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One hospital in Washington state just became the first to offer vaginoplasty. And no, it didn't happen in Seattle.

The Pullman Regional Hospital in Pullman, Washington—a 33,000-population town in Eastern Washington, eight miles from the border of Idaho—will be the first to provide the male-to-female bottom surgery for trans women after the hospital's Board of Commissioners on Wednesday night unanimously approved the services. The decision came after a months-long process, which included one month of public comment in June on whether the hospital should be offering the surgery.

"We're very excited," said Leah Rutman, policy counsel at the ACLU of Washington. She drafted a June 27 letter threatening legal action on grounds of discrimination if the hospital were to refuse the surgery. She said the ACLU began receiving calls from local residents who were upset that the board sought public comment on a kind of surgery. "It is an important step forward that they will be offered at least somewhere in Washington state."

Pullman Regional Hospital's Dr. Geoff Stiller, who's currently being trained on the surgery by another provider, began offering the care months before the board asked for public comment and sought training for the surgery. He takes Apple Health, a free or low-cost medical insurance option. (Cis women may also want vaginoplasty if they're born without vaginas or needing reconstructive surgery.)

It's a great first step, says Danni Askini, director of the Gender Justice League—but it's a drop in the bucket. 

For trans women in the Western part of the state, traveling still becomes a large barrier, Askini told PubliCola. And trans women might not be comfortable traveling to Eastern Washington for transition-related surgeries, anticipating a recovery in the hospital of potentially over a week. With the board's final blessing, it's likely the Pullman hospital could see a lot of demand from across the state, though local news reports say the hospital will offer two sex reassignment surgeries per month. (Stiller also provides the surgery at Gritman Medical Center in Moscow, Idaho, eight miles from Pullman.) Oregon Health Sciences University, which offers comprehensive transition-related care, is the only other regional option for vaginoplasty. 

"There's a huge backlog of people waiting to get access to care," said Askini, who used to run a transition health care clinic in Capitol Hill. She estimated 30-40 people wanting surgeries a month. "It's important for folks to know that vaginoplasty is one small part of a big spectrum of transition-related health care."

She said she hopes the hospital will inspire other Seattle providers to offer the same kind of care. Several providers have expressed interest in learning how to offer the surgery, Askini says, adding that insurance coverage becomes a large part of the discussion. 

"I think a lot of it is transphobia and discrimination and fear on the part of institutions," Askini told PubliCola. "It's complicated to get a program off the ground, but I would love to see it happen." 

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