Surgeon Marci Bowers has performed roughly 100 vaginoplasties on biological males who wish to transition to being female. She is the immediate past-president of the World Professional Association for Transgender Health (WPATH)— the organization that writes the medical standards used by hospitals, insurers, and courts to justify gender-transition procedures. In newly obtained internal messages, she acknowledged that some of her patients simply cannot tolerate what the surgery requires afterward.
"Just because someone does not wish to maintain their vagina because of pain and discharge, jumping to regret should not be our first response," Bowers wrote.
The Daily Wire obtained 250 pages of private WPATH forum messages spanning June 2024 through November 2024. The messages reveal practitioners candidly discussing complications they rarely acknowledge publicly. Bowers admitted that "dilation is crucial but not for everyone. For some, it just isn't worth the time expended or the pain experienced." Dilation — the process of preventing the body from closing the surgically created cavity — requires 30 to 60 minutes daily, three to four times per day during the post-operative period.
A nurse practitioner on the forum reported seeing "quite a few patients recently who after vaginoplasty stop dilating and do not desire to keep the canal." A physical therapist added that "regarding the issue of pain, it is very common in many cases, especially during the first three months." One psychologist — herself a post-operative trans woman — wrote: "I'm speaking largely from experience, as a post-op trans woman who stopped dilating after a certain point and is completely fine with that."
So the practitioners know. The patients know. The organization knows. The question is why the Standards of Care, WPATH's own published guidance — doesn't reflect what the people writing it are saying behind closed doors.
Bowers flagged another issue that connects directly to the pediatric debate. "Laura — as you may be aware, limited skin is a severe limitation for those with early puberty blocked, both cosmetically and for attaining depth," she wrote to Laura Kuper, a psychologist at Children's Health Dallas who co-authored the SOC-8's chapter on nonbinary care. Puberty blockers, in other words, reduce the tissue available for the very surgery the treatment pathway leads to. The Daily Caller previously reported doctors making similar admissions.
The legal system has started catching up. The Federal Trade Commission filed a lawsuit in June 2026 alleging WPATH misled the public about the safety and effectiveness of these procedures. Bowers' name appears 18 times in the FTC complaint. Texas Attorney General Ken Paxton filed a separate lawsuit in February 2026 against Children's Health Dallas, whose gender clinic — the GENder Education and Care, Interdisciplinary Support program, or GENECIS — has since been shut down. Texas banned gender-transition procedures for minors effective September 1, 2023.
Another WPATH member noted in the forum that "voice is one of the hardest things to achieve primarily because surgical options are not usually effective." That's the voice-surgery track, a separate procedure — and apparently another one the practitioners privately admit doesn't reliably work.
Left-wing medical groups will call this cherry-picking from private conversations. Which is an interesting objection to raise about the organization that wrote a public document used to justify irreversible surgeries on minors — while its own leadership was privately admitting most post-op patients regret getting the operation and do not continue to even maintain their vaginal canal, making the surgery worthless.
