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Published by Meredith Peruzzi
V Ramachandran and Paul D. McGeoch .S.

Phantom Penises In Transsexuals
Evidence of an Innate Gender-Specific Body Image in the Brain
Abstract: How the brain constructs one’s inner sense of gender identity is poorly understood. On the other hand, the phenomenon of phantom sensations — the feeling of still having a body-part after amputation — has been much studied. Around 60% of men experience a phantom penis post-penectomy. As transsexuals report a mismatch between their inner gender identity a
V Ramachandran and Paul D. McGeoch .S.

Phantom Penises In Transsexuals
Evidence of an Innate Gender-Specific Body Image in the Brain
Abstract: How the brain constructs one’s inner sense of gender identity is poorly understood. On the other hand, the phenomenon of phantom sensations — the feeling of still having a body-part after amputation — has been much studied. Around 60% of men experience a phantom penis post-penectomy. As transsexuals report a mismatch between their inner gender identity a

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Published by: Meredith Peruzzi on Feb 20, 2012
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01/04/2013

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V.S. Ramachandran and Paul D. McGeoch
 Phantom Penises InTranssexuals
 Evidence of an Innate Gender-Specific Body Image in the Brain
 Abstract 
: How the brain constructs one’s inner sense of gender iden-tity is poorly understood. On the other hand, the phenomenon of   phantom sensations — the feeling of still having a body-part after amputation —has been much studied. Around 60%ofmen experiencea phantom penis post-penectomy. As transsexuals report a mismatchbetween their inner gender identity and that of their body, we won-dered what could be learnt from this regarding innate gender-specificbody image. We surveyed male-to-female transsexuals regarding theincidence of phantoms post-gender reassignment surgery. Addition-ally, we asked female-to-male transsexuals if they had ever had the sensation of having a penis when there was not one physically there. In post-operative male-to-female transsexuals the incidence of phan-tom penises was significantly reduced at 30%. Remarkably, over 60%of female-to-male transsexuals also reported phantom penises. Weexplain the absence/presence of phantoms here by postulating a mis-match between the brain’s hardwired gender-specific body image and the external somatic gender. Further studies along these lines may provide penetrating insights into the question of how nature and nur-ture interact to produce our brain-based body image.
 Journal of Consciousness Studies
,
15
, No. 1, 2008, pp. 5–16
Correspondence:Paul D. McGeoch, Center for Brain and Cognition, UCSD, La Jolla, CA 92093,USA.
Email: pmcgeoch@psy.ucsd.edu
Copyright (c) Imprint Academic 2011For personal use only -- not for reproduction
 
Introduction
(a) The sense of gender identity
What is the ‘self’? Like the word ‘emotion’, the word encompasses anumber of mental attributes that are lumped together as a convenientlinguistic shorthand. These different attributes of self would include:(i) the sense of continuity in space and time;(ii) the sense of agency and free will;(iii) unity or the sense of being a single person in spite of adiversity of thoughts and sensory impressions;(iv) the sense of embodiment or of being anchored in one’s body,which includes one’s ‘body image’— a vivid sense of thedifferent parts of your body;(v) the social dimensions of self-including how ‘others view me’,which allows one to be ‘self-conscious’;(vi) and most enigmatically of all, the sense of ‘self awareness’,the fact that the self is aware of itself.These different aspects of self are, to use Dennett’s (2003) analogy,like different vectors intersecting at a single point (or hazy blob) thatwecalltheself.Braindiseasecanseparateoutsome,ifnotall,ofthesedifferent elements, indicating they are probably mediated by different brain mechanisms. One of us (Ramachandran, 2007) has suggestedelsewhere that the final two aspects in this list (seeing yourself asothers see you and ‘self awareness’) probably co-evolved in primateevolution and have now become closely intertwined. This wouldexplain why we use the phrase ‘self-conscious’, when we really mean being conscious of others being conscious of us.This paper is concerned with one of the most poorly understoodaspects of the self; one’s internal sense of gender identity
1
and sexual bodyimagethatgoeswith it.Webelievewehavefound evidencethat, paradoxically, whilst one’s gender identity and internal body image
2
are usually perfectly synchronised with one’s external physical gender,thetwo develop through differentbiologicalmechanisms, probably
inutero
. It is an uncoupling of this development which causes someindividuals to become transsexuals. We hasten to add here, that trans-sexual people should not be viewed as abnormal, any more than one
6 V.S. RAMACHANDRAN AND P.D. MCGEOCH
[1]
Weareawarethatsomewritersusethewordgendertoimplyapurelysociallyconstructedconcept. This is not how we wish to use the word.
[2]
Weusetheterm‘bodyimagetodenoteahigher-levelrepresentationinthebrainthanthesomatosensory map in the parietal lobes (Critchley, 1953). However, as our results sug-gest, the two concepts are doubtless intimately linked.
Copyright (c) Imprint Academic 2011For personal use only -- not for reproduction
 
should regard someone who is exceptionally tall as abnormal, butmerely seen as part of the spectrum of human gender identity.
(b) Phantom sensations
The vivid sensation of still having a limb although it has been ampu-tated, a phantom limb (Ramachandran & Rogers-Ramachandran,1992; 1996) was first described by Weir Mitchell (1871) over a centuryago. Over the last 15 years there has been a tremendous resurgence of interest in phantom limbs as a tool for exploring the plasticity of the brainandtheextenttowhichaspectsofbodyimageareinnatelyspeci-fied. After amputation of an arm, the region of the Penfieldhomunculus that is deafferented is ‘taken over’ by afferents thatnormally innervate the adjacent face portion of the map (Pascual-Leone
et al 
., 1995; Ramachandran & Hirstein, 1998; Ramachandran& Blakeslee, 1999; Ramachandran & Rogers-Ramachandran, 2000).Consequently, touching the face evokes referred sensations in the phantom arm.Many phantoms are paralysed but can be visually ‘resurrected’ byusing a parasagittal mirror propped vertically on a table in front of the patient so that the reflection of the normal (say right) hand appearsoptically superimposed on the phantom, providing mirror visual feed- back (MVF) (Ramachandran, 1995
et al.
; Ramachandran & Rogers-Ramachandran, 1996; Ramachandran & Hirstein, 1998; Ramachan-dran & Blakeslee, 1999; Ramachandran & Rogers-Ramachandran,2000).Ifthepatientmoveshisrighthanditcreatestheillusionthattheleft phantom arm is moving and, remarkably, it is also felt to move. Inmany patients this procedure can cause the phantom arm to disappear (Ramachandran & Rogers-Ramachandran, 1996; Ramachandran &Hirstein, 1998; Ramachandran & Blakeslee, 1999; Ramachandran &Rogers-Ramachandran,2000),demonstratingthetremendousmallea- bility of body image. Ramachandran and Altschuler showed that themere use of visual feedback can accelerate the recovery of function instroke. They suggested that the procedure may be tapping into mirror neurons (Altschuler 
et al.
, 1999). Yet despite this plasticity there mustalso be a hard-wired, innately specified scaffold for body image; indi-viduals with congenital absence of both arms also experience vivid phantoms (Ramachandran, 1993; Ramachandran & Hirstein, 1998;Saddah & Melzack, 1994). Phantom sensations offer a valuableopportunity to explore how nature and nurture interact to create bodyimage. The present study is concerned with the question: to whatextent is one’s gender-specific body image innately specified?
PHANTOM PENISES IN TRANSSEXUALS 7
Copyright (c) Imprint Academic 2011For personal use only -- not for reproduction

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