Would it have been possible to construct a new penis for baby Bruce?
At the time, plastic surgery was not advanced enough. It is not recommended that new-born babies have phalloplastic surgery. Firstly, they do not have enough spare flesh to create a penis, secondly, the operation is traumatic, and finally, they grow but the penis does not, which means that they would need further operations in later life.

How is a new penis made now?
Flesh from the patient's arm is used to shape a new penis. Part of the skin is kept connected to nerves and blood vessels during the operation. One segment is rolled into a tube, which will be the urethra, and the rest is formed into a tube around this. When the nerves have been excavated in the groin area, the new penis is cut free from the arm and attached at the groin.

Skin from the stomach or buttocks is used to fill in the flesh on the arm. Later the head of the penis is created using a piece of skin from the other arm, and may be tattooed. A saline reserve is buried in the abdomen, with a tube running to the penis. A valve, located in the groin, is turned to allow the saline solution to pump into the penis creating an erection. If the operation is on a female to male transsexual, the clitoris can be embedded in the penis so orgasm is still possible.

David's penis was made from flesh from his thigh, so was less sensitive. A piece of his rib was embedded within the organ to allow him to use his penis sexually, but he had to urinate through a fistula at the base.

What would be done with a case like this now?
Most medical experts would agree that a baby has been subjected to hormones in the womb even before it is born and so has a male or a female brain. Baby Bruce Reimer, if he were born now, would be considered a full biological male. He would probably be allowed to grow up as boy and offered counselling to deal with the loss of his penis, and surgery when he reached adolescence.

Intersex patients, people who are both male and female, believe they should be treated on an individual basis, depending on their exact condition. Many intersex patients are angry that their gender was chosen for them and believe that children now should be brought up as intersex and allowed to choose their own gender and surgery, if appropriate, at a later stage.

Dr John Money carried out the same procedure on another boy in Canada. Was this case successful?
Another Canadian baby also suffered loss to his penis and, on Dr Money's recommendations, was raised as a girl. Called Paula, she is still living as a woman. She is a lesbian truck driver.

Why did Dr John Money believe that the case he called the Joan/John case was not a success?
Dr Money has not spoken about David Reimer publicly, but in Sin, Science and the Sex Police (1998, Prometheus Books) he published the following reasons why David may not have accepted his gender identity:

• The post-traumatic effect of the pain of having a penis burned off incrementally by electrocautery, without an anaesthetic, at the age of seven months.
• The effect of delay in hospitalistion for gonadectomy and first stage of feminising genitourinary reconstruction until the advanced age of 22 months.
• The effect of having an identical twin brother with whom to compare oneself, in the sexual play of childhood, and thus to recognise the abnormal appearance, neither male nor female, of the genital self.
• The effect of knowledge of oneself as an identical twin, and of learning that identical twins are always both boys or both girls.
• The effect of existence of a trust fund for only one twin, not both.
• The effect on the child of post-traumatic pathology in the mental health of parents, grandparents, or other relatives.
• The shock effect on the parents of misinformation about the surgical outcome of phalloplasty in sex reassignment.
• The effect of not presenting a lesbian lifestyle as a viable alternative to a second sex reassignment.
• The effect on the family of the investigative mission of intrusive outsiders, and their explanation of the purpose of their mission.

Further information:
As Nature Made Him: The Boy who was Raised as a Girl by John Colapinto, 2000, Harper Collins, London, NY.

Man and Woman, Boy and Girl: Differentiation and Dimorphism of Gender Identity from Conception to Maturity by John Money and Anke Ehrhardt, 1972, Johns Hopkins University Press, Baltimore.

Sexing the Body: Gender Politics and the Construction of Sexuality by Anne Fausto-Sterling, 2001, Basic Books.

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