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Transsexualism is thus the ultimate acne keloidalis elimite 30gm, and we might even say the logical acne 5 best 30 gm elimite, conclusion of male possession of women in a patriarchal society acne medication accutane safe elimite 30 gm. From these definitions acne needle safe 30gm elimite, it is clear that the process of fetishization has two sides: objectification, and what might be referred to as worship in the widest sense. The fetish is the fragmented part taken away from the whole, or better, the fetish is seen to contain the whole. For example, 31 "Everything You Wanted to Know about Transsexualism" breasts and legs in our society are fetish objects containing the essence of femaleness. However, the other side of fetishization is worship or reverence for the fetish object. In primitive religions, fetish objects were worshiped because people were afraid of the power they were seen to contain. Therefore primitive peoples sought to control the power of the fetish by wor shiping it and in so doing they confined it to its "rightful place. In this sense transsexualism is fetishization par excel lence- twisted recognition on the part of some men of a the creative capacities of the female spirit as symbolized and incarnated in the usurped female biology. This usurpa tion of female biology, of course, is limited to the artifacts of female biology (silicone breast implants, exogenous es trogen therapy, artificial vaginas, etc. Thus trans sexual fetishization is further limited not even to the real parts of the real whole, but to the artifactual parts of the artifactual whole. In summary, then, since men have been socialized to fetishize women, it is not surprising that this fetishization process is one more explanation of why there are more male-to-constructed-female transsexuals. For men it usually starts with the administration of the female hormones estrogen and progesterone. Very often, however, beard growth diminishes only slightly, and other areas of male hair growth also remain generally unchanged. Estradiol monobenzoate, another estrogen, can be injected intramuscularly twice a week. Numerous artifi cial compounds with estrogenic activity have also been synthesized for oral administration, besides the steroids. Estrogenic hormones can also be applied as oint ments or alcoholic solutions and absorbed through the skin. Estradiol, in combination with progesterone, has also been administered in the form of rectal suppositories. The treatment of male transsexual candidates is almost totally dependent on estrogen to induce hormonal castration and feminization. The next step is the surgery itself, which requires the combined techniques of the urologist, gynecologist, and 33 "Everything You Wanted to Know about Transsexualism" the plastic surgeon. The total procedure takes place in four steps, although all of them may or may not be desired by a particular patient. The four steps are penectomy, castra tion, plastic reconstruction, and formation of an artificial vagina (vaginoplasty). Some transsexuals have only the first and second steps performed, and indeed, some writers recommend this approach. An artificial vagina is formed from a skin graft from the thigh and lined with penile and/or scrotal skin. The shape of the artificial vagina is maintained by a mold that is worn continuously for several weeks following sur gery. Once healing has occurred, manual dilation or penile insertion two or three times weekly is necessary to prevent narrowing, which can result through the contraction of scar tissue. However two cases of breast cancer that occurred about five years after such treatment have been reported. Leo Wollman has commented: "The degree of risk may well be a function of the amount of hormone used. The most likely possi bility is that the hormonally feminized male transsexual conservatively treated with estrogen, runs the same risk of breast malignancy as does a normal female. Normal women, even on conservative doses of estrogen therapy, "run a great risk" of incurring cancer.

As the great vessels proceed cranially acne laser purchase elimite 30 gm, the aorta ends up on the left as it arches over the split of the pulmonary arteries skin care insurance safe 30 gm elimite. The trachea is normally easy to follow inferiorly until it bifurcates into right and left main bronchi acne soap safe elimite 30 gm. This bifurcation normally occurs at about the sternal angle acne hormonal imbalance effective 30gm elimite, where the body of the sternum meets the manubrium and where the second rib attaches, which is also the approximate level of the intervertebral disc T 4/5. You deliver a newborn baby girl that has an umbilical hernia with part of another organ attached to its inner surface. What portion of the gastrointestinal tract is most likely to be attached to the inner surface of the umbilical hernia? The pain, which is sharp and constant, began in the epigastric region and radiated bilaterally around the chest to just below the scapulas. The patient, who has a history of similar but milder attacks after hearty meals over the past 5 years, is moderately overweight and the mother of four. Palpation reveals marked tenderness in the right hypochondriac region and some rigidity of the abdominal musculature. An x-ray without contrast medium shows numerous calcified stones in the region of the gallbladder. Diffuse pain referred to the epigastric region and radiating circumferentially around the chest is the result of afferent fibers that travel via which of the following nerves? Between the left and caudate lobes of the liver Between the right and quadrate lobes of the liver In the falciform ligament In the lesser omentum In the right anterior leaf of the coronary ligament 372. The lesser omentum is incised close to its free edge, and the biliary tree is identified and freed by blunt dissection. The liquid contents of the gallbladder are aspirated with a syringe, the fundus incised, and the stones are removed. The entire duct system is carefully probed for stones, one of which is found to be obstructing a duct. The bile duct the common hepatic duct the cystic duct Within the duodenal papilla proximal to the juncture with the pancreatic duct Within the duodenal papilla distal to the juncture with the pancreatic duct 373. Abdominal hernia Cryptorchid (maldescended) testes Varicocele Hydrocele Femoral hernia Abdomen 495 374. Many cesarean sections are performed by making a horizontal skin incision that is slightly curved (about 15 cm) on the anterior abdominal wall just superior to the pubic hairline (bikini or Pfannerenstiel incision). However, this incision is often only made through the skin down to the perimysium of the rectus abdominis muscle. Which of the following cutaneous nerves are at greatest risk with this type of incision? He developed nausea, vomiting 4 days into the trip despite caution about what he ate and drank. On his flight back to the United States the next day he developed a fever and increased abdominal pain, especially in the paraumbilical region. His parents took him to their pediatrician the next day as he was feeling worse and could barely move. On a line drawn between the anterior superior iliac spine and umbilicus on the right; appendicitis c. On a line drawn between the anterior superior iliac spine and umbilicus on the left; appendicitis d. On a line drawn between the anterior superior iliac spine and the pubic tubercle on the right; kidney stone. On a line drawn between the anterior superior iliac spine and the pubic tubercle on the left; kidney stone 496 Anatomy, Histology, and Cell Biology 376. He has no history of peptic ulcers and says the pain does not relate to eating in anyway. Viral hepatitis Blocked cystic duct Open hepatic duct Blocked duodenal papilla Gilbert syndrome 377.

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The 149 Therapy as a Way of Life much-publicized sterilization experiments were carried out on a massive scale at several camps skin care for rosacea proven 30 gm elimite, primarily by radiation and surgical means tretinoin 005 acne cheap elimite 30 gm, for the purpose of seeing how many sterilizations could be performed in the least amount of time and most "economically" (thus anaesthesia was not used) skin care routine for acne order elimite 30gm. However skin care equipment suppliers quality elimite 30gm, the point of all this background is not merely to recite a list of atrocities, but to highlight sev eral points that apply to the situation of transsexualism. Today especially, it is no longer the alliance of church and state that should be feared, that is, theocracy, but rather the alliance between medicine and the state, that is, pharmacracy. The Nazi doctors undertook many of their experiments in the name of science but for the purpose of supposedly gaining racial knowledge. The doctors who treat transsexuals undertake many of their experiments in the name of therapy but for purposes of gaining sexual knowledge. What we are witnessing in the transsexual context is a science at the service of a patriar chal ideology of sex-role conformity in the same way that breeding for blond hair and blue eyes became a so-called science at the service of Nordic racial conformity. It must be remembered that such fixation and "objectivity" led to one of the most profound inhumanities that the world has ever witnessed. It is this kind of fixation, accom panied by a cult of objective truth, which helps to explain why the Nazi doctors did what they did. This is the alchemy of the modem age, the transmogrification of subject into object, of man into a thing against which the destructive urge may wreak its fury without havoc. Karl Brandt, for example, during his trial at Nuremberg, offered his living body for medical experiments like those he had conducted. As stated previously, it is significant also that both govern- 151 Therapy as a Way of Life ment and private medical insurance plans cover the cost of surgery in some cases. Unnecessary surgery is spiraling, especially during the last quarter of a century. The third point to be learned from the Nazi experi ments concerns the information that accrued to medical science because of them. William Shirer, author of the Rise and Fall o f the Third Reich, claims that, "in the use of concentration camp inmates and prisoners of war as human guinea pigs, very little, if any, benefit to science was achieved. Guttentag remarks that "contrary to general belief, some of the experiments that those men performed were scientifically valuable and are quoted in Western literature. While a medical procedure or experiment should not 152 the Transsexual Empire be determined by its origin, nevertheless its origin is in structive. Applying this to the transsexual context, it is significant that the first physician on record to perform sex-conversion surgery was a German by the name of F. Further more, Benjamin relates that the Institute of Sexual Science in Berlin did much work on transvestism (and probably transsexualism before it was named such) under the leader ship of Dr. I met another boy whom the scientists of Auschwitz, after several operations, had successfully turned into a woman. After the war, a complicated operation was performed on him in a West German clinic. However, it is important to understand that some transsexual research and technology may well have been initiated and developed in the camps and that, in the past, as well as now, surgery was not performed for the present professed goal of therapy, but to accumulate medical knowledge. At this point, it is the task of this book to suggest 153 Therapy as a Way of Life different, and what I regard as more adequate, answers to the questions that transsexualism raises. It is my hope that this dis cussion will not be regarded as abstract, or as distracting, but that it will form the basis for viewing the deeper and more mythic aspects of the transsexual phenomenon. Briefly, integration means putting together a combina tion of parts in order to achieve completeness or whole ness. In contrast, the word integrity means an original wholeness from which no part can be taken away. It is my contention that, in a deep philosophical sense, transsexual therapy and treatment have encouraged integration solu tions rather than helping individuals to realize an integrity of be-ing. In its emphasis on integration, much of the recent psychological, medical, and medical-ethical literature on transsexualism, and the solutions they propose, resemble theories of androgyny. In many ways, contemporary trans sexual treatment is a modem version of medieval, androgy154 155 Toward the Development of an Ethic of Integrity nous alchemy where stereotypical femininity is integrated with a male genotype to produce a transsexually construc ted woman. As alchemy treated the qualitative as quanti tative in its attempts to isolate vital forces of the universe within its laboratories of matter, transsexual treatment does the same by reducing the quest for the vital forces of selfhood to the artifacts of hormones and surgical ap pendages. Transsexualism is comparable to the theme of androgyny that represents biological hermaphroditism, be cause ultimately the transsexual becomes a surgically con structed androgyne, and thus a synthetic hybrid. Further more, the transsexual also becomes a sex-stereotyped hermaphrodite, often unwittingly displaying his former masculine gestures, behavior, and style while attempting to conform to his new feminine role.