Occurrence of phantom genitalia after gender reassignment surgery.
TL;DR: It is predicted that male-to-female transsexuals will be much less likely to experience a phantom penis than a "normal" man who has had his penis amputated for another reason, and that the same will be true of female- to-male transsexuals who have had breast removal surgery.
About: This article is published in Medical Hypotheses.The article was published on 2007-01-01. It has received 51 citations till now. The article focuses on the topics: Phantom limb & Gender reassignment surgery.
Citations
More filters
TL;DR: McGeoch et al. as discussed by the authors used magnetoencephalography imaging to record brain activity during somatosensory stimulation of the breast and the hand, a body part that feels congruent.
Abstract: While most people take identification with their body for granted, conditions such as phantom limb pain, alien hand syndrome, and xenomelia suggest that the feeling of bodily congruence is constructed and susceptible to alteration. Individuals with xenomelia typically experience one of their limbs as over-present and aversive, leading to a desire to amputate the limb. Similarly, many transgender individuals describe their untreated sexed body parts as incongruent and aversive, and many experience phantom body parts of the sex they identify with (Ramachandran, 2008). This experience may relate to differences in brain representation of the sexed body part, as suggested in xenomelia (McGeoch et al., 2011). We utilized magnetoencephalography imaging to record brain activity during somatosensory stimulation of the breast-a body part that feels incongruent to most presurgical female-to-male (FtM)-identified transgender individuals-and the hand, a body part that feels congruent. We measured the sensory evoked response in right hemisphere somatosensory and body-related brain areas and found significantly reduced activation in the supramarginal gyrus and secondary somatosensory cortex, but increased activation at the temporal pole for chest sensation in the FtM group (N = 8) relative to non-transgender females (N = 8). In addition, we found increased white matter coherence in the supramarginal gyrus and temporal pole and decreased white matter diffusivity in the anterior insula and temporal pole in the FtM group. These findings suggest that dysphoria related to gender-incongruent body parts in FtM individuals may be tied to differences in neural representation of the body and altered white matter connectivity.
33 citations
TL;DR: Among them is the development of phantom breast pain (PBP) and sensation (PBS) after mastectomy.
Abstract: Background
With the advent of newer treatment modalities, survival rate among breast cancer patients has improved substantially over the last few years. Hence, the concern has also shifted to the impact of treatment, side effects, and the morbidities arising from disease management. Among them is the development of phantom breast pain (PBP) and sensation (PBS) after mastectomy.
Methods
After obtaining ethical committee approval, 80 patients suffering from carcinoma breast undergoing modified radical mastectomy were enrolled into the study. They were assessed preoperatively for presence of breast pain, disease, and surgical concerns and followed up postoperatively at 6 weeks, 6 and 12 months, respectively, for development of PBP and PBS, and other associated effects.
Results
The prevalence of PBP and PBS was 5.4%, 9.5% at 6 weeks, 8.2%, 6.8% at 6 months, and 13.6% and 17% at 12 months, respectively. There was high prevalence of depression, sleep disturbance, and anxiolytic intake among the patients with PBP and PBS (P value < 0.05).
Conclusion
The prevalence of PBP and PBS was very low and of minor clinical significance. There was higher prevalence of depression, sleep disturbances, and anxiolytic intake among the patients with PBP and PBS, but it did not result in any significant impact on the patients daily activities.
30 citations
Cites background from "Occurrence of phantom genitalia aft..."
...Phantom syndrome occurs after amputations of limbs and various organs.(5,6) Phantom limb phenomenon has been widely described and studied....
[...]
TL;DR: Mirror therapy can be used as an adjunct to medical and surgical treatment of PLP, and is a method that patients can practice independently, enhancing self-control over phantom pain.
Abstract: Objectives In the last two decades, mirror therapy has become a frequently used method of managing phantom limb pain (PLP). However, the role of nurses in mirror therapy has not yet been well defined. This study examined the effect of mirror therapy on the management of PLP, and discusses the importance of mirror therapy in the nursing care of amputee patients. Methods This quasi-experimental study was conducted in the pain management department of a university hospital and a prosthesis clinic in Istanbul, Turkey, with 15 amputee patients who had PLP. Forty minutes of practical mirror therapy training was given to the patients and they were asked to practice at home for 4 weeks. Patients were asked to record the severity of their PLP before and after the therapy each day using 0-10 Numeric Pain Intensity Scale. Results Mirror therapy practiced for 4 weeks provided a significant decrease in severity of PLP. There was no significant relationship between the effect of mirror therapy and demographic, amputation or PLP-related characteristics. Patients who were not using prosthesis had greater benefit from mirror therapy. Conclusion Mirror therapy can be used as an adjunct to medical and surgical treatment of PLP. It is a method that patients can practice independently, enhancing self-control over phantom pain. As mirror therapy is a safe, economical, and easy-to-use treatment method, it should be considered in the nursing care plan for patients with PLP.
24 citations
Cites background from "Occurrence of phantom genitalia aft..."
...[3,4,11,12,17,19,20] The feeling of a phantom limb can be so vivid that the patient may attempt to stand up and walk,[12] or sometimes it may feel like a paralyzed limb.[21,22]...
[...]
TL;DR: The results show that capsaicin 8% patch treatment leads to significant reduction in chronic pain and, particularly, in the area of stump hypersensitivity, which may enable patients to wear prostheses, thereby improving mobility and rehabilitation.
Abstract: Purpose The aim of this study was to measure the efficacy of a single 60 min application of capsaicin 8% patch in reducing chronic amputation stump and phantom limb pain, associated hypersensitivity with quantitative sensory testing, and changes in brain cortical maps using functional MRI (fMRI) scans. Methods A capsaicin 8% patch (Qutenza) treatment study was conducted on 14 patients with single limb amputation, who reported pain intensity on the Numerical Pain Rating Scale ≥4/10 for chronic stump or phantom limb pain. Pain assessments, quantitative sensory testing, and fMRI (for the lip pursing task) were performed at baseline and 4 weeks after application of capsaicin 8% patch to the amputation stump. The shift into the hand representation area of the cerebral cortex with the lip pursing task has been correlated with phantom limb pain intensity in previous studies, and was the fMRI clinical model for cortical plasticity used in this study. Results The mean reduction in spontaneous amputation stump pain, phantom limb pain, and evoked stump pain were -1.007 (p=0.028), -1.414 (p=0.018), and -2.029 (p=0.007), respectively. The areas of brush allodynia and pinprick hypersensitivity in the amputation stump showed marked decreases: -165 cm2, -80% (p=0.001) and -132 cm2, -72% (p=0.001), respectively. fMRI analyses provided objective evidence of the restoration of the brain map, that is, reversal of the shift into the hand representation of the cerebral cortex with the lip pursing task (p Conclusion The results show that capsaicin 8% patch treatment leads to significant reduction in chronic pain and, particularly, in the area of stump hypersensitivity, which may enable patients to wear prostheses, thereby improving mobility and rehabilitation. Phantom limb pain ("central" pain) and associated brain plasticity may be modulated by peripheral inputs, as they can be ameliorated by the peripherally restricted effect of the capsaicin 8% patch.
21 citations
TL;DR: Several early reports on phantom penile sensations are presented, with the intent of showing what had been described and why more than 200 years ago.
Abstract: Interest in sensations from removed body parts other than limbs has increased with modern surgical techniques. This applies particularly to operations (e.g., gender-changing surgeries) that have resulted in phantom genitalia. The impression given in modern accounts, especially those dealing with phantoms associated with penis amputation, is that this is a recently discovered phenomenon. Yet the historical record reveals several cases of phantom penises dating from the late-eighteenth century and the early-nineteenth century. These cases, recorded by some of the leading medical and surgical figures of the era, are of considerable historical and theoretical significance. This is partly because these phantoms were associated with pleasurable sensations, in contrast to the loss of a limb, which for centuries had been associated with painful phantoms. We here present several early reports on phantom penile sensations, with the intent of showing what had been described and why more than 200 years ago.
19 citations
Cites result from "Occurrence of phantom genitalia aft..."
...…penile sensations has been noted in other recent publications, some dealing with phantoms in general and others focused on the emerging but complex literature on gender-changing surgeries (e.g., Denes, 1989; Namba et al., 2008; Ramachandran & Hirstein, 1998; Ramachandran & McGeogh, 2007, 2008)....
[...]
References
More filters
TL;DR: In this paper, a virtual reality box is used to simulate the feeling of a real arm being touched by a real hand in order to study the inter-sensory effects of visual input on the phantom.
Abstract: Although there is a vast clinical literature on phantom limbs, there have been no experimental studies on the effects of visual input on phantom sensations. We introduce an inexpensive new device--a 'virtual reality box'--to resurrect the phantom visually to study inter-sensory effects. A mirror is placed vertically on the table so that the mirror reflection of the patient's intact had is 'superimposed' on the felt position of the phantom. We used this procedure on ten patients and found the following results. 1. In six patients, when the normal hand was moved, so that the phantom was perceived to move in the mirror, it was also felt to move; i.e. kinesthetic sensations emerged in the phantom. In D.S. this effect occurred even though he had never experienced any movements in the phantom for ten years before we tested him. He found the return of sensations very enjoyable. 2. Repeated practice led to a permanent 'disappearance' of the phantom arm in patient D.S. and the hand became telescoped into the stump near the shoulder. 3. Using an optical trick, impossible postures--e.g. extreme hyperextension of the fingers--could be induced visually in the phantom. In one case this was felt as a transient 'painful tug' in the phantom. 4. Five patients experienced involuntary painful 'clenching spasms' in the phantom hand and in four of them the spasms were relieved when the mirror was used to facilitate 'opening' of the phantom hand; opening was not possible without the mirror. 5. In three patients, touching the normal hand evoked precisely localized touch sensations in the phantom. Interestingly, the referral was especially pronounced when the patients actually 'saw' their phantom being touched in the mirror. Indeed, in a fourth patient (R.L.) the referral occurred only if he saw his phantom being touched: a curious form of synaesthesia. These experiments lend themselves readily to imaging studies using PET and fMRI. Taken collectively, they suggest that there is a considerable amount of latent plasticity even in the adult human brain. For example, precisely organized new pathways, bridging the two cerebral hemispheres, can emerge in less than three weeks. Furthermore, there must be a great deal of back and forth interaction between vision and touch, so that the strictly modular, hierarchical model of the brain that is currently in vogue needs to be replaced with a more dynamic, interactive model, in which 're-entrant' signalling plays the main role.
1,027 citations
TL;DR: It is suggested that patients with phantom limbs provide a valuable opportunity not only for exploring neural plasticity in the adult human brain but also for understanding the relationship between the activity of sensory neurons and conscious experience.
Abstract: Almost everyone who has a limb amputated will experience a phantom limb--the vivid impression that the limb is not only still present, but in some cases, painful. There is now a wealth of empirical evidence demonstrating changes in cortical topography in primates following deafferentation or amputation, and this review will attempt to relate these in a systematic way to the clinical phenomenology of phantom limbs. With the advent of non-invasive imaging techniques such as MEG (magnetoencephalogram) and functional MRI, topographical reorganization can also be demonstrated in humans, so that it is now possible to track perceptual changes and changes in cortical topography in individual patients. We suggest, therefore, that these patients provide a valuable opportunity not only for exploring neural plasticity in the adult human brain but also for understanding the relationship between the activity of sensory neurons and conscious experience. We conclude with a theory of phantom limbs, some striking demonstrations of phantoms induced in normal subjects, and some remarks about the relevance of these phenomena to the question of how the brain constructs a 'body image.'
968 citations
01 Jan 1998
717 citations
"Occurrence of phantom genitalia aft..." refers background in this paper
...Notwithstanding this malleability there is undoubtedly also a hard-wired, innately specified scaffold for body image; patients with congenital absence of both arms may also experience vivid phantoms [6,12,13]....
[...]
...Often repeated use of this procedure can cause the patient’s phantom arm to vanish [6,7,9,11]; indicating the remarkable malleability of body image....
[...]
661 citations
Book•
01 Jan 1998
340 citations
"Occurrence of phantom genitalia aft..." refers background in this paper
...After removal of a hand, the region of the somatosensory cortex that is de-afferented is ‘‘taken over’’ by afferents that normally innervate the adjacent face portion of the map [6–9]....
[...]
...Although phantoms are often paralysed, some can be visually ‘‘resurrected’’ by use of a parasagital mirror positioned vertically in front of the patient so that the reflection of the normal (say left) hand appears optically superimposed on the phantom [6,7,9–11]....
[...]
...Often repeated use of this procedure can cause the patient’s phantom arm to vanish [6,7,9,11]; indicating the remarkable malleability of body image....
[...]