The Impossible Space

When you can’t go forward, but you can’t go back.

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In the United States, we don’t often hear about the young male refugees from genderism who have an artificial “neo-vagina” in their pubic area instead of a penis.

Newspaper articles regularly profile young women such as Chloe Cole, Prisha Mosley, and Camille Kiefel who lost their breasts to medical malpractice and have since brought suit, but you don’t often hear about the castrated men. Photos of Michelle Alleva’s scarred chest regularly show up on my X timeline, but for obvious reasons, regretful men don’t usually share pictures of their intimate body parts post-surgery.

On June 4, 2024, Prisha announced via X that she’d given birth to a son. While the world empathizes with her grief that she’ll never be able to enjoy breastfeeding her baby, we share her relief that “gender-affirming care” didn’t destroy her fertility. Prisha’s story mingles feelings of regret and triumph, of loss and joy—an ultimately uplifting tale of healthy motherhood and a new life.

In short, Prisha may have taken a detour into genderism and suffered a poignant loss, but now she’s back on track and able to enjoy a loving relationship with her baby.

For the men in my practice who faced up, too late, to being gay, there’s no going back. Going forward (what’s deceptively referred to as “transition”) turned out to be an illusion, but how do they “go back”—that is, take up the life of a gay man when they no longer have a penis?

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Warning: the following descriptions might make some readers deeply uncomfortable. I advise them to keep reading and I promise to keep disturbing details to a minimum.

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In the surgical procedure known as a “penile inversion vaginoplasty” (PIV), a man’s penis is sliced open and used (sometimes along with scrotal tissue) to line an artificial cavity created in the pubic area. Typically referred to as a neo-vagina, it’s a surgically-created wound which must be regularly dilated to prevent the body from trying to heal it—that is, to close it up because the body senses that it doesn’t belong there. In addition to penile skin grafts, intestinal tissue may sometimes be used to line the neo-vagina. During the operation, surgeons relocate the prostate away from its normal position below the bladder and in front of the rectum.

The operation is irreversible, obviously, just as a double mastectomy can’t be undone. Prisha can’t recover her healthy breasts, and my male clients will never again have a functioning penis.

Administration of cross-sex hormones is part of the usual protocol for men undergoing PIV, both pre- and post-op; among the side-effects are brain fog, and sometimes a complete loss of or profound diminishment in sexual desire. In some cases, the surgically created neo-vagina is too small for penetrative sex; for others, such sex is painful or unsatisfying.

In short, for many gay men, so-called “gender affirming care” has deprived them of a satisfying sex life. I acknowledge that not all men with a neo-vagina report the same dissatisfaction, but I haven’t seen them in my practice.

To combat the brain fog associated with estrogen, some male clients try adding a small dose of testosterone to their hormone regime. The effects can be troubling. One client felt simultaneously aroused and perturbed: while the nerves from his former penis had been preserved during surgery, they were no longer “where they were supposed to be,” as he put it. Another suffered from “phantom penis syndrome,” a condition akin to phantom limb syndrome where the person experiences hallucinatory sensations of a lost body part. A third felt intense desire to take part in receptive anal intercourse, only to find it painful (due to a post-op fistula) and unstimulating because his prostate had been relocated away from the rectal area. For these men, achieving orgasm is quite difficult and often leads to painful after-sensations in the genital area.

The idea of anal intercourse between two men makes some readers uncomfortable, and I believe that’s an additional reason why we hear so little about the male victims of genderism. Members of the public with conservative religious views who regard homosexuality as a sin will naturally find it hard to empathize. Straight females such as Laura Becker who lost their breasts to medical malpractice earn public sympathy and acclaim, but the plight of post-operative gay men is largely met with silence.

In the United Kingdom, gay man Ritchie Herron has spoken with feeling about his loss of sexual function post PIV. In a poignant X thread from 2022, he says:

I have no sensation in my crotch region at all.

No one told me that the base of your penis is left, it can’t be removed – meaning you’re left with a literal stump inside that twitches.

When you take Testosterone and your libido returns, you wake up with morning wood, without the tree.

And if you do take testosterone after being post op, you run the risk of internal hair in the neo-vagina. Imagine dealing with internal hair growth after everything?

What a choice … be healthy on Testosterone and a freak, or remain a sexless eunuch.

And thats something that will never come back …

For the full horror of what it means to be caught in this nightmarish limbo, read the complete and powerful thread.

Realizing post-surgery that you’re actually a gay man means you’re caught in an impossible space. You learned, too late, that so-called “transition” is a lie, but the full-spectrum life of a gay man is foreclosed to you. You’re unlikely to have a satisfying relationship with another gay man because, to be frank, gay men are attracted to male bodies that have penises, full stop, despite what the genderists will tell you. If you do try to date, your options have narrowed. As one of my clients puts it, your dating pool usually shrinks down to “chasers”—that is, men who will seek out and fetishize you, often reducing you to your anatomy rather than seeing you as whole person. 

Psychotherapy with these men means sitting with them in a complex and deeply painful place, what I’ve called an impossible space, sharing the grief of immense loss without succumbing to despair. As with anyone who has ever experienced a profound and irremediable loss, my clients must nonetheless pursue a meaningful existence and find creative ways to feel good about themselves. It’s my job is to help them as best I can. I often find that sitting with them in their pain without minimizing it is what helps the most.

In a way, Prisha’s story is a classic tale of triumph over adversity, of new life beyond a death cult. This is the kind of story the public enjoys, and it’s one of the main reasons she and other young women in her position receive so much attention. The gay men in my practice have a far less satisfying and more complex story to tell, and one I fear the public has limited interest in hearing.

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