Jo's Vagina Monologue

[CANTERBURY, NZ] - Nature cast Joanne Proctor as a male at birth. Fifty years on she has undergone a remarkable change of life. Joanne Proctor was conceived as a boy. She was born with XY chromosomes, testes, and a penis - but the psyche of a girl. YVONNE MARTIN reports. "It means my brain is wired up to be inside a female body," she says.

Growing up in Kaikoura in the '50s as the second of four children, her father could not fathom why his son, then John, preferred dolls. As a schoolboy, he would duck home during lunch breaks to cross-dress in his sister's clothes.

Jo's mother was later to wish her dead, which Jo says is not unusual in families torn apart over a transgendered son or daughter. Both parents died before Jo was able to reconcile her difference.

She would spend 53 "lost years" trapped inside a mismatched body, trying to explain her predicament to an army of psychologists and psychiatrists.

When the message finally got through and she was listed for a sex change at Waikato Hospital, funding for it was pulled at the 11th hour. Jo was forced to step from her reclusive life in rural King Country into a five-year battle with bureaucracy.

It was, she says, a fight for survival inside a foreign body.

Jo's chances of breaking the resistance of a public health system looked bleak until the Chief Ombudsman, Sir Brian Elwood, took up her case. Three weeks ago Jo underwent a $24,000 taxpayer-funded sexual reassignment surgery in Christchurch. Ridding her body of the male genitalia she loathed brought relief - and a raft of unexpected complications to prolong her hospital stay. Technically, Jo is a new woman. But her initiation into womanhood has been far from easy.

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Jo is a strapping gentle giant, with long, naturally straight brown hair and eyes the blue of Lake Pukaki. She is articulate, a voracious reader, and educated, with a Bachelor of Arts from Canterbury University, where she dressed as a woman.

It is not hard, at times, to imagine her in one of her other incarnations as a burly crane driver at Lyttelton during the tumultuous early '80s, marked by strikes and picket lines.

A decade of hormone- replacement therapy, mainly oestrogen, has feminised her frame and softened her voice. An anti-androgen, Siterone, has dulled the effects of testosterone, inhibiting facial, pubic, and chest hair, and acting as her "chemical castrator".

A Christchurch surgeon's scalpel has completed the hat- trick, amputating her penis and fashioning parts of it, origami- style, into a new vagina.

It is a bright autumn day when we call by the '70s-style budget motel where Jo is recovering from the surgery, but the curtains are drawn.

Three weeks after D-day, Jo still spends part of the day in bed, catching up on sleep that eludes her at night, and easing the pressure on her wound.

She cannot sit for long due to a haematoma the size of a golf ball that has sprouted on her perineum, causing tears in her labia.

Jo sits awkwardly on the soft sofa with her legs splayed ragdoll-style at all angles. Unladylike, she knows, but there is no other way.

Sitting on wooden chairs at the dining room table a few metres away is impossible.

Jo longs to be back on her isolated rented rural paradise in southern King Country. In this safe, cocooned world, Jo is able to limit herself to six or seven "contact hours" with people a month, including grocery shopping and GP visits. "Nobody comes to me ever. I say to people, if I need company I will come to you. And I don't have a television."

But most of all, right now, with all the prodding and poking going on, Jo wants to feel her normal self again. That same joyous feeling she got the morning she broke her nine- day post-op fast by biting into her favourite marmalade on toast. She had, by that stage, lost 10kg in 10 days.

There is a bittersweet irony about Jo being sent south for surgery by Christchurch plastic and reconstructive surgeon Peter Walker. It is the city in which her battle for surgery began with an unsympathetic psychiatrist who told her emphatically her stature and looks eliminated her as a potential candidate.

Christchurch is also where she survived a rocky adolescence, a seven-year drug dependency, and a later suicide bid using barbiturates.

Jo detoxed herself by 27 and tried to mask her gender conflict by working in the harsh macho environment of Port Lyttelton. Looking back now, she sees a very angry man spooked by his true identity.

Convinced life would only be worth living as a woman, she began taking hormones and dressing as a female. She graduated from Canterbury University in 1990 and headed north, studying a further three years at Waikato Law School.

In early 1997 Midland Health, the former regional health authority, approved a sex operation, then cancelled it shortly before the surgery was to have been done when its funding policy changed. Jo's endocrinologist, John Conaglen, begged unsuccessfully for authorities not to turn their backs on his client. "She is talking about going down and buying a pair of shears from Mitre 10 and amputating her penis herself," he wrote at the time. "She has attempted this in the past and I believe her mood has sunk to the level that she will actually carry out this action."

In 1998 Jo complained to Sir Brian Elwood, triggering an investigation that dragged on for more than two years because of bureaucratic delays by health authorities.

Frustrated, Jo tried to pull her complaint in October 2000. "I know of no state of human existence more soul-destroying or self-destructive than this transgendered state that I live with," she wrote to Sir Brian. "I know of only one other way out of this dilemma. Today I have destroyed my anti-hypertensive and anti-anginal medications. I will let nature run its course."

But Sir Brian persevered, issuing his finding the next month that Jo had indeed been treated unfairly. He recommended the then Health Funding Authority (as Midland Health's successor) reassess the case and fund the operation if it was medically justified.

The decision sparked an outcry - with requests flooding in to the Ombudsman for free operations and insomniacs jamming talkback lines. "People don't realise how debilitating gender identity disorder can be. I blame the Judeo-Christian creation myth. God only makes two, he doesn't make anything else.

"Sir Brian wasn't judgmental. He looked at the issues and wasn't concerned with the social and cultural baggage."

Jo is pleased she stuck to her guns.

She had her six hours under the knife early in May. Her first few days, under epidural and a drip-feed, were groggily painfree, until her bowel collapsed. Jo's stomach bloated and she was whisked into theatre for a procedure which kick-started her bowel 18 uncomfortable hours on.

Longer-lasting and more worrying has been the stubborn haematoma, which she fears will alter the appearance of her genitalia for good, and may require further work.

"I wanted this operation desperately ... but it is hard."

Jo compared intimate notes with friends who had undergone a traditional male- to-female transition, but Walker's preferred method was "uncharted territory" to her.

Walker's way, adapting a technique used to help girls born without vaginas, uses the S-shaped tail end of the large intestine, the sigmoid colon.

A portion of the appendix end of Jo's intestine (the ascending colon) was cut and trained down between the bladder and rectum.

Skin from the penis was bunched up to mimic the labial folds and form the vagina entrance. A nub of erogenous tissue, taken from the glans penis, forms the clitoris.

Nurses were curious to know how Jo felt about her new organ. "It didn't feel strange because in my mind I had been carrying around this image of a vagina for so many years. It was almost like a positive visualisation that that was what was there, even though it wasn't," she says.

"I still got a shock each time I stood in front of the mirror and saw the male image."

The surgery signals the start of an emotional healing process. She has been told to expect subtle physical changes in the next year. With the reduction of testosterone and continued hormone treatment, she may get some growth in her 16A bust and hips.

"The chance of breast cancer increases, but I can't get prostate cancer. The prostate would have been shrunken down to a raisin with medication." With no uterus, she cannot go through menopause.

The consensus among her friends is that it takes 12 to 18 months to fit inside yourself, Jo says. "But all my soul- searching has been done. I have lost count of the number of psychiatrists and psychologists since I was 18 or 19."

On her return home, Jo intends to write a novel, tracking the path of several transgendered people whose lives overlap. The key character's name will be Tania, but the plot is achingly familiar.