.

The neovagina’s activity is passive: it accommodates and must make room for an imagined phallus, the dimensions of which constitute the neovagina’s recommended size (its “depth should be at least 10 cm and its diameter should be 30 mm” (Karim 1996)). The space of the vaginal cavity (or “vaginal vault”) is typically kept open after surgery through the use of a medical dilator. Rather than using a dilator, Karim et al., “advise applying a dildo for only 15 min a day” (1996, 671). Defined in medical terms as “An object that is shaped like and is used as a substitute for an erect penis” (American Heritage Stedman’s Medical Dictionary 1995), the dildo anticipates the penis for which it stands as a substitute. Echoing Freud’s assertion that, “The value of the vagina is that it functions as an abode for the penis,” (Rocah 2010, 131) Irigaray described the vagina as, “The negative, the underside, the reverse of the only visible and morphologically designatable organ… the penis” (1985:26). In these surgical texts, the “adequacy” of the vagina is figured in these terms, as the reverse of and ultimate place for a penis (cf. Braun and Wilkinson 2001, 19–21).

The sexual function of the neophallus is defined by its ability to “obtain rigidity sufficient for penetration.” Being able to have “normal sexual intercourse with penetration” (Monstrey et al., 2009, 516) is what constitutes, “Being able to have sexual intercourse like a natural male” (Fang, et al., 1999, 271). The achievement of rigidity in the neophallus has proven exceedingly difficult.
Microsurgical techniques are used to connect nerves from grafted tissue onto the ilioinguinal nerve, thus allowing what surgeons take to be analogous forms of sensation. This is a topography of pleasure—a mappable means of measuring sensation that is named by its location and nerve pathway. Efforts to produce this sensation demonstrate that in addition to producing properly gendered men and women through public and private interaction, the nonreproductive genitals must also produce proper forms of gendered pleasure.

  • 피인용 문헌

성전환 처방으로서의 성차 기술: 안면 여성화 수술에 관하여

  • Eric Plemons (2014) "Description of sex difference as prescription for sex change: On the origins of facial feminization surgery", Social Studies of Science 2014, Vol. 44(5) 657­–679, DOI: 10.1177/0306312714531349

The patient request that would lead to the development of FFS came in 1982, when plastic surgeon Dr Darrell Pratt 2 approached Dr Douglas Ousterhout as a colleague asking for a favor. Candice, a male-to-female transsexual patient on whom Pratt had successfully performed genital sex reassignment surgery (GSRS), had returned to the clinic some months later with a new surgical request. Although GSRS had changed her sex both genitally and in profoundly personal ways, it had made exactly no impact on how others perceived her sex in everyday social life. The fact of her new female genitalia – the bodily site of sex difference whose transformation is often considered to instantiate, if not to define ‘sex change’ – was secreted away behind the bounds of propriety in social life. But people did see her face. It was clear to Candice that her face was the problem. She had a man’s face and no amount of make-up or decoration could hide it. She wondered whether anything could be done.

Rather than refusing Candice’s request on account of this uncertainty, Ousterhout set about trying to determine what constituted ‘masculine’ and ‘feminine’ as craniofacial categories. His research, as he explained it to me from behind the large desk in his personal office, involved three main steps. First, he consulted literature from early 20th century physical anthropology in order to identify sites in the facial skeleton that physical and forensic anthropologists had used to characterize sex differences in dry skulls. Second, he took those sites of differentiation and quantified them by applying a set of measurements derived from a longitudinal orthodontic cephalogram study. Finally, he used these newly acquired skills of distinction to evaluate a dry skull collection, with the aim of cultivating a new way of viewing skulls as distinctly sexed objects. He understood this proposed intervention as working within the logic of the larger transsexual surgical project: transsexual surgical interventions are intended to enact a change of sex. Thus, his research did not question whether there are significant sex differences in the facial skull, but rather what those differences were and how they could be surgically (re)constructed. In other words, he wanted to know how to clinically understand the maleness that he and others already recognized in Candice’s face and how to change it.

Physical anthropologists and forensic pathologists are concerned with the identification and separation of skulls by sex. Prior to the computer and discriminant function analysis, these scientists primarily used three skeletal characteristics to separate the male from the female skull: the chin, the nose, and the forehead. (Ousterhout, 1987: 701)

According to the patients and surgeons with whom I worked, interpreting FFS as a cosmetic procedure leads to misunderstanding of its aim and efficacy. Rather than pro- ducing a change in degree – from less beautiful to more beautiful or from old to young – FFS effects a change in kind by reflecting the fundamental form of males and females whose distinctiveness as natural kinds is measurable and observable through the ostensi- bly objective and value-neutral methods of biology and anatomy.

Because faces are not easily recognized as sexually dimorphic in the way that genitals often are, framing facial reconstruction as a sex-changing procedure requires rhetorical labor. Ousterhout’s turn to ‘science’ and ‘numbers’ is an important means through which this work is done. By stabilizing male and female faces as anatomically distinct, rather than subjectively distinguishable, Ousterhout is able to frame his FFS operations as oriented to the same kind of ‘normal’ outcomes that guide his other reconstructive procedures. Preoperatively, his patients are normally male – a reality to which their expe- riences of social exclusion can often quite painfully attest – and postoperatively they will be normally female. This understanding of what FFS aims to do is set in explicit contrast to the frequent interpretation that it is simply a trans-specific variation on cosmetic sur- gery. Such a framing not only threatens the therapeutic and medical legitimacy of FFS as a sex-changing intervention, it also paints FFS surgeons undesirably as peddlers of a misogynist myth of feminine perfection (Talley, 2011).

According to the patients and surgeons with whom I worked, interpreting FFS as a cosmetic procedure leads to misunderstanding of its aim and efficacy. Rather than pro- ducing a change in degree – from less beautiful to more beautiful or from old to young – FFS effects a change in kind by reflecting the fundamental form of males and females whose distinctiveness as natural kinds is measurable and observable through the ostensi- bly objective and value-neutral methods of biology and anatomy.

Ousterhout’s ‘female face’, rendering equal as it does the feminine type with the female mean, is a kind of ‘factish’ (Latour, 2010), one that holds within it a complex his- tory in which the epistemologically mired claims to the bony skeleton as the form of social difference and the fetish of racialized and gendered beauty cannot be separated, in which forms of knowledge and value about the real body commingle and coproduce. Tracing the means by which ‘the female face’ emerged as an object that could ground the growing practice of FFS, we can consider these medico-surgical interventions into the gendered, and more specifically, the trans- body, as problems of historically specific forms of knowing and intervening. Deriving power and legitimacy by insisting on the objectivity of science in naming a distinctively female form, the origins of FFS were guided as much by a desire to meet a burden for medical practice as they were by the goal of making patients recognizable to themselves and others as women.

해부학적 권위: 성전환 수술 환자의 경험론적 배제에 관하여

  • Eric Plemons (2015) "Anatomical Authorities: On the Epistemological Exclusion of Trans- Surgical Patients", Medical Anthropology, 34:5, 425-441, DOI: 10.1080/01459740.2015.1036264

For Blank, a photographic collection demonstrating the variation of vulvas was a critical part of the movement to reclaim female genital anatomy and assert feminist authority over its rep- resentation. In the introduction to the first edition of Femalia, Blank lamented that “outside of ‘men’s magazines’ where the women’s genitals were often powdered and half-hidden, and the images often modified and airbrushed, women had no resource for photographic representations of vulvas” (1993:n.p.). The effect of this absence of representation, according to Blank, was that “a majority of women believe to this day that, in one way or another, their genitals are not quite ‘normal’” (n.p.). This claim illustrates an important strategy of the US feminist health movement that Nancy Tuana has called “the epistemology of ignorance” (2004, 2006). For Tuana, claims to what people do not know—in this case that their genitals are normal—should be “understood as a practice with supporting social causes as complex as those involved in knowledge prac- tices” (2004:195). Resources such as Femalia were meant to respond to a type of ignorance that feminist activists saw as deliberately produced by medical doctors whose claim to expertise was produced, in part through the exclusion and devaluation of women’s experience of their own bodies. Feminist health activists leveraged embodied experience as an important source of female anatomical knowledge, but such epistemological grounding is by definition unavailable to those who occupy other kinds of bodies.

Michelle Murphy describes the subject of the feminist health movement as an ‘immodest witness’ whose claim to knowledge derived explicitly from her particular and embodied experience. Photographs and illustrations presented in move- ment literature were set in living rooms rather than medical examination suites, and included the faces of the women whose genitals were being pictured. This kind of representational specificity located authoritative knowledge about female bodies in those who inhabited those bodies, rather than those who studied them. Grassroots promotion of women’s self-knowledge was an explicit challenge to biomedical authority.

When Wilson compared the most favored photographs to those that were selected less fre- quently, the most salient differences he saw were based on the size of various features. Reflecting the trend that drives a considerable amount of FGCS, his patients indicated ‘small’ and ‘relatively delicate’ characteristics as those “they would ideally choose for themselves.” Noting the prefer- ence for small and thin labia across many groups of women, Blank was not surprised to see which of the photographs had received the highest praise. “I’m sure that trans- women are not going to start to ask for big puffy fleshy vulvas. It’s sort of more demure to have them not be that way,” she said. The relation between ‘natural’ and ‘ideal’ that haunts so much elective surgery and blurs the line between enhancement and cure is here mapped onto the gendering of anatomical forms.

Although the project of Femalia was to disrupt idealized images of female genitalia by demon- strating (a limited range of) variation as itself the norm (cf. Canguilhem 1991), in Wilson’s practice the book had been put to very different use. Rather than opening space for variety as other surgeons are rumored to have done (Blank 2011), Wilson used the book to help locate an ideal.

For him, their expectations not only reflected the kinds of ignorance to surgical capacities common to most non-surgeons, but a more basic problem that trans- women do not know how vulvas really look and therefore do not know what to want or expect. Like other women who seek surgery to change the appearance of their genitalia, trans- women’s expo- sure to genital esthetics most often comes from pornography curated for the sexual consumption of straight men. But unlike women who have had the embodied experience of their own vulvas for their entire lives and who are therefore imagined to come to terms with their own normalcy through viewing resources like Femalia, trans- women view such resources only as objects of desire and aspiration. Especially when their surgeon asks them to do so.

When Wilson handed his patients Femalia and asked them to sign their names next to the vul- vas “they would ideally choose for themselves,” he placed them awkwardly between two forms of knowledge from which they are differently excluded. Neither a modest witness with the biomedical authority he wielded, nor an immodest one with authority derived from the embod- ied experience of living with female genitals, the trans- woman patient was asked to negotiate between them. She could indicate her ideal, not shop for an outcome. Although Wilson responded to his patients’ most popular choices by attempting to shift technical priorities that reflected their preferences, he did so on the understanding that his patients’ signatures were ultimately indicative of their ‘impossible standards.’ To him, patients’ ‘ideal’ and ‘impossible’ expectations attested to their fundamental misunderstanding of what surgery could do. In this way, Femalia was used both to ground a claim to the natural body, and to subvert trans- patients’ authority to speak to it as a form of their own surgical future. Patients’ affirmations of desire for particular forms were seen to indicate that they did not understand surgical capacities and so could not formulate expectations outside of a fantastical ideal.

Because the success of GSRS is measured by ‘patient satisfaction,’ the efficacy of surgery depends on patients cultivating expectations of their surgical outcome that reflect the individ- ual capacity of the surgeon who will operate on them. Patients may only ‘realistically expect’ what their surgeon can realistically do. Surgeons can sometimes identify a patient’s inability to formulate realistic expectations before surgery, but sometimes it is not clear that a patient has ‘impossible standards’ until after the surgery has been performed. Such a designation may emerge when a surgeon feels that a procedure went well but the patient disagrees. In the matter of postoperative assessments, patients’ opinions and subjective evaluations are often dismissed when they contrast with the surgeon’s definition of success, with outcomes studies elaborating on patients who were ‘satisfied’ by surgery, and noting but declining to expand on those who were not. Patients who complain or request revisions that the surgeon feels are ‘unreasonable’ are frequently recognized as ‘problem patients;’ fault is found with the patient herself rather than with the surgeon or procedure (Lorber 1975; Werner and Malterud 2003; Wright and Morgan 1990). Calling up a characterization of trans- women as paranoid and incapable of understanding the realities of womanhood into which they are newly thrust, identifying trans- women as having ‘impossible standards’ ensures that it is unhappy patients rather than wanting surgical technique that absorb (and constitute) the gap between the ‘natural’ and its surgical approximation.

In addition to the question of who has the authority and credibility to comment on the technical aspects of surgery, the epistemological exclusion that occurred in Wilson’s office was based on the claim that trans- women cannot formulate realistic expectations of surgery because they can- not know what real female genitals look like. Denied legitimizing epistemological positions of the ‘modest witness’ whose disinterested gaze is a fundamental precept of biomedicine (and upon which the surgeons’ claims to authoritative pre- and postsurgical assessments are based), and the ‘immodest witness’ whose feminist claims to embodied and experiential knowledge have allowed Femalia to travel from activist literature to a medically endorsed representation of ‘real’ bodies, trans- women patients could not know; they could only desire. Enacting a desire whose form and content have been marked by the historical and institutional stigma of psychosocial pathology, trans- patients are often cast as lacking both epistemological and moral grounds to meaningfully contribute to the regimes of care they seek.

여성성의 형성: 안면 여성화 수술의 과학과 미학

  • Eric Plemons (2017) "Formations of Femininity: Science and Aesthetics in Facial Feminization Surgery", Medical Anthropology, 36:7, 629-641, DOI: 10.1080/01459740.2017.1298593

Beck’s work with trans- patients began in 2005 not as a response to a patient request or as the result of his personal interest, but as a strategy for financial success. This attests to the massive changes in American trans- medicine since the early 1990s. No longer a marginal or derided specialty, Beck saw his work with trans- patients as a smart business decision for a surgeon otherwise competing in the mainstream cosmetic surgery market. He grew his business, in part, by casting his approach to FFS in competition with Ousterhout. Beck’s difference of approach did not stem from a definition of the normal female that contrasted the one that Ousterhout originally established. Instead, he disagreed with the idea that creating “normal” females ought to be the goal of FFS at all.

Beck saw his trans- patients’ desire to appear more feminine as one that was shared by virtually all of the women who visited his office. He did not identify his FFS patients as people with distinctly male faces; instead, he saw them as women who were unfortunately unattractive in a predictable set of ways that could be improved through particular bone and soft tissue procedures, electrolysis, and skin care regimens. Divorced from an historical discourse of pathologized transsexualism (and its many sequelae 5 ) in which gendered identity and sexed anatomy existed in mismatched binary pairs, for Beck, FFS was simply a means to the kind of self-optimization and aspirational beauty that all of his patients sought. For his non-trans- patients, surgical optimization was called beautification; for his trans- patients, it was called feminization. The collapse of this distinction is what helped Beck to frame his surgical approach the way he did.

Although Beck and Ousterhout ostensibly shared a common aim for FFS—that patients who had been recognized as problematically masculine before surgery would be recognized as unproblematically feminine after—their different surgical orientations and the different moments in which they began offering trans- specific procedures meant that they understood and materialized “woman” in their patients’ faces in distinct ways.