Why N = 1, and why publish it
A single-subject design can’t tell you what is true of a population. It can tell you, in unusual detail, what happened in one body — and that has its own kind of value.
The literature on peritoneal-flap neovaginas is thin in the place I care about most. There is a reasonable body of surgical outcome work, but very little that follows the tissue’s biology longitudinally — how the microbiome establishes, how the mucosa responds to hormones, what changes over months and years rather than weeks.
A single subject cannot close that gap for the population. What it can do is produce one densely sampled, fully documented trajectory where almost none exist. As both the investigator and the subject, I can sample at a frequency, and sustain it over a duration, that a funded multi-subject study would rarely justify.
The obvious objection is bias. I know my own hypotheses, I have a stake in the outcomes, and I cannot blind myself to my own body. I do not pretend otherwise. Instead I constrain it: protocols are registered before measurement, analysis plans are fixed in advance, and the raw data is published so that someone who distrusts my interpretation can reach their own.
I also try to be precise about what a result here means. An N of one is one trajectory. It can establish that something is possible, characterize how it unfolded in this case, and generate hypotheses worth testing properly. It cannot tell you how common any of it is. I would rather state that limit plainly than dress a case study up as something larger.
So I publish it because one carefully documented body is a data point that did not exist before — for the next researcher, and for the next person deciding whether this anatomy can do what they hope it will.