History was made earlier this year at MetroHealth in Cleveland when their first ever vaginoplasty was performed.
Research has shown that this procedure used to construct a vagina can be as gender-affirming as it is life-saving for individuals who choose to go that path.
To learn more, The Buckeye Flame spoke with Ginger Marshall, the first patient at MetroHealth to undergo a vaginoplasty surgery, and Dr. Kirthishri Mishra, the reconstructive urologist who performed the procedure. Click play directly below to listen to our interview or read our edited conversation underneath.
Ginger, start us off by telling us where you grew up.
Ginger: I grew up in Mentor when I was little and then we moved to Painesville in the fifth grade.
I know you had quite the journey growing up first identifying as gay before you were able to put words to trans. How would you describe growing up LGBTQ+ in Ohio?
It was kind of weird because there was no context living in white suburban Painesville. It was kind of scary. I remember at eight-years-old seeing Kurt Russell on “The Wonderful world of Disney.” He was 17 or 18 and the most beautiful thing I had ever seen. And I couldn’t tell anybody, because if I told anybody, I knew that I was not going to be accepted.
And so you waited until a bit later in life for that coming out journey?
Ginger: Yeah. I mean, I did things with guys. I actually identified more in the pansexual, bisexual area. So I had some girlfriends but I did a lot of things with guys when I joined the Navy and was in San Diego. I really explored but I didn’t really get into it until I was in my forties and was finally at a point where I could be more honest with myself. That’s when I started coming out as gay, and then had really discovered trans [identity].
Do I get a medal for resisting any and all Navy jokes?
Ginger: [Laughs] Yes. Yes. Yes.
So with your trans journey, what are the milestones that you often tell people about? What were those significant touchpoints for you as you incorporated trans into your identity?
Ginger: [It was] the first few times where I was able to start going out more as myself. At the time, I was in a relationship with a trans guy. And that meant that I had some safe community there. Then I kind of went back in the closet for a little while. I knew what was going on, but I stopped expressing it until we actually moved to Cleveland. And Cleveland is a really queer place and there was safety here. So I was able to start coming out.
Milestones: Telling my wife where I was. She knew. But she didn’t know.
And telling my doctor. I decided that, “Okay, I need to do something rather than continuing my plans to buy life insurance and wait the two years and all that kind of stuff to kill myself.” I didn’t want to leave my wife stranded. And so that’s when I began talking to my doctor. And that was [Dr.] Henry Ng. At the time he was at Metrohealth.
I remember him looking slightly shocked. And the reason was because he had not had a trans person my age come out to him. And so I got to be kind of a trailblazer there.
The next big [milestone] was when I came out at work. I was out everywhere else. And I had a policy that once I went someplace as Ginger, they never saw the old person again.
My only exception to that was the doctor’s office because sometimes I could go during the work day when I had to present more male, and sometimes I would go after work when I was presenting female. So coming out at work was a big deal.
The boss had been out of town. I wrote an email that I agonized over. Oh my god, Ken, I spent so many hours on this email editing and re-editing and re-reading. And I sent it. When she was back in her office, she heard me come in the back door. And she yelled a couple of questions down the hallway about stuff with classes at the school where I worked. And it was like business as usual.
I went up the hall, and I kind of looked around the corner, and I said, “Did you get my email?” And she said, “Oh, yeah, that. When do you want to transition? Are you going to tell your students or do you want me to?” I was expecting some big deal. And it was a fantastically supportive experience.
Our readers know that gender identity is a way that individuals can conceptualize themselves and, although it may correspond to gender presentation, not everyone pursues medical routes. Can you talk a little bit about that point where you decided, “Okay, I would like to speak to some experts, some medical providers about my gender expression”?
Ginger: That was with Dr. Ng and he had experience working with trans people. We talked and did lab work. My wife was struggling a little bit with the change. So I just kind of put things on hold for a little while.
And about six months later, I talked to Dr. Ng again. And then a few months after that, I signed the consent forms and started the hormones. I knew where I was and who I was. At six years old I knew that I wanted to be a mom. And I couldn’t be one. That was devastating to me.
Bring us into the present. You have pursued a route that not everyone has done. In fact, one could argue that, in this surgical sphere, you are the first. Tell everybody about that decision.
I met Dr. Mishra on the phone. I knew he was coming to MetroHealth to start a program. And I’m the admin coordinator here at the hospital for the Pride Network and was working with him. But then I went to see him as a patient. By this point I was very comfortable with what the procedures were and how it would be handled. And he agreed that, yes, I would be a candidate. We talked about things like my diabetes and that it needed to be under control. And where my weight was because that has a major impact on healing of the area. I also needed to get clearance letters so I had to seek out some therapists.
And then, February 27th of this year, I became the test pancake. You know, that first pancake that maybe goes on a plate, maybe slides off under the sink into the trash. Apparently I went on a plate because the next thing I knew I was covered with maple syrup and butter. Metaphorically speaking. [laughs]
Dr. Mishra, let’s, let’s bring you into this part. First of all, I have to imagine that “test pancake” is not the way that you refer to Ginger.
Dr. Mishra: [laughs] Definitely not. First of all, I really want to thank you for taking the opportunity to feature Ginger’s story. I think her story is unique in a way that is specific to her, but a lot of the different aspects of it are actually true for many of my patients, whether it be the early part of navigating to find out who they are and how they want to go through this whole process or the challenges within their society, within their family. So I’m incredibly proud of Ginger for being courageous enough to share her story. She’s just a tremendous advocate for our community and the transgender community overall.
How do you explain a procedure like this to those maybe who don’t even have familiarity with the trans community or who have a limited medical knowledge?
Dr. Mishra: Actually [that lack of knowledge] is not uncommon. A lot of the patients who are coming to see me often are just learning about their identity as well as what can be done about it.
A lot of times when the patients are coming to see me, their complaint may just be, “This is not my body.” Let’s say they are born natal male, but they identify as a female. They just feel like, “Whatever’s down below is just not who I perceive myself as.” My job as a surgeon is to align their physical aesthetics to how they feel mentally and as a person.
What I tell them is that I will help them through this whole process in every way that I can, including from an emotional perspective. Our team is amazing at doing that.
I can’t believe I even need to ask this question, but just to dispel some of the propaganda that is often put out there about the trans community: Is it possible for someone to wake up one day, go and see you and have the surgery by the end of the day?
Dr. Mishra: No. No, we would not do that kind of disservice to anybody.
The process of going and pursuing surgery is very strict and we follow those guidelines very strictly. WPATH, the World Transgender Health Organization, has very strict guidelines that we abide by, which includes the fact that the person needs to be on hormones at least for a year. They need to live in the identified gender role for a year. They need to have letters of endorsement from licensed providers who vouch that they’re in a good space – mentally, emotionally, socially – where they would be able to undergo a major surgery like this and thrive afterwards.
Ginger, can you talk to us about the day before and the day after? How were you feeling the day before this procedure and how were you feeling after?
Ginger: The day before surgery was a Sunday. I was kind of mellow. I had started some of the dietary stuff. I spent some time with friends Saturday night. We had dinner, and then Sunday was kind of mellow. I talked to a few people, made sure that my stuff was packed to go to the hospital.
Monday was kind of a blur because I was kind of stressy. And then there were drugs. Lots of drugs. So I don’t remember a lot of that.
The day after, the pain was nowhere near what I expected. And I had a heavy surgical compression dressing down there and a wound vac that uses a vacuum to encourage healing. And then a catheter. So basically I had this lump in my pelvic region. It hurt to sit. Standing up was okay.
The most fantastically wonderful thing that happened was when I stood up and my wife completely washed me head-to-toe and then dried me and lotioned me. And it was like I had died and gone to heaven.
The next couple of days, I just kind of floated through: getting up and getting around and getting more comfortable with that. Friday morning, a whole herd of residents came in and began removing all of the tape. They took a picture for me because I was still too sore to try to sit up and look. I looked at the picture and it was like, “Oh my God, that’s what it should look like. That’s what I should look like.”
Getting home was, of course, painful and uncomfortable. And then I had an appointment with the other surgeon, Dr. Vargas. And she said, “You’re well healed, you can look.”
And so the next day I used my mirror and I looked and it was like, “That’s me.” It was one of the best moments I’ve ever had in my life.
Seven months later, I’m ecstatically happy.
To close out, I’ll ask you both a version of the same question. Doctor, let’s start with you. Talk about the significance of this procedure for the entire community.
Dr. Mishra: That’s the biggest reason why we do this. The rate of suicide in the U.S. amongst the adult population is about 4%, which is incredibly high. One out of every 25 people will attempt and maybe be successful with suicide.
The rate of suicide in the transgender population is 41%. That is more than 10 times as high as the general population. Research has suggested that being able to allow patients to have a congruent physical appearance to how they perceive themselves significantly reduces gender dysphoria.
And that’s the ultimate goal of everything that we’re doing here. And obviously we are trying to be judicious with the patients that we operate on and make sure that they indeed do need this. Despite what certain media outlets may be presenting, the patients who have this surgery actually have significant improvement of their gender dysphoria from this.
As a provider, nothing makes me feel better than feeing like I have helped a patient live their full life.
Ginger, talk about the significance for you.
The significance is I feel better about myself. My body is more congruent to what I picture it to be. I feel more comfortable in my clothing. I feel more comfortable moving around.
My wife knows [about the surgery]. My doctor knows. Nobody else knows. Well, now, you know, and several million Buckeye Flame readers are gonna know. But it’s not something that shows. It’s not like I had breast augmentation, which is a more obvious thing.
This is more internal, and I have been surprised at how much more comfortable and at peace I am, how much I feel freed up and the confidence that I have gained. And it’s all internal.
It’s been an amazing journey to go through this and feel myself moving into this fuller phase. Part of what I did after the surgery was to get a large tattoo. It’s a stem coming up and it’s kind of brown with a brown leaf with a brown caterpillar. Then it turns green and it’s this brilliant, beautiful butterfly. There’s color exploding out of the butterfly.
And that’s how I feel. I feel like I’m that butterfly that finally came out and color is just exploding out of me everywhere. 🔥
- Learn more about MetroHealth’s Adult Transgender & Non-Binary Care by going here.
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