107: Caring for LGBT Persons in Dermatology Flashcards
What does the term LGBT encompass?
LGBT is an umbrella term that includes MSM (Men who have Sex with Men) and WSW (Women who have Sex with Women) who engage in same-sex sexual behaviors.
How does sexual orientation relate to sexual behavior?
Sexual orientation does not dictate sexual behavior. For example, a self-identified straight person may engage in same-sex sexual behaviors, while a self-identified gay person may not be sexually active.
What are MSM and WSW?
MSM and WSW are terms that describe same-sex sexual behaviors regardless of self-identified sexual orientation.
Why is the term ‘homosexual’ considered outdated by many in the LGBT community?
The term ‘homosexual’ is often viewed as outdated and derogatory by many LGBT persons because it does not encompass the complexity of sexual orientation and identity.
What dermatological conditions disproportionately affect MSM?
MSM are disproportionately impacted by dermatologically relevant conditions, including HIV, STDs, and other infectious and non-infectious diseases.
What are the recommendations for HIV and STD screening for MSM?
Recommendations for MSM include more frequent screenings for HIV and additional STDs such as syphilis, urethral/rectal/pharyngeal gonorrhea, and Chlamydia. MSM in mutually monogamous relationships might not require more frequent screening.
What is the HPV vaccination recommendation for MSM?
HPV vaccination is indicated for MSM and for women through age 26 years; for non-MSM men, it is indicated through age 21 years (but permissible through age 26 years).
What is PrEP and its significance for MSM?
PrEP (pre-exposure prophylaxis) is indicated for HIV-negative MSM who are at high risk of acquiring HIV. Daily emtricitabine-tenofovir disoproxil fumarate can reduce HIV incidence in MSM (and transgender women) by up to 92%.
What is nPEP and when is it indicated for MSM?
Nonoccupational HIV post-exposure prophylaxis (nPEP) is indicated in settings of substantial risk exposure to HIV transmission for MSM, such as unprotected receptive anal intercourse with an untreated HIV-positive person. It must begin within 72 hours of exposure.
What does gender identity refer to?
One’s basic internal sense of gender, such as being a man or a woman, which does not dictate sexual orientation or behavior.
What are the implications of sexual orientation on sexual behavior in the context of LGBT individuals?
Sexual orientation does not dictate sexual behavior. For example, a self-identified straight person may engage in same-sex sexual behaviors, while a self-identified gay person may not be sexually active.
What are the STD risks for women who have sex with women (WSW)?
WSW are at risk of acquiring STDs from current and prior female and/or male partners, including genital HPV, herpes simplex virus, syphilis, and HIV.
What is the seroprevalence of herpes simplex virus Type 2 among women with same-sex partners?
30%.
Do screening guidelines for STDs differ between WSW and women who do not have sex with women?
No, they do not differ.
What types of gender-affirming treatments may transgender persons undergo?
Transgender persons may undergo psychological counseling, hormone therapy, and surgical interventions such as facial feminizing procedures, ‘top’ surgery, and ‘bottom’ surgery.
What role can dermatologists play in the care of transgender persons undergoing gender-affirming treatments?
Dermatologists can manage cutaneous adverse effects of hormonal and surgical treatments, perform safe and effective procedures for gender-affirming physical transformation, and facilitate screening and preventive care.
What are the potential cutaneous adverse effects of hormone therapy and surgical interventions in transgender persons?
Potential cutaneous adverse effects include keloids and other skin changes.
What is the importance of contraception counseling for transgender men?
Contraception counseling is crucial because transgender men who retain female natal reproductive organs can become pregnant, even while taking testosterone.
What are the desired effects of feminizing hormone therapy in transgender women?
Breast development, reduction of body and facial hair, redistribution of subcutaneous fat, change in sweat and odor pattern, arrest or reversal of hair loss, decreased sebum production, improvement in acne vulgaris, and reduction in gender dysphoria.
What complications can arise from unlicensed silicone or filler injections in transgender women?
Serious complications include foreign-body granulomatous dermatitis, bacterial or atypical mycobacterial infections, bleeding, pain, scarring, ulceration, fistula formation, gross disfiguration, lymphedema, silicone migration or embolism, sepsis, hypersensitivity pneumonitis, and death can occur hours to decades later.
What treatments are available for silicone granulomas in transgender persons?
Treatment options include intra-lesional corticosteroid, topical imiquimod or tacrolimus, oral doxycycline or minocycline, isotretinoin, etanercept, carbon dioxide ablative laser, and surgical excision.
What should dermatologists provide to transgender persons regarding injectable treatments?
Dermatologists can provide safe, effective gender-affirming injectable treatments, including facial contouring with botulinum toxin neuro-modulation and soft-tissue augmentation to add volume to the cheeks, lips, or chin.
What is included in culturally competent care for transgender patients?
Culturally competent care includes use of inclusive language and demonstration of equality and respect, eliciting relevant information on sex anatomy, gender identity, sexual orientation, and sexual behaviors in an effective and sensitive manner.
Why is it important to screen transgender persons who have received fillers from unlicensed providers?
Transgender persons with fillers from unlicensed low-cost ‘pumpers’ should be screened for hepatitis C due to the potential health risks associated with unregulated procedures.
