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H&P #1 > (4) LGBTQIA+ History and Physical Exam > Flashcards

(4) LGBTQIA+ History and Physical Exam Flashcards

1
Q

Define Intersectionality:

A

The interconnected nature of social categorizations as they apply to a given individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage

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2
Q

Define Lesbian:

A

A woman who is emotionally, romantically or sexually attracted to other women. Women and trans/non-binary people may use this term.

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3
Q

Define Gay:

A

A person who is emotionally, romantically or sexually attracted to members of the same gender. Men, women and trans/non-binary people may use this term.

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4
Q

Define Bisexual and Pansexual:

A

A person who is emotionally, romantically, or sexually attracted to more than one sex, gender or gender identity; Pansexual is similar, though with inclusion of non-binary people

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5
Q

Define Transgender:

A

People whose gender identity/expression is different from cultural expectations of that identity based on sex assigned at birth

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6
Q

Define Queer:

A

An expansive term often used by people who do not identify as straight, or have non-binary or gender expansive identities

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7
Q

Define Intersex:

A

Persons born with a variety of differences in sex traits and reproductive anatomy: inc. genitalia, chromosomes, gonads

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8
Q

Define Asexual:

A

The lack of sexual attraction or desire for other people

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9
Q

Define +:

A

inclusive denotation of all other people on the spectrum of gender and sexuality

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10
Q

Describe the differences between Gender Identity, Sexual Orientation, Sex:

A

Gender Identity:
- One’s innermost concept of self as either male, female, both or neither
- Gender Identity can be the same or different from sex assigned at birth; has no impact on sexual orientation

Sexual Orientation:
- Emotional, romantic or sexual attraction to other people

Sex:
- Biological traits, chromosomes, sex organs, hormonal profiles

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11
Q

Define Cisgender:

A

People whose gender identity aligns with the sex assigned at birth

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12
Q

Define Nonbinary:

A

Genderqueer, Gender Non-Conforming, Gender Neutral, categorizations that may be used for people who may identify as both male and female, or neither

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13
Q

Define Gender fluid:

A

No single fixed gender identity

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14
Q

Define Gender dysphoria:

A

A condition in which differences between physical appearance and assigned gender cause distress

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15
Q

List (5) types of Sexual Orientation:

A
  1. Gay/Lesbian
  2. Bisexual
  3. Pansexual
  4. Asexual
  5. Queer
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16
Q

Identify strategies to engage LGBTQIA+ patients in the clinical realm:

A
  1. DON’T ASSUME to know an individual’s gender identity and sexual orientation; let the patient guide you
  2. Begin with OPEN ENDED QUESTIONS to allow patients to describe themselves in the way that they are most comfortable
  3. MATCH their language
  4. Take the time to ESTABLISH RAPPORT, identify yourself as someone with both medical and cultural knowledge
17
Q

Describe methods to sensitively approach history taking and physical examination with LGBTQIA+ patients:

A
  1. Ask the patient their name, and their pronouns (DON’T ask preferred pronouns)
  2. Introduce yourself with your own pronouns
  3. Allow patients to identify their own goals of transition (1 year or 5 year plans)
18
Q

What are (4) types of pronouns?

A
  1. He/Him
  2. She/Her
  3. They/Them
  4. Ze/Hir
19
Q

Identify (5) goals of transition:

A
  1. Socially transitioning
  2. Professionally transitioning
  3. Use of prescribed hormone therapies
  4. Gender Affirming Surgeries
  5. Legal Goals
20
Q

What are (3) types of hormonal therapy?

A
  1. Transfeminine Hormone ‘Feminizing hormone’
  2. Transmasculine Hormone ‘Masculinizing hormone’
  3. Pubertal Blockers
21
Q

Define Transfeminine Hormone, and its associated medications:

A

Used to induce physical changes in the body caused by female hormones (trans-woman, non-binary, intersex). If feminizing hormone therapy is started before the changes of male puberty begin, male body hair and changes in voice pitch can be avoided.

  1. ESTROGEN decreases testosterone production and induce feminine secondary sex characteristics
  2. PROGESTERONE is reduced to tiny particles, which might improve breast development
  3. SPIRONOLACTONE blocks male sex hormone (androgen) receptors and can suppress testosterone production
22
Q

Define Transmasculine Hormone, and its associated medication:

A

Used to induce physical changes in the body caused by male hormones (trans-man, non-binary, intersex). If masculinizing hormone therapy is started before the changes of female puberty begins, the development of breasts can be avoided.

  1. TESTOSTERONE: Suppresses your menstrual cycles and decreases the production of estrogen from your ovaries
23
Q

Define Puberty Blockers:

A

Puberty blockers are medications that block the hormones testosterone and estrogen. When a person reaches puberty, these hormones cause changes in the body, such as periods, breast growth, and facial hair growth.

24
Q

Describe the (6) types of Transfeminine Surgical Options:

A
  1. Breast Augmentation (implantation)
  2. Female Feminization Surgery: forehead and brow bone reshaping, jaw and shin contouring, rhinoplasty, hairline advancement, tracheal shave
  3. Orchiectomy (removal of testes)
  4. Vaginoplasty: creation of clitoris, vagina, labia majora/minora, typically via penile inversion
  5. Voice feminization: glottoplasty (shortens the length of the vocal cords to produce a higher pitch)
  6. Body Contouring: liposuction and fat transfer, abdominoplasty, buttock augmentation
25
Q

Describe the (5) types of Transmasculine Surgical Options:

A
  1. Chest Masculinization: top surgery surgical removal of mammary and fat tissues
  2. Metoidioplasty: release of the clitoris from the ligament that holds it in place, tissue is grafted around to create a phallus
  3. Phalloplasty: a penis is created out of skin from another area, usually occurs with urethral lengthening and scrotoplasty
  4. Hysterectomy: uterus and ovaries removal
  5. Vaginectomy: frontal pelvic opening removal
26
Q

Explain the rational for taking an inclusive sexual history:

List the most common sexual history script ‘the 5 Ps’:

A

Sexual health screening is the same between everyone! We need to know more about someone’s body to assess their risks:

(partners, practices, protection from STIs, past history of STIs, and prevention of pregnancy)

  1. RPR (rapid plasma reagin; screening test for syphilis, an STI)
  2. Pregnancy
  3. HIV
  4. HSV
27
Q

How do you screen for Gonorrhea and Chlamydia?

A

Site specific Nucleic acid amplification tests (NAAT) (oropharyngeal, rectal, urine, cervical)

28
Q

How do you screen for Syphilis?

A
  1. Blood test
  2. TPA (Treponema Pallidum Antibodies) vs. RPR (rapid plasma reagin)
29
Q

How do you screen for Herpes?

A
  1. Physical exam
  2. Viral RNA PCR culture
  3. Blood? (it’s complicated)
30
Q

How do you screen for HPV?

A
  1. physical exam
  2. cervical PAP
  3. anal PAP
31
Q

How do you screen for Trichomonas?

A
  1. Vaginal/Penile Swab
  2. Urine
32
Q

How do you screen for Mycoplasma/Ureaplasma?

A

Urine

33
Q

How do you screen for Pubic lice/Scabies?

A
  1. PE
  2. Microscopic exam
34
Q

Define PrEP and two types of pills?

A

Pre-exposure prophylaxis is medicine taken to prevent getting HIV. PrEP is 99% effective for preventing HIV when taken as prescribed

  1. Truvada
  2. Descovy

35% of sexually active men who have sex with men are on PrEP; an option for all patients of course, not just LGBTQIA patients

35
Q

What are (3) ways for taking PrEP to prevent HIV?

A
  1. Daily PrEP: Truvada and Descovy; for everyone
    - NO DESCOVY if female assigned at birth!
    - have to take for 7 days for anal sex and 21 days for vaginal sex
  2. On-demand, 2-1-1, PrEP: ONLY Truvada; ONLY works for gay and bisexual cisgender men
    - Protects partner during anal sex but may not prevent HIV during receptive vaginal sex.
    - 2 pills are taken 2-24 hours prior to a potential risk
    - 1 pill is taken 24 hours after the first dose and 1 is taken 24 hours after the second dose
  3. Long-acting injectable PrEP
36
Q

Define PEP and two types of pills?

A

Post-Exposure Prophylaxis is a “28 day course of an antiretroviral 3 drug treatment” that is taken to prevent HIV after a possible exposure. PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV.

  1. Truvada
  2. Tivicay
37
Q

What are two preventative health for transmasculine patients?

A
  1. Pap smears
  2. Mammograms (if no chest surgery)

H&P #1 (8 decks)

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