Vaginoplasty with Milton
In 2008, a University of Virginia spokesperson sent the following update: "Dr. Edgerton retired years ago, and we no longer offer gender reassignment surgery."
Address: University of Virginia Medical Center
Dr. Edgerton is a major figure in the history of surgical intervention for
women seeking trans health services. As you will see in the selected bibliography
I have compiled, his articles when read from earliest to latest read like an
unfolding of the history of our community.
Practiced with John Kenney.
Edgerton MT. Plastic
surgery: its roots and rewards. Ann Plast Surg. 2003 Mar;50(3):240-3. PMID:
Edgerton MT. Early
plastic surgery at the Johns Hopkins Hospital. Plast Reconstr Surg. 2002
Jul;110(1):229-33. PMID: 12087260
Edgerton MT. Plastic
surgery: the rainbow profession. Ann Plast Surg. 1997 Mar;38(3):197-201.
Edgerton MT, Langman MW, Pruzinsky T. Plastic
surgery and psychotherapy in the treatment of 100 psychologically disturbed
patients. Plast Reconstr Surg. 1991 Oct;88(4):594-608. PMID: 1896531
This paper reviews the senior author's long-term experience with the surgical-psychiatric
treatment of 100 aesthetic surgery patients with significant psychological
disturbances. Patients with psychological disturbances of a magnitude generally
considered an "absolute contraindication" for surgery were operated
on and later assessed to determine the psychological impact of surgery. Patient
follow-up averaged 6.2 years (maximum follow-up 25.7 years). Of the 87 patients
who underwent operation (7 patients were refused surgery and 6 voluntarily
deferred surgery), 82.8 percent had a positive psychological outcome, 13.8
percent experienced "minimal" improvement from surgery, and 3.4
percent were negatively affected by surgery. There were no lawsuits, suicides,
or psychotic decompensations. Patients with severe psychological disturbances
frequently benefited from combined surgical-psychiatric treatment designed
to address the patient's profound sense of deformity. This study suggests
that plastic surgeons are "passing up" a significant number of patients
who may be helped by combined surgical-psychological intervention. Comment
in: * Plast Reconstr Surg. 1992 Aug;90(2):333-5.* Plast Reconstr Surg. 1992
Edgerton MT Jr, Langman MW, Pruzinsky T. Patients
seeking symmetrical recontouring for "perceived" deformities in the
width of the face and skull. Aesthetic Plast Surg. 1990 Winter;14(1):59-73.
This article describes plastic surgery patients who sought symmetrical recontouring
of the width of the face and skull. The basic demographic and personality
characteristics of these facial width deformity (FWD) patients and the surgical
procedures performed on them are discussed. Details of the surgical and psychological
management of three representative cases are given. Speculative conclusions
regarding the general characteristics of the FWD population are offered. Suggestions
are proposed for a combined surgical-medical psychotherapeutic collaboration
in managing these patients.Comment in: * Aesthetic Plast Surg. 1990 Fall;14(4):299-300.
Pauly IB, Edgerton MT. The
gender identity movement: a growing surgical-psychiatric liaison. Arch Sex
Behav. 1986 Aug;15(4):315-29. PMID: 3741090
The evaluation and treatment of individuals with gender identity problems
has resulted in an interesting and productive collaboration between several
specialties of medicine. In particular, the psychiatrist and surgeon have
joined hands in the management of these fascinating patients who feel they
are trapped in the wrong body and insist upon correcting this cruel mistake
of nature by undergoing sex reassignment surgery. Over the last two decades,
some 40 centers have emerged in which interdisciplinary teams cooperate in
the evaluation and treatment of these gender dysphoric patients. The model
for this collaboration began at The Johns Hopkins Hospital, where the Gender
Identity Clinic began its operation in 1965 (Edgerton, 1983; Pauly, 1983).
This "gender identity movement" has brought together such unlikely
collaborators as surgeons, endocrinologists, psychologists, psychiatrists,
gynecologists, and research specialists into a mutually rewarding arena. This
paper deals with the background and modern era of research into gender identity
disorders and their evaluation and treatment. Finally, some data are presented
on the outcome of sex reassignment surgery. This interdisciplinary collaboration
has resulted in the birth of a new medical subspecialty, which deals with
the study of gender identification and its disorders.
The role of surgery in the treatment of transsexualism. Ann Plast Surg.
1984 Dec;13(6):473-81. PMID: 6524842
The increasing use of surgery for sex reassignment in the treatment of transsexualism
is described. The author's early experience over a twenty-year period with
the Gender Identity teams at The Johns Hopkins University and The University
of Virginia is summarized. Many of the reasons for slow acceptance of this
type of surgery by many members of the medical profession are analyzed. The
satisfactory subjective results described by patients who have received sex
reassignment continue to exceed the results obtained by other methods. The
author concludes that further study of surgical treatment is justified, but
that it should be limited to established multidisciplinary teams working in
academic settings. Physicians are urged to withhold judgment on the role of
surgery in gender disorders until they have had significant personal experience
with these desperate and complex patients.
Edgerton MT Jr, Langman MW, Schmidt JS, Sheppe W Jr. Psychological
considerations of gender reassignment surgery. Clin Plast Surg. 1982 Jul;9(3):355-66.
Edgerton MT, Sheppe WM Jr, Turner UG 3rd, Thorup OA. Transsexualism.
An insight into the power of psychologic gender--a panel discussion. Pharos
Alpha Omega Alpha Honor Med Soc. 1978 Oct;41(4):31-6. PMID: 724795
Turner UG 3rd, Edlich RF, Edgerton MT. Male
transsexualism--a review of genital surgical reconstruction. Am J Obstet
Gynecol. 1978 Sep 15;132(2):119-33. PMID: 356612
Transsexualism is a poorly understood, uncommon, and controversial entity
of recent interest to the lay public and medical profession. Important features
of the condition are discussed, surgical procedures for genital conversion
in male transsexuals are compared, and our experience at the University of
Virginia where 53 patients have been treated surgically is presented. All
patients have made satisfactory postoperative psychosocial adjustment despite
a surgical complication rate approaching 50 per cent. It is concluded that
alternative (better) surgical procedures for male transsexuals should be explored.
Bralley RC, Bull GL, Gore CH, Edgerton MT. Evaluation
of vocal pitch in male transsexuals. Commun Disord. 1978 Sep;11(5):443-9.
A 49-year-old male-to-female transsexual was administered voice therapy following
surgery. Tape recordings were made of her speech prior to and each week during
therapy. Selected sentences from these reocrdings were analyzed. Results indicate
that changes in both fundamental frequency and perceptual judgments of femininity
were statistically significant and supportive to the client. The voice of
the client was still discernible from that of a female speaker, although less
so than before therapy. It is suggested that a composite treatment program
combined with laryngeal modification through surgical intervention may be
Thomson JA Jr, Knorr NJ, Edgerton MT Jr. Cosmetic
surgery: the psychiatric perspective. Psychosomatics. 1978 Jan;19(1):7-15.
Edgerton MT. Liquid
silicone injections to improve scars: is this a solution to the problem?
Clin Plast Surg. 1977 Apr;4(2):311-9. PMID: 852228
Edgerton MT. The
surgical treatment of male transsexuals. Clin Plast Surg. 1974 Apr;1(2):285-323.
Edgerton MT. Transsexualism--a
surgical problem? Plast Reconstr Surg. 1973 Jul;52(1):74-6. PMID: 4713823
Edgerton MT, Bull J. Surgical
construction of the vagina and labia in male transsexuals. Plast Reconstr
Surg. 1970 Dec;46(6):529-39. PMID: 4923947
Edgerton MT, Knorr NJ, Callison JR. The
surgical treatment of transsexual patients. Limitations and indications.
Plast Reconstr Surg. 1970 Jan;45(1):38-46. PMID: 490284
Knorr NJ, Hoopes JE, Edgerton MT. Psychiatric-surgical
approach to adolescent disturbance in self image. Plast Reconstr Surg. 1968
Mar;41(3):248-53. PMID: 5644617
Knorr NJ, Edgerton MT, Hoopes JE. The
"insatiable" cosmetic surgery patient. Plast Reconstr Surg. 1967
Sep;40(3):285-9. PMID: 6037160
Consumer experiences (most recent first)
Turner, Edlich & Edgerton, 1978
Dept. of Obstetrics, Gynecology and Plastic Surgery, University of Virginia
Medical Center, Charlottville, VA, USA
In structure and representation this publication is closely related to the one
of Edgerton & Meyer (1973), that is, it is no follow-up study with reliable
data. Related are mostly surgical techniques for MFTs and surgical complications.
Under historical viewpoints it is an interesting statement that Edgerton was
already in 1963 the director of the Johns Hopkins Gender Identity Clinic in
Baltimore, MD, while everywhere else the founding of this institution is generally
dated two years later. Also it is interesting that a psychologist is given a
key role or a veto right to the indication to surgery. For the rest, the necessity
for a successful one-year-long "Real-Life-Test" as it was already
in Edgerton & Meyer (1973), the experimental surgical breast enlargement
is recommended as a step if the patient and treatment provider are insecure
regarding the stability of the female identity of the patient. In how far the
statement: "The only justification for the ongoing evaluation of surgery
as a definite treatment entity is that patients with this condition have proved
resistant to psychotherapy and drug therapy" (p. 121) is a general postulate
or if the corresponding possibility has been tested with those who underwent
surgery is not to be discerned by the publication.
It is reported about 53 gender reassignment surgeries of MFTs that Edgerton
made after changing from Baltimore to Virginia.
Forty seven females came to the follow-up study in the first year after surgery.
Globally it is said that all were subjectively happy and self-secure and socially
better adjusted. "Psychological testing has substantiated these subjective
claims" (p. 128). Suicide attempts after surgery or desires to role re-reversal
were not observed. Eighteen females had gotten married and six had adopted children.
In the series of the first 20 surgically treated, 14 females required corrective
surgery; in the series of the second 20, only eight. The most frequent complication
was the stenosis of the vagina. Injuries of the urethra or rectum with corresponding
fistulae did not occur.