Penis as Risk: A Queer Phenomenology

of Two Swedish Transgender Womens

Narratives on Gender Correction
Signe Bremer

Right now Im kind of in the middle of a nervous breakdown.

My psychologist did not think I hated my penis enough and my
investigator had a bad day, she said, so Ive been turned down until
further notice. . .

This quote from Vera, a preoperative transgender woman, reveals

Swedish gender-confirming health care as a system that provides
transgender women who aim for juridical gender correction with few
options for how to embody and present femininity. Real preoperative
transgender women are expected to be well-behaved, modest
and sexually passive, in line with the white, middle-class standard
of respectable femininity that informs the obligatory psychiatric
assessment required to alter legal sex. As I will argue here, in the
context of Swedish gender-confirming healthcare, such respectability is
intimately bound to the cultural genealogy of the penis of flesh. This
means that ideas of original, non-performative, sexually active, and
white superior masculinity clings to the penis of flesh, just as the penis
of flesh always sticks to its history the phallus.
The image of a woman with a penis does similar work to that of
the pregnant man they both destabilize the Swedish societys
naturalized and anti-transgender ideal of unambiguously gendered
bodies (Sullivan & Davidmann 2012). Accordingly, alternative forms of
gender embodiment (or corporealities) conjure up notions of chaos.
The naturalized assumptions that a persons birth-given material body,
legal sex, gender identity, gender expression, sexual desire, parental

Somatechnics 3.2 (2013): 329350

DOI: 10.3366/soma.2013.0101
# Edinburgh University Press
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status, kinship and death point in the same direction position

transgender women, who desire legal gender recognition but not
genital surgery, within the sphere of the unthinkable, uninhabitable,
unintelligible and less human. Therefore in a psychiatric contex
transgender women are denied sexual pleasure before they are
granted the legal status as female. Any sign of sexual activity before
vaginoplasty would imply a certain degree of penis acceptance. Thus,
I argue, the penis, and transgender womens acceptance of it, becomes
a risk. Denial of transgender womens sexuality is also coupled
with ideas about fetishist transvestism acting as the sexualized
and false constitutive outside to real and sexually passive male to
female transsexualism. According to psychoanalytical theories of
sexual pathology, which form the cultural horizon through which
transgender women are assessed, fetishism is isolated to the domain of
men. Transgender women who turn to gender-confirming healthcare
are thus always already perceived as potential male fetishistic
transvestites. A transsexual man on the other hand appears as less of
a threat since unlike to his transgender sister he cannot occupy the
fetish position.
What alternatives do transgender women who undergo
Swedish psychiatric gender assessments have for articulating and
embodying alternative forms of femininity? What is the role of bodily
materiality in the processes whereby intelligible, real and respectable
femininity is made, renegotiated, and lived in transgender womens
meetings with Swedish psychiatry? In addressing these questions, this
article focuses on public assumptions of real intelligible femininity
and on strategies of resistance, as they appear in two heterosexual,
white and postoperative transsexual womens narratives in email
correspondence and interviews about their lived, bodily experiences
of gender correction: 50 year-old Vera and 30 year-old Tove, both
Swedish citizens. The opening quote is part of the email conversation
I had with Vera in 2008, when she found out that the outcome of her
first year in gender assessment was negative. She received the
statement after a meeting that is customarily held when a patients
gender assessment has passed roughly one year, positively with the
preliminary diagnosis of transsexualism as a possible result. Yet, instead
of getting a preliminary diagnosis, Veras process was temporarily
delayed. The same psychiatrist, who initially confirmed Vera as an
authentic female and genuine transsexual, suddenly changed their
mind or so it seemed. The other subject of this article, Tove, and
I met when she had completed most of the gender corrective
surgery and had lived legally as a woman for a year. In contrast to

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Vera, Tove had met with her psychiatrist many times over several years.
Tove described her relationship to her psychiatrist as business-like:
she compared it to the seemingly neutral, but still asymmetrical
relationship between a manager and an employee who are both aware
of the legal and cultural terms for interaction with one another.
Vera and Tove are two of eighteen Swedish transgender persons
featured in my four year ethnographic research on lived experiences
of gender correction.1 This article centres on Veras and Toves
narratives, because theirs addressed the concrete effects of penis
acceptance as a risk in transitioning. Ethnographic research is not a
positivist science that strives for statistically valid claims about an
objective order of things. Rather, empirical data might be seen as a
kaleidoscopic assemblage of visual, written, and oral stories, which
form a version of transgender social life as it is lived by some subjects
within the group (Marcus 1998). Because of the ethical sensitivity
of involving individuals whom are in the middle of their gender
assessment in a qualitative study conscious ethical considerations were
made throughout the research project. Inspired by critiques delivered
by Vivianne Namaste (2000), Jay Prosser (1998) and Sally Hines
(2007), among others, I strived for an ethically accountable study
situated in the contributors everyday lives, written in ways that could
be politically useful in trans-activism.2
As a field of research, transgender studies foregrounds
the inescapable interrelations between social bodies, bodies of flesh
(soma), technology, state governance, and subjectivities (techne)
and the material consequences of such configurations in and for
transgender peoples lives. Taking a critical stance towards the
historical, cultural and political processes or somatechnologies
through which materializations of gender belonging are embodied,
made, renegotiated and lived, transgender studies underlines the
body of flesh as the fundamental, but nevertheless contingent, starting
point for any persons being in the world (Ahmed 2006; Stryker 2006;
Sullivan 2009). Transgender is sometimes, but far from always,
equated with a desire for a new juridical gender and/or access to
opposite sex hormones and/or gender corrective surgery. In a medical
context the terms that have historically been used to address such a
desire, are transsexualism and gender dysphoria; according to Western
international diagnostic manuals, regarded as a psychiatric diagnosis
treatable with surgical and hormonal intervention. Yet, since the
genealogy of transsexualism, as a psychopathology, involves multiple
practices of biopolitical oppression, many transgender people with
needs similar to the diagnosis now avoid using these terms.

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Accordingly, I only use the term, transsexualism, with regards to

the medical diagnosis. Until recently, Sweden, and the overall Nordic
region, lacked humanities research specializing in transgender
studies. The past few years has seen a major increase in attention to
transgender phenomena (Harrison & Engdahl 2010).3 This is
evidenced among other things by a number of dissertations
defended and in progress at Nordic universities on the subject.4
Thus far, my work is unique in its focus on qualitative experiences
of Swedish gender correction (Bremer 2011a).5 Transgender is
frequently used as an umbrella term, referring to identities,
expressions, bodies and lives that do not fit with binary gender
assumptions of what is commonly believed to be real women and
real men.
The article consists of three parts. Given that few studies
of transgender lives in Sweden have been published in English,
part one offers a bit of context for the present discussion. Secondly,
I outline key elements of queer phenomenology as the framework
that theoretically underpins the study. The main part elaborates
the articles founding arguments drawing on Veras and Toves
narratives. In closing I discuss what an analysis of the heretofore
legal and cultural conditions (forced castration being newly
abolished from the law) brings to discussions of transgender
womens situation today.

Sweden a context
Successful nation branding has constructed Sweden as one of the most
modern, good, non-racist, LGBTQ friendly and gender egalitarian
nations in Europe, with an equally successful separation from a
national history of advanced racial biology that resulted in eugenics
(Hubinette & Lundstrom 2011: 4; Rydstrom 2011). A crucial part of
this story is that Sweden was the first country in the world to legislate
state funded gender correction in 1972. Due to a general lack of
transgender legislation globally, the law was viewed as radical for its
time. That Swedish gender-confirming healthcare is state funded,
means that surgical and hormonal gender correction is paid for by
public taxes, and personal cost such as medical products, hospital
visits and travels that exceeds the officially established limit, is
subsidized. However, no changes have been made in the legal wording
between 1972 and 2013, thus leaving the radical potential of modern
Swedish transgender law fundamentally weakened. Until recently,
the Swedish law on the confirmation of gender in certain cases has

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stated that any person who wants to change their legal sex has to be
over 18 years of age, unmarried, without reproductive capacity and
a Swedish citizen.6 The required lack of reproductive capacity has
been publicly described as forced sterilization, but practiced as
forced castration. That is, rather than blocking the path of sperm
and egg cells (sterilization), the gonads (testicles and ovaries) are
permanently removed.
Swedish gender-confirming healthcare follows a single script.
Once a patient is registered as undergoing a psychiatric gender
assessment, they can either choose to go all the way including
hormone therapy, genital surgery and new legal sex or drop out of
(or be discharged from) the assessment.7 The gate-keeping routines
that condition transgender peoples access to gender correction
mirror rigid culturally specific heteronormative ideas of what makes
non-ambiguous real men and women. The final gate-keepers are not
the psychiatrists in charge of the assessments, but The National Board
of Health and Welfares (NBHW) special unit for gender corrective
affairs, The Legal Advisory Board, who has the final say before the legal
sex of any Swedish citizen is altered. This is further reinforced by
the fact that only a few of Swedens altogether six centralized units
for gender assessments have more than one psychiatrist working
within the team, which generally include specialists from psychiatry,
psychology and social work. This circumstance makes it difficult for
those who wish to change investigators. Furthermore, although
transvestic fetishism was abolished from the Swedish version of ICD-
10 on January 1st 2009, it stands out as one of the prime characteristics
for being rejected from the differential diagnostic work establishing
the diagnosis male to female transsexualism. Transgender women are
thus frequently asked about their masturbation habits and potential
erotic investments in traditional womens undergarments (Landen
et al. 2001; Edenheim 2005: 119; Kroon 2008: 71; Bremer, 2011a:
106117).8
Interestingly, civil rights activist and trans law scholar Dean Spade
once compared the current Swedish system to the early gender clinics
back in the U.S. during the 1960s and 70s, which were critiqued as a
gate-keeping and gender conservative system (2009: 369). Even though
the national contexts of Sweden and the US are very dissimilar for
example in regard to the poor American social security system and
gender correction in the U.S. largely being a question of funds
Swedish gender-confirming healthcare, as it is generally practiced
today, is partly comparable to American gender-confirming healthcare
60 years ago (Ibid.).

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Since The NBHW was sued and convicted for violating the
European Convention on Human Rights and the United Nations
Universal Declaration of Human Rights in 2010, there are no longer
any legal hindrances for married people undergoing gender
correction. The Swedish government has also received much critique
regarding its policies on forced castration, as forced castration
has been internationally recognized as violating the United Nations
Universal Declaration on Human Rights and the European
Convention on Human Rights. This is, I argue, what made the
official Swedish governmental view finally change, from a conservative
wish to maintain castration, to interpreting the law as obviously
inhuman and in need of abolition. A new law was adopted from
January 1, 2013. Since the Swedish government declared that questions
concerning family formation, and the legal benefits associated with
parenting, had to be further investigated, it was decided that forced
castration was not to be abolished from the law until July 1, 2013, at the
earliest. Nevertheless, The NBHW was recently sued and convicted
again, now for violating both Swedish constitutional law and the
European convention of human rights, after they rejected legal gender
recognition to a transgender person who refused to get rid of their
reproductive capabilities. From there on practicing the law would have
been illegal, even though lack of reproductive capacity was formally
not abolished from the law several months after.9
Invocations of human rights have changed public and state
opinion. Among the critics of the Swedish transgender legislation was
Thomas Hammarberg, former European Commissioner of Human
Rights. Hammarbergs report, Gender Identity and Human Rights (2009)
radically altered the political language through which transgender
rights has been articulated in Sweden since. Accordingly, it seems that
transgender rights can only be accepted as valid rights if they are
articulated in a human rights discourse, which as many have argued, is
part of Eurocentric history, Western colonialism and liberal capitalist
culture (Sullivan 2009: 278; Spade 2011). Transgender activists
arguments, made strictly from a human rights perspective therefore
risk veiling a number of intersecting power axis - such as race,
functionality, sexuality, age and class which form how transgender
people situate themselves globally. The human rights discourse
disguises how, historically speaking, the white, Western, heterosexual,
able bodied man has figured as synonymous with what is culturally
believed to constitute the Human. Along those lines, racial, ethnic,
disabled, sexual and gender minority groups, such as transgender
people, are rendered less human. The human right to that which,

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according to heteronormative, white, middleclass, western ideals, is

regarded as a normal and thus happy life, could in fact exacerbate
and/or replicate, rather than reduce, institutional transgender
oppression (Ahmed 2010; Spade 2011). This normative human
rights discourse is crucial for understanding Veras and Toves
healthcare situations, since their quality of life are not only questions
of legal rights. Similar anti-transgender attitudes that once made
Swedish politicians legislate in a way that caused transgender people
physical and mental harm have also frequently been, and still are,
materialized in acts of gender based violence in other areas of
transgender peoples everyday lives.

Linear gender
Vera and Tove turned to Swedish gender-confirming healthcare,
as they experienced severe suffering without legal acknowledgement
of the gender they recognize themselves to be the material and
felt sense of who they are as gendered subjects in the world. Taking
their embodied experiences, and the cultural conditions through
which their felt sense of being a material person in the world arises
theoretically and ethically seriously, I turn to Sara Ahmeds queer
phenomenology. It adheres to critical queer and postcolonial
perspectives, while also making the phenomenological argument
that our bodies provide us with a perspective: The body is here as
a point from where we begin, and from which the world unfolds,
as being more and less over there (Ahmed 2006: 8). Central to queer
phenomenology are questions of orientation; how embodied subjects
make their ways through life and how bodies take place in, pass
through, impress on, and inhabit space (Ibid: 5). Here I discuss
two transgender womens embodied experiences of finding their
way through the Swedish, gatekeeping, psychiatric gender assessment,
and further into what they imagine as a more livable and good life.
(Ibid: 5).
How Vera and Tove make their way through life their
orientations is not coincidental. Rather, the routes through which
a persons life is expected to occur are determined by normative and
performative lines. Lines serve as spatial, pre-set routes for how life
ought to be shaped in order to be recognized as a life worth living.
They direct, condition, and make embodied subjects and the
worlds they inhabit. In the context of Swedish gender-confirming
healthcare, this means, for example, that vaginoplasty can be analyzed
as part of the seemingly naturalized orientation which historically is

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assumed as equated with real male-to-female transsexualism. Queer

phenomenology underlines embodied subjectivity as conditioned
through a naturalized western, white and heteronormative straight
line, whereas straight refers to both the expected verticality of lines, as
well as, normative monogamous two-some heterosexuality (Ahmed
2006: 6671). Except for the obvious straightness of heteronormativity,
it is an institutionalized model that organizes bodies according to
two ideal types: the able and white, middle class, masculine man and
the able and white, middle class, feminine woman, who are assumed to
match, desire, reproduce and monogamously organize life with one
another as if by nature (Butler 1990).
Following Ahmed, I contend that Vera and Toves lives are
regulated through what I call linear gender. Linear gender explicates
the heteronormative assumption that a persons genitals, general
bodily materiality, legal sex, gender identity, gendered expression,
sexual desire, ways of reproduction, parental status, kinship and
death point in the same direction through a life course along a
straight line from birth to death (Bremer, 2011a: 214). Linear gender
is similar to Fanny Ambjornssons and Janne Bromseths notion of
a heteronormative life script, which explains, for example, why a
middle aged, single lesbian is likely to be assigned a non-adult and
less responsible position, while a heterosexual, married mother, is
generally not (Ambjornsson and Bromseth 2010: 207). Ambjornsson
and Bromseth center heteronormativity as normative heterosexuality
and family formation. Gender-queer bodies and thus cisgender
privilege are largely left out of the picture. Cisgender privilege is a
term for a person whose body morphology, legal sex, gender identity
and gender expression point in the same direction, according to
established norms, and who, because of their cispositionality, are less
likely to have their gender questioned (Serano 2007; Cavanaugh 2010:
54). Here linear gender is an analytical tool which: a) exposes
normative gender and binary embodiment as a central and yet often
neglected, aspect of heteronormativity, as it is historically applied
in Scandinavian queer studies, and b) problematize cisgender, since
it reduces trans and non-trans positions as seemingly clear-cut
counterparts. As opposites, they are expected to either transcend or
secure societys gender norms. Linear gender admits the multiple, and
sometimes overlapping, dimensions of cisgender and heterosexual
privilege. For example, non-trans people with sexually queer identities,
such as butch lesbians and effeminate gay men, sometimes have their
gender questioned. Equally, transgender people sometimes have their
sexuality questioned, simply because they are read as gender-queer.

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Just as Swedish gender-confirming healthcare is situated in time

and space, the normative lines that work as its normative prerequisite
are fundamentally plastic. Although linear gender works as the
normative script through which Vera and Tove are compelled to
embody gender in order to qualify as legitimate candidates for
gender correction, there are also always opportunities for change.
By intentionally or unconsciously treading and repeating alternative
paths, new lines and alternative bodily forms of existence, that is
resistance, become imaginable (Ahmed, 2006: 18). Nonetheless, Veras
narrative reminds us that sometimes being the one who takes the
alternative path has a price in this case, temporary denial of
diagnosis, anxiety and distress. Her quality of life deteriorated.
Nevertheless, Vera chose to take action.

The promise of aversion

Vera felt misunderstood and upset after receiving the negative
statement from her psychiatrist and sent the psychiatrist a letter
of complaint to the psychologist who had stated that Vera did not
detest her penis enough to come across as truly transsexual.
She writes:
Now we come to my penis, as you know, I have no grudge against it in the
way that I want to cut it off or something like that. Because of this feeling
I never made contact with the healthcare system in the 80s, since
interviews with TS people that I read only focused on how they tried to
cut off their penises. This gave me the impression that a change of sex
was not something you could seek help for on your own, but was assigned
from the hospital bed. Yet, most TS that I come in contact with, in
retrospect, think that your interest in genitals, or the desire to become
mutilated, is exaggerated. The only people who take that position, that
they cry when they get a hard on, who want to chop it off and so on, are
people who are very, I emphasize, very mentally unstable.

In writing the letter, Vera refused to accept the meaning that the
healthcare staff assigned her body and those of other transgender
women. In part, the letter is her way of laying claim to her body and
her lifes future trajectory, one where linear gender is not the only
imaginable way to organize an intelligible, and thus good, life. Not only
does she oppose penis aversion as essential to the male-to-female
transgender experience, she also labels transgender women, who
are appalled by their penises, as unstable. Instead of turning to
gender-confirming healthcare, the younger Vera thought that a

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transgender womans desperate attempt at penis mutilation was the

requirement for hospitalization and a doctors subsequent prescription
of gender-confirming treatment.
Veras email is slightly ironic in that it draws on urban legends of
gender correction (Bremer 2011a: 120). One recurring account in
Sweden features a transgender woman so desperate to undergo gender
correction that she goes to an emergency room, cut off her penis and
demands to be sewn back together with a vagina. A version of this was
even presented by a well-known, experienced Swedish psychiatrist in a
national TV show. While told to illustrate transgender suffering, it too
effectively reduced the lived experience of gender transitioning to a
fixation on genitalia. The point here is not to evaluate the storys truth
claim. Rather, its power lies in its ability to shape the situation in which
Vera found herself when she was temporarily denied diagnosis, and
explains why the younger Vera did not turn to gender-confirming
healthcare when she did not think that she resented her penis enough.
Self-harming actions, caused by a strong sense of penis aversion,
appear to lead to a promise of legal and bodily gender correction. In
stating her arguments, Vera ensures that her psychiatrist understands
that she refuses to accept the terms of such a promise. Her email
also articulates that those transgender women, seeking juridical
womanhood, who do not condemn their penises as something to be
removed, are far from the minority.
That said, I am not suggesting that if Vera had been given the
choice to do so, she would have continued her life without a vagina.
The point here is that, regardless of Veras intention to undergo
genital surgery, the legal and cultural conditions of Swedish gender-
confirming healthcare at that time offered very few alternatives
for embodying and presenting femininity. Recent achievements in
Swedish Trans politics have since changed these terms; but these were
the rigid terms that Vera had to negotiate with at the time.
Interestingly, neither diagnostic manuals nor Swedish law, as it
looked before the change, had ever included removal of congenital
genitals as a mandatory condition for giving a diagnosis or changing
ones legal sex. To feel, as stated in ICD 10, discomfort with, or
inappropriateness of, ones anatomic sex, is not synonymous with
complete aversion to, or a wish to get rid of, the gonads or sexual
organ (ICD-10 F64.0). Obligatory genital surgery for transgender
women is thus the effect of an institutionalized interpretation and
normalized part of the expected transsexual narrative (Stone 1991:
297; Sullivan 2003: 112; Hines 2007: 63). These ideas had material
consequences for how Vera could imagine her future life course.

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The penis is assumed to be the obvious abject limb of all preoperative

transgender women who aim for a female legal status. Genital surgery
then, becomes the concrete means through which authentic gender
transitioning, and a preoperative transgender woman, can finally reject
that which is assumed essentially opposite to, yet also intimately part
of her. As Julia Kristeva writes, It lies there, quite close, but it cannot
be assimilated; the abject penis is the offensive and inescapable
constitutive outside of male-to-female transsexual authenticity
(Kristeva 1984:1).
Importantly, transgender men do not face these conditions.
The vagina does not pose as their obvious abject, even if a transgender
mans pregnant belly might (Sullivan and Davidmann 2012;
Bremer 2011a: 207212). This was apparent in the media storm
surrounding Thomas Beatie, globally known as the pregnant man,
when he was expecting his first child.10 Unlike transgender women,
Swedish transgender men have always had the possibility to keep their
congenital sexual organs. As a result, there are very few, legally female
Swedish citizens with penises, but an increasing number of legally
male Swedish citizens with vaginas. Yet, as Nikki Sullivan and Susan
Stryker (2011) show, todays manuscript of normative male-to-female
transsexualism has not always existed. In the early years of
gender-confirming surgery, the standard procedure was not surgical
transformation of the penis into a vagina (vaginoplasty). Instead, plain
amputation of the penis (penectomy) and removal of the testicles was
the norm. Vaginoplasty was regarded a non-obligatory aesthetic
surgery, and many physicians did, in fact oppose genital surgery as a
needless removal of healthy limbs (Sullivan and Stryker 2011: 5455).
In other words, it was not the presence of a vagina that changed
the relationship between the male-to-female transgender body and
the state, in the early ages of transsexual surgery, it was the absence of
a penis (ibid: 5455). These historical shifts underline how
transgender bodies and subjectivities are bound up with medical
technology and biopolitics, just as technology is also the means by
which transgender subjects actively turn to medical authorities in order
to realize themselves as the gender they recognize themselves to be
(Sullivan and Murray 2009).

Fear of fetish
There may be other reasons for why the medical staff in charge of
Veras assessment did not give her a diagnosis. Veras email reveals that
Vera did not only transgress the mandatory standards of penis

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aversion, she also refused to accept being denied her sexuality (Kroon
2007; Bremer 2011). She writes:
I sit in front of the psychologist and she almost in passing asks about my
penis, I say that I have no problem with my penis, in that, as I mentioned
earlier, indifferent and arrogant tone Ive obtained because Im so tired
of all the interrogating. When I noticed that she raised her eyebrows in
surprise, it simply added to my need to show my feeling of I dont care
about your questions because I am a TS and if Im not a TS, there are no
TS attitude. Sure, I can masturbate to a porno movie, I believe I said,
or something like that. . .

Frustrated about having to repeat her story a third time, Vera did not
have enough energy to, once again, tell her story according to the
narrative of heteronormative, sexually submissive, modest and white
middle class femininity (Skeggs 1997; Dahl 2011). As she self-
confidently, and seemingly casually, tells her psychologist that
she might have been masturbating while watching a pornographic
movie, Vera misbehaves in a way that transgresses respectable
femininity. She is loud, disruptive, sexually active, and she complains
to her psychiatrist. These are all properties which, according to
sexist logic, make her seem male, in the context of a psychiatric
gender assessment. Normatively speaking, a real white woman
should not be loud, self-confident or outspoken about her sexuality
(Skeggs 1997; Kroon 2007). As the psychologist raises her eyebrows in
concern, Vera defies normative, respectable femininity while, in anger,
she leaves the already deserted script of normative transsexualism
behind.
Ann Kroon and Erika Alm have shown that early Swedish
psychiatrists engaged in creating gender confirmative healthcare,
held a strong conviction that male-to-female pre-op transgender
women could not (or should not) be sexually active before
genital surgery (Kroon 2007; Alm 2006: 145; see also Stone 1987).
According to Sandy Stone, in the US, up through the 1980s, no
preoperative, transgender woman would have risked confessing that
she masturbated, or that she was having sex. Veras situation confirms
Stones argument. Judging from the consequences of her actions,
preoperative, transgender women are still deprived of their sexuality
and the possibility to feel good through sexual pleasure. Even so,
I read this section of Veras email as resistance through illicit pleasure.
She admits the reality of her sexual urges and that she sometimes
chooses to act on them, despite the fact that the sexist context in which
she acts, expects her to be passively waiting for genital surgery before

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she can begin having a sexuality at all (Stone 1987; Sullivan 2003;
Kroon 2007).
Furthermore, the de-sexualization of preoperative, transgender
women is clearly related to psychopathological ideas of fetishistic
transvestism, acting as a constitutive outside to real transsexualism.
As Sara Edenheim states, transvestism serves as the threat in the
investigation on transsexualism, as the incorrect which threatens to
fool the doctor and the law from spotting the genuine and legitimate
transsexualism (Edenheim 2005: 119; authors translation).11 All
of the 18 participants in my study were aware that the fetishistic
transvestite is a precarious position for transgender women, Vera even
said that, Actually, she [the psychiatrist] wants to find out if I am a
fetishist transvestite. In addition to opinions on her sexual activity and
alternative approach to penis aversion, Vera also received comments
on her clothes. The psychiatrist seemed to think that Vera ought to
dress more according to her age. Indeed, my material shows that
transgender women are often subjected to special attention regarding
fashion and taste, by the healthcare professionals who are involved in
their assessments. Clothes and fashion come up as a result of the
stereotyped assumption that fetishistic transvestites act as transsexual
womens tasteless, sexualized, hyper-feminine and thus false, Other.
Rejecting transvestism, and any characteristics associated with the
category, was one of the means by which diagnostic authenticity, and
thus linear gender, could be continually produced and maintained,
both by healthcare professionals and transsexual women (Bremer
2011a: 106123). Transgender men, on the other hand, seem
unaffected by this potential risk. In fact, as both Nikki Sullivan and
Anne McClintock show us, fetishism, as a psychoanalytic category of
sexual pathology, has historically been isolated to the domain of men
(Sullivan 2003: 176; McClintock 1995; cf. Kroon 2007). According to
Freud, the fetishized object is a mans substitution for his mothers lack
of a penis, and thus it acts as a lucky charm for the mans fear of
castration (Sullivan 2003; McClintock 1995). The DSM describes
fetishistic transvestism as heterosexual men wearing traditional, female
clothing in order to obtain orgasm through appropriation of the
female gender role (DSM IV-TR, 302.3). In terms of transgender
womens gender assessment, these theories are the historical, cultural
horizon by which psychologists and psychiatrists understand
transgender positions today. None of the transgender men in my
study mentioned transvestism as a precarious position in relation to
themselves or transgender men as a group, only in relation to
transgender women.

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Here we might understand the penis as a sticky object

(Ahmed 2004: 89). As a sticky object, the genealogy of the penis, as
a cultural symbol, sticks to the penis as a bodily organ, similar to that
of fresh glue that clings itself to objects within near reach. As
Ahmed argues, [W]hat sticks shows us where the object has
travelled through what it has gathered onto its surface, gatherings
that become a part of the object (2004: 91). Like historic glue, the
symbolic phallus, composed of white male authority and sexual
domination, Freudian fetish theory sticks to the penis of flesh just
as the penis of flesh sticks to its genealogy (cf. Bordo 1999: 95). For
the transgender women in my study, what sticks to the penis
orients mental health professionals to ask some questions and not
others. At the same time, Freudian theory of sexual fetishism
orients mental health professionals to the penis. Veras future life
trajectory, as legally female, gets blocked since she is penis accepting,
sexually active and dressed in a way that her psychiatrist considers
inappropriate for her age. What clings on to the penis renders Vera a
potentially hypersexual male appropriating the female gender role as
a fetish and thus, according to Freudian fetish theory a penis
substitute.

The abject as keepsake

Unlike Vera, Tove has not had problems with delayed assessments or
medical staff telling her that she did not hate her penis enough. Toves
overall impression of the years she spent in gender assessment is that it
went well, in the sense that her assessment was not postponed or
cancelled, and she never doubted that her psychiatrist believed that
gender correction was the right treatment for her. In contrast to Vera,
Tove explained that her psychiatrist thought she was an authentic case
of the diagnosis, and that Tove was so good looking as a woman, that
the psychiatrist had actually wanted to show her off to their colleagues
as an example of how good the outcome of a gender correction can
be. Aside from the potential satisfaction of getting compliments,
Toves story is an example of a psychiatrist who seems to understand
her postoperative transgender client as, more or less, aesthetically
pleasing products created by others; another expression of anti-
transgender and heterosexist objectification. Similar to the rest of the
narratives in my study, what is considered aesthetically pleasing, in
the eyes of Toves psychiatrist, is a postoperative bodily here and now
that materialize in line with heteronormative intelligibility (Bremer
2011; Kroon 2007).

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 Penis as Risk

Aside from her own personal experience, Tove explained that she
knew someone who had been denied further assessment because of
her reluctance to undergo genital surgery. As we talked about it, Tove
seemed provoked by the fact that this person spoke openly about her
wish to continue life with a penis to her psychiatrist. She says:
Last week someone I know was kicked out of the assessment. Because
she . . . yes she did apparently tell everyone in the team that she wants to
keep her dick and stuff like that. My best friend also wanted to keep her
dick when she began her assessment. She made no big deal about it.
Because she had a similar attitude as me, that I have no major problems
with it today other than it can be in the way sometimes . . . like
that . . . Then as time passed she did actually feel that she wanted to go
all the way. And it would not have been in her favor if she had stood there
explaining that she wanted to live as something in between in the
beginning. This other person has done so and now the whole process is
just called off . . . so . . . in that situation, that you have that degree of
doubt, I would not recommend that you talk about it with the team, or at
least not make a big deal about it, just as she did. And she did not take my
advice so I guess she has herself to blame.

Tove describes her friend as naive and unnecessarily open about her
wish to keep her penis. She seems to think that the reason her friend
was discharged from the assessment was self-inflicted. Here, Tove
seems quick to interpret her acquaintances wish to continue life with a
penis as a sign of doubt. Tove does not consider her friend suffering
from real transsexualism. A different perspective might suggest that
her acquaintance is not doubtful but rather resolved to go through
with legal gender correction with both her integrity and genitals intact.
She refused to orient herself in line with normative expectations of
real transsexualism. Ideas of un-performative and original masculinity
stick to the fleshly penis rendering her bodily future as between
lines, bent and queer.
Toves narrative might also suggest that she and her best friend
were gradually pushed into line during the course of gender
correction. It appears as if Tove mostly found her penis to be in the
way sometimes. Yet, since she chose not to relay her possibly queer
understanding of the penis, she still had the capability to pass as
really transsexual. Her bodily future materialized in line with
assumptions of what counts as a life worth living. Thus, Tove was not
blocked in her journey straight forward on the path towards gender
correction, and that which she holds as a livable life as legally female.
Why Tove and her best friend changed their minds from accepting

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their penis, to deciding to undergo genital surgery, is not simply an

individual choice, however; they had no other choice but accepting the
terms and fall into line. This was what most people in the Swedish
transgender community believed, before criminal proceedings came
across as an alternative. One of the few plausible strategies to deceive
the system would have been having dual citizenship, with one foot in
Sweden and one foot in a nation where forced castration was not part
of the legal terms for gender recognition. After correcting their legal
sex abroad, they would probably have had the possibility to demand a
new, corresponding legal status in Sweden, without the necessity to
pass through the National Board of Health and Welfares Legal
Advisory Council. Yet, this is a strategy that requires time, energy and
money that most transgender people do not have.
Earlier in the interview Tove expressed some relatively
unconventional, thoughts about her former organ. Before she went
through with vaginoplasty, Tove decided to save a keepsake from her
past:
. . . It has not felt like a part of me, it has more or less . . . I have repressed
that it was there at all. It has not been a major part in my life. So I have
not felt any hatred for it at all [laughs] . . . but . . . I made a cast of it
before I [said with a laugh] had the operation. I thought it was a little bit,
well, symbolic. Like now I have it at home. . .and I can literally fuck myself
with it. . . [laughs]

As a material memory of abject flesh, Tove can still picture that body
part which cultural significance, if not amputated, would have made
some believe she was a male fetishistic transvestite. The Freudian past
of sexually active masculinity and fetish psychopathology, sticks to
the now prosthetic penis the cast and vice versa. In transforming
penis into vagina, Tove was able to erase both her own bodily history as
legally male, as well as, make the cultural penis disappear from view. As
both Tove and Veras narratives clearly show, any attempt to
incorporate the penis as part of a legally authorized female body is
closely related to the fact that transsexual women are, and have
historically been, at risk for being rendered abject themselves.
Toves psychiatrist is unaware of Toves penis cast. Since one has
to be accepted at the Legal Advisory before one can be granted
surgery, Toves bodily future was beyond the psychiatrists control by
the time she had the surgery. Tove was already confirmed to be
fulfilling the diagnostic criteria. The cast might here be understood as
a melancholic materialization of the more or less, impossible bodily
future Tove never had the choice to take into consideration - an

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alternate, bent and queer path that, according to the valid terms at that
time, did not exist. At the same time, making a cast of her penis
provides an alternative path of its own. The cast queers her bodily past,
as well as her future. She was bold enough to do that which, according
to a rigid gender normative, wrong-body discourse, would be
considered a forbidden act. This is similar to what Sandy Stone
writes about when she describes preoperative transgender womens
fear of admitting sexual activity in front of their psychiatrists:
Wringing the turkeys neck, the ritual of penile masturbation just
before surgery was the most secret of secret traditions (Stone 2006:
228). Like a preoperative transgender woman masturbating before
surgery, making a cast of the penis and later on joking about using it, is
a way of bashing back on the sexist conditions of gender correction.
Here, Tove goes from a slightly conservative position, to sharing
the radical story of the cast, while making jokes about the possibility to
masturbate with it her own self-made prosthetic penis and phantom
limb. By preserving the abject keepsake from the past manhood she
once rejected Tove, just as Vera, clarifies that mandatory penis
aversion does not count for all transgender women who desire access
to hormones and/or legal status as women. And further, just as Vera,
Tove rejects the assumption that male-to-female transsexualism is
synonymous with white, sexually submissive, and modest middleclass
femininity. Although Tove laughed frequently when she talked about
what she had done that final moment before surgery, it was not the
kind of laughter that signals shame or embarrassment. Rather, Tove
was laughing in the face of defeated danger represented by her
psychiatrist, the Legal Advisory Board and the overall heterosexist
conditions of Swedish gender-confirming healthcare. The cast
resembles a trophy from a hard won victory. It really seemed to be
the right thing to do at the moment. Laughter is an effect of resistance.

Closure
The Legal Advisory Council, at the Swedish NBHW has been consistent
in requiring vaginoplasty as an unconditional prerequisite for
transgender womens gender correction. With regard to Veras and
Toves situations, the general practice of Swedish gender-confirming
healthcare, at that time, gave the impression that transgender women
simply had to go through the procedure.
Thus, as I have shown in this article, vaginoplasty has in
reality never been a mandatory procedure in theory - neither
according to Swedish transgender legislation, nor to international

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 Somatechnics

diagnostic criteria. Yet, years of repetition have produced sexual

passivity, penis aversion and vaginoplasty as the natural and thus only
acceptable path to transgender womens legal gender recognition in
practice. By refusing to accept the meanings which the Swedish society
in general, and gender-confirming healthcare in particular, have
assigned their bodies, Vera and Tove negotiate with, and resist, the
anti-transgender, implicitly racist, colonialist, and bourgeois conditions
through which transgender women become recognized as respectable
and thus intelligible candidates for legal gender correction. As Veras
and Toves narratives show, attempts to bend the rules of penis
aversion have material consequences for transgender womens future
life trajectories. Their situations actualize the limits of bodily self-
determination the somatechnic events when public authorities
political investments in bodies outweigh the individual citizen. As the
abject belly of a pregnant man a legal woman with penis are coupled
with ideas of chaos. One common argument in Swedish political
documents concerning continued forced castration of transgender
people remains that a real woman is someone who may or should
become the mother of a child. Similar to the pregnant man, a legal
woman with a penis would risk creating disarray in the linear kinship
between gendered subjects. In light of this argumentation obviating
the possibility for women to give life through ejection of semen and for
men to become pregnant is the means through which the Swedish
state has been able to prevent linear kinship from shattering (Alm
2006: 193; Bremer 2011a).
What relevance does an analysis of heretofore legal and cultural
conditions have for the situations which transgender women now face
in current Swedish gender confirming health-care? My study offers
historically important insights in a cultural context situated in a time
and space when Swedens transgender population was obligated to
leave their reproductive capabilities and healthy organs behind as they
struggled for legal gender recognition. We must not forget that this
is still the reality for transgender people in numerous nations
globally. Legally speaking, there should no longer be any hindrance
for transgender women to be granted legal status as women without
submitting to genital surgery in Sweden. Yet, the shift in legal
conditions does not necessarily mean that penis acceptance can no
longer be considered a risk for transgender women who undergo
gender assessment. These changes do not make the Freudian
genealogy of the cultural penis unstick from the penis of flesh. Thus
it is reasonable to assume that fetishistic transvestism will remain as
the constitutive outside to what is generally assumed by mental

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 Penis as Risk

professionals working within gender confirming health care as real

transsexualism. Gender confirming health-care does not only care for
the patients who turns to its business it works to protect the Swedish
society from bodies that is historically associated with ideas of
disruptive and abject sexual perversions.
As a final point, the anti-transgender structures lying behind these
processes are not isolated to the members of the Legal Advisory Board
or the health care professionals working with gender assessments.
These are the same anti-transgender principles of linear gender which
lies behind how transgender people globally are always at risk for being
subjected to marginalization and gender based violence be it in the
home, the neighborhood, gender segregated public toilets and
dressing rooms, swimming pools, gyms, public transport, and park
areas. In order for this to change, more profound and radical
strategies than those available in a human rights discourse will be
needed (Spade 2011).

Notes
1. The study (Bremer 2011a), which was conducted between 2007 and 2011 explores
how the medical category transsexualism is embodied, made, renegotiated and
lived over the course of gender correction. Four central themes are identified and
thus form the structure of the dissertation: waiting, qualifying, passing, net-working
and legal affirmation. I base the study on: twenty-seven in-depth interviews with
persons undergoing gender correction, three transition blogs, longer reflective
texts written by two informants, texts posted on internet forums, photographs,
e-mails and ethnographic fieldwork notes. Eight participants identified as women
and ten as men and they were between ages of 20 and 50, and in different stages of
gender transition.
2. All names, geographical specificities and hospital wards are fictitious in the text. All
contributors were informed that they could choose to completely withdraw their
participation at any time, and one of the contributors chose to do so. Ethical
considerations have also been made in choice of theory, research objectives,
interview questions, terminology, analysis and writing style. For further discussions
on research ethics and reflexivity, see Bremer, 2011a and Bremer, 2011b.
3. Zeiler and Wickstrom 2009; Alm 2010; Engdahl 2010; Raun 2013.
4. See, for example, Raun 2013. See also these ongoing Ph.D. projects: Lisa Guntram,
Linkoping University, Department of Medical and Health Sciences, Division
of Health and Society; Wibke Straube, Linkopings University, Department of
Thematic Studies, Gender Studies; Anna Olovsdotter Loov, Lund University,
Center for Gender Studies; Kalle Westerling, Stockholm University, Department of
Musicology and Performance Studies.
5. See Bergstrom 2007 for research focusing experiences of meaning-making in close
relatives of transsexuals who undergo gender correction.
6. Swedish constitutional law No 1972:119.
7. Yet, throughout the 40 years of Swedish state funded gender-confirming healthcare
there have been a few (meaning no more than two or three) cases of transgender

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 Somatechnics

women who have been given the Legal Advisory Councils permission to alter
their legal sex without submitting to vaginoplasty, and they have thus had their
reproductive capabilities deleted through other procedures. The permissions have
been granted on the grounds of incapability to undergo surgery or lack of desire to
undergo vaginoplasty. I have confirmed this claim with the Legal Advisory Board,
but since there are not statistics on these disappearingly few number of cases
I cannot be more specific.
8. Other categories/diagnoses that come up for consideration is effeminate
homosexuality, schizophrenia, intersex and unspecified gender identity disorder.
9. According to Swedish constitutional law, all citizens are protected from forced
physical violation (174:152:6, authors translation).
10. Publicity surrounding Beatie in Sweden was not as Jack Halmberstam states
quite positive and confirmed a preference for loving parents over gender
conforming parents (Halberstam 2010; cf. Sullivan and Davidsman 2012). Rather,
Swedish news tabloids were quite consistent in their display of Beatie preagnant as
a freak.
11. Unlike Edenheims study, which stresses homosexuality as a risk position
equal to transvestism in psychiatric gender assessments, my research shows no
indications of same-sex desire as a risk. One possible explanation for this
could be that Edenheims study concerns a time period when homosexuality was
still regarded as a disease in Sweden. Presumably, more than thirty years after
Sweden removed homosexuality from the list of mental illnesses, same-sex desire
has been accepted as an imaginable life course also within the mental health
profession.

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