The Sex Change Doc

Sunday Star-Times 24/9/95

The country's only 'gender reassignment' team operates out of conservative Merivale in Christchurch. Its head, Peter Walker, talks with Matt Conway about a surgical procedure that still raises eyebrows.

As a schoolboy, Peter Walker had a flair for off-beat inventions. At 14, he built an ether-fuelled flying saucer out of an old lampshade. And he once rigged spotlights on his parents' Morris Oxford to swivel around street corners before the car itself.

These days, the prominent plastic surgeon applies his gift to the most offbeat and radical of reinventions - morphing human beings from one sex to another.

Peter Walker heads the only "gender reassignment" team in the country. Since 1991, he has masterminded sex changes for 13 transsexual men who craved the female form.

Transsexuals have the physical makeup of one sex but an overwhelming psychological empathy with the other. A woman, as they say, trapped in a man's body - the reverse is relatively rare. They are distinct from cross-dressing transvestites who get their sexual kicks from a gender-bending look rather than psyche.

There are thought to be about 300 transsexuals in New Zealand, although not all seek surgery.

The ground-breaking technique used by the Walker team to engineer female genitalia is astonishing. As is the fact that virtually no one, outside his patients and colleagues, knows about it.

From his private consulting rooms in the conservative suburb of Merivale, this shy genius has revolutionised the crude operating procedure used elsewhere in the world.

The critical aspect of changing a man into a woman is the construction of the vagina. The testes and penis are easily castrated and breasts can be induced by prescribing feminising hormones to the patient for up to three years before surgery.

Sex change surgeons elsewhere form a vagina by cutting a cavity between the rectum and bladder and lining it with skin from the thighs. But the skin is prone to flaking, difficult to keep clean and lacks erotic sensation. It is essentially a token cosmetic solution.

In 1991, working in tandem with colo-rectal and genito-urinary surgeons, Mr Walker adapted a vastly superior technique conceived by a London paediatric surgeon to help seven little girls with vaginal agenesis, or malformed genitalia.

In a successful series of operations, the British surgeon fashioned genitalia from the sigmoid colon of each girl. We can survive quite comfortably without a chunk of colon, the standard advantage of which is that is secretes mucus.

News of the coup reached Christchurch colo-rectal surgeon Ted Perry, now retired. He and Mr Walker had just seen a patient requiring a male-to-female sex change and they quickly recognised the procedure's potential.

"The advantage of using colon is that it has its own blood supply, its own sensation of stretch, it is capacious, self-cleansing because it secrete mucus, resistant to infection and doesn't smell - it does all a vagina is supposed to do," Mr Walker said.

"It's fantastic - quantum leaps ahead of the other ideas. We decided to do it and do it better."

While that first pioneering effort was a complete success, the drawback is using the sigmoid colon was the tight stretch for the blood vessels in reaching the groin.

In a modified version of the operation, the Walker team used the ascending colon, which has more elastic arterial connections. A world-first, the procedure has been used in 11 of the 13 gender reassignments.

Exactly how it is done is a medical marvel. Using delicate telescopic instruments with inbuilt cameras which beam pictures to a video screen, the three sex change surgeons work simultaneously.

The ascending colon is cut at the top end and flipped 180 degrees, with the arteries still attached. The appendix is removed and the small intestine reattached to the transverse colon. Trained down between the bladder and rectum, the 20cm piece of colon meets an incision made next to where the testes used to be. Skin from the shaft of the soon-to-be-defunct penis, meanwhile, is concertinaed up to mimic the labial folds. The crowning touch is the clitoris, a tiny piece taken from the erogenous end of the penis. The operation takes five hours, costs $19,500 and can end a lifetime of torment for transsexuals whose sexual maelstrom began as young as age five.

"They enjoy associating with females and hate doing things that the boys normally do. They get to be called a sissy at school," Mr Walker said.

"Their schoolwork suffers, they are socially isolated and get bullied and beaten up by the boys.

"At 16 or 17, boys are beginning to do manlike things but transsexuals are feeling sexually confused. They see females as friends, they don't eye them from a sexual point of view. A transsexual doesn't have sexual fantasies."

As much as they may want to switch anatomically, transsexuals must first satisfy several years of protocols framed by the Walker team, including biological tests, counselling, hormone therapy and a committment to live and work as a woman - or man - for two years.

Kiwi transsexuals come from a variety of backgrounds and occupations - computer programmers, plumbers, electricians, bakers, clerical workers. Six more are in line for gender reassignment in the next couple of years, including two women who wish to become men.

For them, Mr Walker has mapped out an untried theory based around the gracilis muscles of the inner thigh. First, the muscles are sliced away from each leg - except where they meet at the pelvis - and stitched together around a catheter bound in mucus membrane from the inside of the patient's mouth. Thigh skin is then wrapped around the stitched muscles and the catheter is removed, leaving a membrane-lined urinary tract. Two erectile rods which allow the "penis" to be pumped up to attention are implanted and the outer labial folds are transformed by a tissue expander into a scrotum, which can hold a prosthetic testicle.

Mr Walker (53) confidently predicts another successful world-first with the woman-to-man makeover.

Before his sex change surgical team was formed in 1991, transsexuals had two options for surgery - go offshore, usually to Australia, or hope to be chosen for one of the sporadic operations undertaken at Middlemore Hospital in Auckland to help train junior plastic surgeons.

Middlemore was where Mr Walker learned the rudiments of the crude thigh skin procedure in the mid-1970s.

He never planned to be a surgical saviour for one of society's most misunderstood minorities, actually graduating as a dentist from the Otago Medical School in 1965.

Born in Sydney, he grew up in Egypt and was sent to St Andrew's College in Christchurch as an 11-year-old boarder when the Suez crisis broke out in the 1950s. His father, Hendrick, was a Dutch career diplomat.

"I was good at using my hands at school. I wanted an occupation which could combine what intelligence I had with my manual dexterity. My careers adviser suggested dentistry."

His inspiration for switching to reconstructive surgery came during summer holidays, when he assisted oral surgeon David Poswillo at Burwood Hospital. Dr Poswillo helped children with cleft palates and Mr Walker, then 23, was moved by the results as he grew up with a stutter.

He returned to Otago to do medicine, a path made doubly difficult because he had already used his bursary allowance in becoming a dentist. Mr Walker had to come up with $3000 a year in fees. He found $1200 by working as a dentist in the holidays and the rest by running a part-time dental practice at the Medical School.

"I treated all the hospital doctors and I was a medical student! I worked on Wednesday afternoons when everyone was playing sport and Friday nights when everyone was at the boozer. I did this for five years."

Juggling his medical studies with a post-graduate degree from the Royal Australasian College of Dental Surgeons and 200 dental patients was testimony to Peter Walker's remarkable intellect, tenacity and discipline. Those qualities have taken him to the top of his field as one of only 25 plastic surgeons in the country.

His consultations with transsexuals account for only one case in a thousand. He works his magic on the children who first inspired him. And in conjunction with Canterbury University engineers, he pioneered another notable first - the removal of port wine stains and vascular blemishes by laser surgery.

The riveting ink sketches of architectural perspectives in his rooms at St George's Hospital reveal the well-spring of his surgical talent - his mother, Hilda, who exhibits her work at the National Academy.

"A plastic surgeon needs to have some artistic flair," he agreed.

"It's very delicate work, working in three-dimensional concepts, like being a sculptor."

Mr Walker feels compassion for the transsexual's plight, as he did with the cleft palate kiddies, after his own struggle to overcome stuttering. He speaks barely above a whisper and sometimes haltingly, a disarmingly articulate blend of self-assuredness and humility. Proud of his achievements but mindful of his journey.

"Transsexuals can come to me because nobody else will listen to them. People in the mainstream want to disassociate themselves. It's not socially acceptable."

Exploring this point further, Mr Walker suddenly reaches for his handkerchief to wipe away tears. He talks of a labouring job he applied for as a shy teenager, of being interviewed by the boss of a big construction company in Wellington and feeling overawed.

"The boss came out from behind the desk and said: 'You're finding this very hard, aren't you?' He took five minutes to walk me around the block to unwind me."

The gesture stuck with Mr Walker and became part of his personal creed. It was the reason he agreed to an interview with the Sunday Star-Times the day after being contacted despite his relentless 12-hour days at the office.

Notwithstanding the $19,500, it is also the reason he makes his skills available to transsexuals when others shy away.

Mr Walker said his anaesthetist, a Christian, recently decided the sex change surgery breached his moral code and disqualified himself from future gender reassignment work but will continue to assist with other surgical procedures.

"My idea of a Christian is that you are magnanimous and treat everyone equally," Mr Walker said. "So I think I'm more of a Christian than he is." He doesn't accept the notion that he is in some way tampering with the natural order of creation - whatever that might be.

"I'm not playing God, as in being authoritarian. I am taking a woman in a man's body and changing the anatomy to make them in tune with what they think they are." It is deliciously ironic that Merivale - the heartland of Christchurch affluence and conservatism - should be revealed as the nerve centre for sex change surgery.

This, after all, is the suburb where residents last year went into spasms about a mural painted on the wall of a veterinary surgery, featuring such offensive material as... a cheetah and... a rhinoceros.

Hmmm. A mural on the wall of Peter Walker's rooms.

Now that would cause a ruckus.

• Peter Walker is featured in Born to be Different on TV3's Inside New Zealand on October 4.