When Judy arrived in Montreal from the US, she got the red-carpet treatment: limousine, private room, catered meals. Judy, who was born with male sexual characteristics, had come to Montreal for a sex-change operation. Certain about her female identity, she had been living as a woman for 5 years. She chose Dr. Yvon Ménard to perform the surgery that would make her decision final, bypassing 6 American surgeons who offer the same service. FIGURE
Three days after the surgery, she was relaxing poolside at the suburban house that Ménard uses to provide preoperative and postoperative care, reflecting on her life-changing experience. "I was pretty insecure until I crossed the border. When the limousine picked me up at the airport, they knew my name and we came right here to the residence. It's truly like coming to Dr. Ménard's home - I feel so safe here."
Debra, another American transsexual who came to Montreal for surgery, agrees that feeling looked after and well prepared were paramount factors in her decision to come to Montreal. "You can't buy this kind of compassion."
Ménard, a 59-year-old plastic surgeon from Sherbrooke, Que., is one of the handful of North American physicians who routinely perform gender-reassignment surgery. In Canada, Ménard has sewn up this surgical specialty: he performs about 160 of the procedures annually, and the work of his younger associate, Dr. Pierre Brassard, brings the total to 200. The waiting list is more than a year long, and 95% of the patients are American.
What draws them to Canada? For starters, there's the low Canadian dollar and sizable difference in cost. In the US, this surgery usually costs between US$14 000 and US$25 000. At Ménard's private hospital, the same procedure costs between Can$9800 and Can$11 100, including care at the secluded residence. The fees are billed privately - Ménard does not accept provincial health insurance.
For his patients, though, cost isn't the most important factor. "We take care of them as if they were our children, our brothers and our sisters," he says.
Why did Ménard choose to practise within this narrow field? "The first reason is that the technical aspects of the surgery are interesting," he says. Three primary techniques are used in gender-reassignment surgery, an arcane expertise Ménard has acquired over 26 years of practice and professional development in the US and Europe.
Vaginoplasty, or male-to-female surgery, is the most common procedure. Ménard uses a skin-inversion technique, in which scrotal and penile tissue is used to construct a vaginal cavity, clitoris and labia. The surgery lasts approximately 2 hours and requires 10 days' recovery.
Transforming a woman into a man via phalloplasty is a much more complex procedure that requires 2 surgeons to work side-by-side for 6.5 hours; it costs $28 000. Another technique provides an alternative for women who don't want to incur the scarring, skin grafts and expense of phalloplasty.
This type of surgery requires considerable technical skill. Ménard says his desire to master the skills was fuelled by feelings of compassion for people "who are rejected by everyone in society."
The gratitude shown by his transsexual patients means a lot to Ménard. "Afterwards, they send cards, faxes and emails to thank me, to tell me how their lives have changed. One even invited me to brunch."
Ménard witnessed his first case of gender reassignment during his surgical training in 1971. In those days, many hospital administrators looked askance when the procedure was mentioned, and it was difficult to find a place to operate. Two years later, Ménard and some colleagues decided to open a private hospital where he could perform this type of surgery.
Initially, Ménard had doubts about whether surgery was the right way to treat these patients, but these have disappeared over time. "This is a real phenomenon that can happen to anyone. There is one case in 50 000, and if it's you, you feel alone, you feel marginal. The only way to help is to change their sex." SYMBOL