Hernias

pmdsI had just turned nine years old and was at the beginning of my summer break in 1980. Back then, having a nice golden tan was still en vogue. After finishing a shower I ran, naked, into my father’s bathroom.

“Look at this tan line! Can you believe how dark I am?” I asked with excitement.

My father looked at me strangely and told me to be still as he probed my scrotum. He inserted his finger into one side and instructed me to cough. He then repeated on the other side. After some additional visual examination, he told me to go get dressed.

Later that week, I had a visit with a surgeon who diagnosed me with cryptorchidism and a bilateral inguinal hernia. Surgery soon followed.

Back in those days, a few days in the hospital was the norm. It was so very painful and they kept trying to make me walk. I remember being afraid the stitches would tear and my intestines would fall out.

Now, I don’t know how prevalent bilateral inguinal hernias are in young boys. An inguinal hernia occurs when the inguinal ring, a small opening in the abdominal wall that conveys the spermadic cord, ruptures and allows abdominal contents to protrude outside the abdominal wall. In other words, a person’s intestines poke through and often find their way into the scrotum. The rupture normally occurs during heavy lifting.

I’m not sure how much heavy lifting I could have done at age nine.

Fast forward to 1994. I was working a temporary position at an industrial coating manufacturer. That’s a place that makes high quality paint, in other words. That night I was assigned the unenviable job of filling off 800 gallons of military zinc rich primer into five gallon buckets. Zinc, well, it’s really damn heavy. A five gallon container weighed 125 lbs. Five gallon containers were to be stacked on pallets three high. It takes an awful lot of physical strength and effort to stack 160 five gallon buckets weighing 125 lbs each up to four feet in the air. Mid way through my second pallet I felt an explosion inside me and immediately had my supervisor take me to the emergency room.

The inside of my left leg, just below the skin, contained a large dark lumpy mass reaching down toward my knee. This was my intestine. I had blown a hole in my abdominal wall. This turned out to be an incarcerated femoral hernia: it was irreducible, meaning the intestines were stuck in the femoral canal and and obstructed because it had become entangled.

Now before I go any further, I cannot express how deeply most trans people want to believe there is an explainable biological cause for their gender dysphoria. A femoral hernia is rare. Only 3% of all hernias are femoral. While femoral hernias can occur in both males and females, almost all of them develop in women because of the wider bone structure of the female pelvis.

A week later I was in my post operative follow-up with the surgeon. He asked me a very odd question.

“I thought you told me you’d had a double inguinal hernia repair when you were a kid. Am I right?”

“Yeah,” I responded.

“I’ve seen hundreds of hernia repairs. I can probably identify the surgeon just by the technique. You didn’t have a hernia repair. I don’t know what they did. I can see the scars, but there was no evidence of a previous hernia. Also, well…it was really a mess in there. The spermadic cords were fused in some anomalous tissue and we couldn’t seem to free the testes without severing the cords. At least now they’ll hang right.”

Not a few months later, I was diagnosed with another hernia. This time stainless steel mesh was stitched around my inguinal canal.

Many years have passed and I know live as my true self, Carla. However, in the back of my mind that conversation with the surgeon has always nagged at me. Then one day, after exhaustive research, I found what may have been the answer: Persistent Mullerian Duct Syndrome (PMDS). Males with this disorder have normal male reproductive organs, though they also have a proto version of a uterus and fallopian tubes, which are female reproductive organs. The uterus and fallopian tubes are derived from a structure called the Müllerian duct during development of the fetus. The Müllerian duct usually breaks down during early development in males, but it is retained in those with PMDS.

The first noted signs and symptoms in males with persistent Müllerian duct syndrome are usually undescended testes (cryptorchidism) or soft out-pouchings in the lower abdomen (inguinal hernias). The uterus and fallopian tubes are typically discovered when surgery is performed to treat these conditions.

Back in 1980, is it possible that a surgeon would have assumed I had a hernia, only to find anomalous tissue? Would that surgeon have performed a partial hysterectomy knowing or not knowing what it was he was looking at? The surgeon is long dead. Who knows where the records are.

I often wonder if at one time I had a uterus that was taken from me.