Much of the literature emphasizes the negative aspects e. Several of the wives, regardless of their own sexual orientation, voiced concerns that their partners would begin to desire other people, specifically men. This means that they are unable to bear children or menstruate until a uterus transplant is performed, and that they will need to remain on hormone therapy after their surgery to maintain female hormonal status. Several experienced depression, at least for a time. She contrasts the acceptance of two-spirit people in Native American culture to European persecution of such individuals and forcing two-spirit people to present as their biological sex. While the major life transition for this unique form of couple does not come without challenges, it is inspiring to learn of their ability to work through these issues and strengthen their relationships. Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability which is affected by age, nutrition, physical activity and smoking , any previous surgery in the area can impact results, and surgery can be complicated by problems such as infections, blood loss, or nerve damage. I became a mother, and Mitch became a father. Opinions expressed do not necessarily reflect the views of TIME editors. Data Analysis Four researchers were involved in this project: In a large majority of cases reviewed, the MTF partner disclosed the gender variance to the natal female partner. But not being able to genetically father our child was a profound loss for Mitch. Findings Intrapersonal Level The main theme of the Interpersonal Level has to do with internal processes for the wives. Of the couples who received some support from family, about half were totally accepted. Plastic surgery , since it involves skin, is never an exact procedure, and cosmetic refining to the outer vulva is sometimes required. Clinicians who work with transgender individuals often receive calls for support from partners and family members.