I had an interesting client the other day. They were seeing me for their feet when the conversation turned to their top surgery from several years ago and some of the odd sensations, they were still having which sometimes became distracting during sex. Their problem was that after the surgery things did not feel like they were in the correct spot. When they look in the mirror, they like what they see, and it confirms that they are who they think they are however when touching certain parts of the chest it feels like they are being touched in a different spot. This is where we need to introduce the homunculus.

The homunculus is a graphic proportional representation of our body on the brain based on nerve density for the motor (brain to muscle to tell them what to do) and sensory (body to brain to tell us what is going on) and are fairly similar from person to person. This is the brain’s map of where things should be on the body so that if I touch your toe and move it you will know it without ever looking at it. The problem this person is having – and they are not alone in this – is the brain map has changed. The nerves still go back and forth from the brain to the body, but they end in a different location from when the brain map was formed many, many years ago. This is similar to what amputee’s experience with phantom pain due to the loss of the nerves at their end point, as well as a person after a stroke in which the map itself gets damaged and the nerves still go to their destination, but the starting point is no longer there.

This is also like my car. The GPS is from 2007 and has not been updated. The maps have changed, and I’ve gotten lost because the roads are now different – case and point would be where 695 and 95 north of the city has been redesigned.

The big question is: What do we do about it? This part I love! The body is adaptive, including the brain. Believe it or not, we can update our brain map through a technique called mirror therapy. This is a technique used for neurological reeducation and can be used here. Neurons that fire together will wire together. This is how we form habits and why change to our routine is a challenge with a very awkward feeling. With that said what we need to do is show the brain where those nerves are located today! This is where the mirror comes in to play. Stand in front of a mirror and touch yourself. No, not the naughty way! Put your pants back on and take off your shirt so you are topless (like so many of us at MAL). Use a finger to feel around your chest, watching yourself in the mirror. When you find a spot that feels odd, confused, like it is not where it is “suppose” to be, give it some more attention. The whole time you are watching yourself in the mirror. What is happening is the brain is comparing information from the visual cortex with the proprioceptive information from the hand doing the touching to the brain map in the homunculus to see if all the information agrees. If it doesn’t agree it will start to update the brain map in the homunculus as to where those nerves currently go. This is something to be done daily, multiple times a day if possible due to the fact that the brain map is so strong, you have had it for a long time, and it is going to take time and consistent reinforcement to update with the new information.

Now the curve ball. We have separate nerves for light touch, sharp / dull, hot / cold, vibration, pain, pressure and proprioception. Each of these “files” need to be updated. Start with light touch, it is the easiest. There are many ways to handle the others.

I would like to end with a question for you. Gender confirmation surgery helps a person look the way they envision themselves. My question is this; is there some dysphoria that continues, even on a low level, because the body doesn’t quite feel the way you would like it to?

I would love to hear back from you regarding your experiences with this, successes and struggles. Email me at charles@dudleypt.com.

Your body in proportion to its nerve-ending endowment