Modern Medicine

Like any other human medium, the Internet is big on firsts. The first live birth. The first presidential chat.

And now, at least in theory, the first live sex-change operation.

Earlier this month, the Ramtin Cosmetic Institute, a cosmetic-surgery clinic in Costa Mesa, launched, a “medical advancement” site that offers up-close-and-personal videos of surgical procedures. The Ramtin Institute's focus is on plastic surgery, so it's no surprise that the first batch of videos available online are heavy on the cosmetics: breast implants, liposuction, hair transplants and even penile enlargement. (The penile-enlargement video is particularly worthwhile, especially if you enjoy the sight of the male member being yanked like candy at a taffy pull.) The site promises to eventually feature brain, cardiac and transplant surgeries as well.

Also on the site is a registration form, where folks who are into “medical advancement” can, for $10 a pop, make reservations to view the first live sex-change operation ever broadcast over the Internet, currently scheduled for Dec. 10.

According to Dr. Fred Sahafi, founder of the Ramtin Institute, he met the patient, “Kim,” through another patient of his. Kim, an Inland Empire resident, has been living as a woman and undergoing hormone therapy for the past three years. According to the Amazing Surgeries site, Kim was born as Richard in the 1950s, went through two failed marriages and a lengthy stint in the military, and is now ready to take the plunge and go in for sex-reassignment surgery.

“I want the whole world to know that there is no shame in being different as long as you follow your dreams,” Kim says on the site.

According to Sahafi, the $10 admission fee is being charged to cover the costs of the operation; in exchange for allowing the operation to be broadcast online, Kim will not have to pay for the procedure. The Webcast is expected to last about three hours.

But at least one person is uncomfortable with the pay-per-view model Amazing Surgeries has set up: the surgeon performing the operation.

Dr. Daniel Greenwald is a surgeon in Tampa, Florida. He says he has been involved in gender surgery for about seven years, although it comprises only about 4 percent to 5 percent of his medical practice. So when Kim was referred to him, he treated it as he would any other case. When he was asked to videotape the surgery, he had no problem with that—it's apparently not an unusual request. He got nervous when he found out about the plans to broadcast the operation over the Internet and charge viewers a fee.

“When I spoke to [Kim], she obviously was not playing up the sensational aspects of it,” Greenwald said. “But I think the sponsors are totally hip to the sensational aspects of it or they wouldn't be offering it on pay-per-view. There is a mercenary element to this on the part of the sponsors, and I'm not comfortable with that, but I would not stand in the patient's way.”

His discomfort is understandable—the history of live Internet broadcasts has its sordid side. For instance, in July 1998, a Web site called Our First Time claimed it was going to broadcast two virgins' first sexual experience. The claim was met with widespread skepticism, and the site was soon revealed as a hoax—the two “virgins” were actors. The previous month, the first live Internet birth had gone off without a hitch, viewed by more than 1.4 million people. But a few too many people saw it, as it turned out: Florida police recognized the mother as someone they'd been looking for on bad-check charges; she turned herself in the following month.

Certainly there are plenty of reputable medical-education sites out there, and many of them have broadcast operations over the Internet. But a sex-change operation clearly has the potential for sensationalism. Example: the Internet Entertainment Group. The Seattle-based Internet company runs a collection of adult sites; it is probably best-known for its distribution of the Pamela Anderson/ Tommy Lee honeymoon video. And on Jan. 28, its site at www.genderchange. com was supposed to broadcast the first live sex-change operation over the Internet.

It never took place. On Jan. 26, two days before the scheduled Webcast and after people had already sent in their $10 registration fees, the site announced it was postponing the event due to “temporary patient risks that must be avoided at this time.” It promised to reschedule the surgery as early as possible.

That promise is still up on the site—10 months later. Internet Entertainment Group president Seth Warshavsky failed to return repeated phone calls asking about the reason for the postponement.

Sahafi said he was unaware that someone else had set out to broadcast a live sex-change operation nearly a year ago, but he was quick to emphasize the difference between his site and Warshavsky's.

“They are an adult site. We are a medical site,” he said.

For now, Greenwald is still willing to go along with the operation—assuming he gets the documentation he's still waiting for from the patient. “I've agreed in principle,” he said, “but I'm not willing to commit to the surgery until I've verified that the patient was properly referred and is a proper candidate for surgery. If the patient is able to secure a letter of reference from her therapist, I have no problem with the surgery taking place on Dec. 10. It all depends on the evaluation from a licensed therapist, and as far as I know, that has not yet occurred.”

Greenwald added that there's no real time constraint on when he needs the documentation—he could get it the day before the surgery and still go ahead with the scheduled operation.

“I'm not in a rush to operate on this patient, and I'm not in a rush to sensationalize this,” he said. “I'm uncomfortable with the Web thing, but I'm willing to provide the service the patient requests. I'm not going to put up a barrier if the patient needs this to fund the operation. I understand that all patients who would like this surgery can't afford it, and if this is a way for the patient to get funded, I'm okay with that.”

Sex-change surgery can cost tens of thousands of dollars, and it is frequently a challenge for those wanting surgery to come up with the money. Attempts to get funding from government agencies, such as Medicaid, have often met with fevered and hostile resistance from those opposed to the whole idea of gender surgery.

“My goal here is not to publicize the operation,” he said. “My goal is to take care of the patient.”

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