Dr. B and the Women


By T Cooper

Bowers herself seems most incredulous about the next stage of the surgery, in which a pretty sizable cavity must be created where there wasn't one before. Essentially, the doctor makes room for the vaginal canal by boring a hole into the area between the anus and the neo-clitoris by cutting and cauterizing. 'There's this potential space we open up -- it's amazing we can do it. It's very tedious, but we do it day in and day out, so it works,' she explains.

And the skin that creates the lining of that new pocket? It comes from turning the penis inside out (yes, exactly like a sock)and then grafting it to the harvested scrotal skin, which meanwhile, at a separate work station, has been wrapped around a dildo-like stent and sewn together (with any remaining hair follicles removed). The whole graft -- penile and scrotal skin sewn around the stent -- is then placed inside the cavity to create the neo-vaginal canal, which in Bowers's surgeries generally ends up providing about six inches of depth for her patients (not to mention her patients' future sexual partners) to enjoy.

Before wrapping up the three- to four-hour procedure, a new urethra is created, the inner labia is sculpted and lined with urinary mucosa (to give it the pinkish, moist attributes of a natal vagina), and a protective hood is sculpted over the clitoris. The labia majora is closed up in a large but tidy 'V' shape, which will be completely concealed when pubic hair grows back. Four days in the hospital plus a few more under Cometto's tutelage at the Morning After, and patients are good to go. They are asked to refrain from heavy lifting and activity and instructed to dilate their vaginal canals with increasingly larger dilators over the next weeks and months. Sexual activity is specifically discouraged for at least six weeks (though three months is suggested), but some patients report experiencing what they believe is an orgasm from the dilation process. Remarkably, the vast majority of Bowers's patients do not experience much pain at any time during the process -- just a bit of persistent discomfort from the catheter and vaginal packing, both of which are removed about a week after surgery.

Bowers has been performing her revolutionary vaginoplasties solo for six years, having taken over the practice of Dr. Stanley Biber, an early pioneer of sexual reassignment surgery who established his practice in Trinidad in the late 1960s, after his death. Trinidad, population 9,000, is a gritty old mining town along the Santa Fe Trail, halfway between Santa Fe and Denver on Interstate 25. 'Not a day goes by where I don't wish I was out of here,' Bowers says of her adopted hometown -- she spends a good deal of time in Seattle, where her children live with their mother (whom Bowers still calls her spouse even though they are no longer intimate). 'I mean, you gotta buy your cosmetics at Wal-Mart. But I've come to realize that L'Or'al mascara is just as good as Chanel.'

In addition to the lure of the Wal-Mart Supercenter just south of town, Trinidad proudly boasts some pretty righteous New Mexican and Mexican cuisine, a quaint, authentic Western-storefronted downtown vaguely expectant of another showdown at the O.K. Corral, a few dozen churches -- and a 'down-home friendly atmosphere' touted on the official Trinidad Chamber of Commerce website. But what's not mentioned on the town's promotional websites or in any of the myriad tourist brochures proffered at local businesses is what Trinidad -- as evidenced on Oprah, Tyra, CBS Sunday Morning, BBC, NPR, MSNBC, We TV, the Discovery Channel, and so on -- is best known for: being the 'sex change capital of the world.' Well before Bowers arrived to work with Biber in early 2003, Trinidad had earned its unofficial official moniker. According to Wikipedia, as far back as the '60s the saying 'taking a trip to Trinidad' was a euphemism for having an MTF sex-change operation.

Bookended by two prominent red-rock peaks, palpably low-key Trinidad is nestled into a small southern Colorado valley that gets its name from the sleepy river that runs through it, the Purgatoire. From there it's an easy symbolic leap to that other state of purgatory: a place of limbo between heaven and hell, torturous and unsettling, where you're stuck until somebody back in the real world can cobble together enough cash for your indulgences to spring you into heaven.

While not all transpeople opt for surgical transition -- many simply cannot afford the luxury; some prefer solely hormonal transition; and still others are comfortable with no hormones or surgery at all -- a lot of transfolk who do want to alter their genitals will describe feeling 'stuck' in between sexes. Hedwig and that angry inch. 'So many MTF patients figure it's all about the vagina. Build it and they will come,' Bowers riffs, laughing. 'But that's simply not true. Not only will they not come, but they won't even get it up for you.'

'And that's one of the tragedies of transition,' she continues, more soberly. 'There are a lot of people who get left behind. Because the fact is, the rules are different for women, and society judges very harshly if you don't meet a female standard, if you're not beautiful in some way. And some people who transition -- they were the star football player with shoulders you could eat lunch on. Then you transition over and you want to be, you know -- you're not going to be Twiggy.'

Each year, Bowers's practice pumps hundreds of thousands of dollars into Trinidad's somewhat shaky economy and generates millions in revenues for Mount San Rafael Hospital, where she performs her surgeries. And yet, the hospital board recently presented her with new requirements that would have made most of her procedures so expensive that few patients would be able to afford them any longer, essentially pricing her out of town.

It was apparently the multipart television documentary Sex Change Hospital that whipped one particularly intolerant member of the hospital administration into a bitter froth, which raised some warning flags for the hospital's board of directors, whom Bowers describes as 'good old boys who don't have any malice toward what I do and know it's been going on here forever.' But the board's already tepid and religion-tinged predisposition was buffeted by this very squeaky wheel, and then, according to Bowers, in addition to untenable price hikes, 'they put what I think are unhealthy restrictions on the media, basically charging them, to keep the sensationalism away. No other hospital in the state charges the media.'

Biber was no stranger to fights with the town about his practice either. Cometto, who grew up around the doctor and his family, explains, 'I ate at Dr. Biber's table more often than not. And this man fought, every day, to get where he was. I told Marci, 'You have to fight. Just because you're this big-shot surgeon, [doesn't mean you don't] have to fight. You can't let this man down and just pack up your bag and leave.''

In fact, Bowers has been considering two very tempting offers, to take her practice to either Seattle or San Francisco. But when some members of the Trinidad community got wind of the hospital's hostile maneuvering, Bowers recalls, 'People were like, 'Oh, she's gonna leave? Oh, wait, Maybe that's not a good idea.' And then the town's ready to march with picks and shovels and burning torches like they did in Frankenstein. It's the history. It's the people. But you're also literally supporting a community. There would be a sucking sound as things left here -- it would really change the fabric of the community.' And so ultimately, the board backed down and accepted Bowers's pricing proposal, just a slight increase akin to those issued every year to adjust for costs. For now, the rock star of the transgender surgery world has decided to stay in Trinidad.

'Listen, you're going to fight it no matter where you go. Somebody always pops up who's going to have an issue with what you're doing,' Bowers says. 'Of course, there's a little resentment like, 'Why couldn't we be known as the mining capital of the West, have everyone from all over the world coming to look at our mining museum?' Little towns struggle without a niche, but we have a niche. If Trinidad would really get it, they'd put in T-shirt shops, make it a curiosity. the sex change capital of the world! They'd have a lingerie shop, tattoos, coffee cups, and souvenirs. Carol said we need blow-up dolls; blow 'em up and the dick pops out!'