exam 1 - lgbtx Flashcards
natal sex, gender, sexual orientation = identity
differences between sex assigned at birth, gender identity, and sexual orientation
Not binary scale
Its a spectrum
sexual orientation
-its possible for someone whose sexual orientation is heterosexual to be SA with same sex partner (female with a biological female that identifies as a man)
-How important is it to know the patient’s sexual orientation?
-It is more significant to know with whom pt is SA, and what sexual activities in which they participate with their partner(s)
-This permits a better opportunity to assess risk for STIs, pregnancy, and need for PrEP
other terms related to the gender minority community: trans, cis, non-binary
-Transgender- umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth
-Cisgender refers to people whose gender identity is congruent with the sex they were assigned at birth
-Non-binary or genderqueer: terms used by people who experience their gender identity and/or gender expression as falling outside the categories of man and woman.
-However, it is more inclusive to refer to this community as gender diverse or gender minority
what is LGBTQAI+
-Agender
-Asexual
-Bisexual
-Cisgender
-Gay
-Gender fluid
-Gender expansive
-Gender non-binary or genderqueer
-Gender non-conforming
-Intersex (differences of sexual development)
-Lesbian
-Pansexual
-Queer
-Questioning
-Transgender
sex assigned at birth definition
-The gender given to a neonate at delivery based on the appearance of the external genitalia
-Assigned male at birth (AMAB)
-Assigned female at birth (AFAB)
gender dysphoria / incongruence and DSM-V
-distress experienced by pts with gender discordance bc of incongruence between their gender identity and physical gender
-This term is included in the Diagnostic and Statistical Manual, 5th ed. (DSM-V) and should be used rather than gender identity disorder (an outdated term)
DSM-V dx of gender dysphoria:
-marked incongruence between one’s experienced or expressed gender and their assigned gender, -> at least 6 months, as manifested by 2+ of following:
-marked incongruence between one’s experienced or expressed gender and primary and/or secondary sex characteristics (in young adolescents, the anticipated secondary sex characteristics)
-A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced or expressed gender
-A strong desire for the primary and/or secondary sex characteristics of the other gender
-A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
-A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
-A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender)
-The condition must also be associated with clinically significant distress or impairment in social, occupational or other important areas of function
what percent of population is intersex
-2%
-gender minority- 1%
complete gender insensitivity (AIS)
-common! - more common than people with green eyes
-XY
-loss of function gene -> blocks recognition of testosterone production
-you make test but body doesnt recognize it
-these people have no idea they are XY, they present as XX
-go through female puberty without mensuration -> no ovaries
-testicles are internal and stay warm -> increase risk of cancer -> gonadectomy
-normally testosterone produced at 11 weeks gestation
-partial- ambiguous genitals
-wait and see how that person identifies
-AIS
janice langbehn and lisa pond case
Lisa = SAH pt dies alone and partner not allowed to see her bc florida is “antigay”
But it is human right
Stats regarding health care discrimination of LGBATQAI+ pts
->50% of LGBTQAI+ pts experience some form of discrimination when seeking medical care
-20% of gender minority people have been denied care because they are transgender or gender non-conforming
->50% of gender minority patients find their practitioners are not sufficiently aware of their needs
-28% of gender minority patients have postponed medical care because of this discrimination
-LGBTQAI+ patients who are black or brown are 2x more likely to avoid medical care than white patients
-75% of lesbians report delaying or avoiding health care -> most likely to be financially challenged bc they are women
anti-LGBTQ bills
what diseases or conditions are lesbians/gay men pts at increased risk?
Lesbians:
-Alcoholism- from depression, minorities met at bars
-Obesity
-Tobacco related disorders
-Breast, ovarian and endometrial carcinomas- not ever having been pregnant
-Cardiac disease
-Depression and anxiety
-Suicide
-PTSD
-Physical violence
Gay men:
-Alcoholism and drug use
-STIs- HIV/AIDS, Syphilis, HPV -> other STIs go up as HIV becomes less of a worry
-Hepatitis B and C
-Cardiac disease- stress
-Anal carcinoma
-Depression and anxiety
-Suicide
-Eating disorders and body dysmorphic disorders
-bisexual women:
-cardiac ds
-breast carcinoma
-obesity
-binge drinking
-tobacco dependence
-bisexual men:
-HPV
-anal carcinoma
-bisexual men and women:
-increased intimate partner violence
-alcohol
what diseases or conditions are bisexual women and men pts at increased risk?
bisexual women:
- cardiac ds
- breast cancer
- obesity
- tobacco dependence
bisexual men:
- HPV
- anal CA
bisexual men and women:
- increased IPV risk
- alcohol
violence in the gender minority community in 2024
-The Human Rights Campaign reported that in 2024, at least 36 gender minority people were killed through violence
-Of these, nearly half were black or brown transgender women
-tend to be sex workers
For what diseases or conditions are gender minority patients at increased risk?
violence:
-16-60% of transgender pts are victim of physical assault or abuse
-13-66% of transgender individuals are victims of
sexual assault:
-all minorities are at higher risk for sexual assault- even disabled
-suicide:
-38-65% of transgender individuals report suicidal ideation
-up to 28% of young gender non binary individuals have reported suicidal ideation
-16-32% of transgender pts attempt suicide
mental health: depression, anxiety, and other psychiatric conditions
substance abuse
tobacco dependence
HIV/AIDS
STIs
how to have your office staff welcome LGBTQAI+ pts
-Practice cultural humility -> Your own experiences may not be similar to those that others have had
-Your pts may have different experiences or identities
-Do not expect pts to teach you about how to care for a LGBTQAI+ pt (or any other kind of pt)
-Help educate your staff: MAs, receptionists, phlebotomists, etc. all need to welcome all pts in a positive, affirming, compassionate and non-judgmental manner
avoid assumptions
-key principle of effective communication is to avoid making assumptions:
-Don’t assume that:
-You know a person’s gender identity or sexual orientation based on how that person looks or sounds
-You know how a person wants to describe themselves or their partners
-All of your pts are heterosexual and cisgender (not gender minority)
registration form: what components
-Registration forms should have a space for patients to enter their preferred name and pronouns
-This information should also be included in medical records
-pt’s pronouns and preferred name should be used consistently by all staff
use of pronouns
-use pts preferred names and pronouns
-transgender often change their name to affirm their gender identity
-name is sometimes diff from what is on insurance or identity documents
-If unsure about pt’s preferred name or pronouns:
-“I would like be respectful—what name and pronouns would you like me to use?”
-If pt’s name doesn’t match insurance or medical records:
-“Could your chart/insurance be under a different name?” -> make sure you confirm the pt before anything else
-“What is the name on your insurance?”
-If you accidentally use the wrong term or pronoun:
-“I’m sorry. I didn’t mean to be disrespectful.”
terms to avoid
-AVOID:
-homosexual -> gay, lesbian, bisexual, or LGBT
-transvestite; transgendered -> transgender, gender minority, gender non-binary (GNB)
-sexual preference; lifestyle choice -> sexual orientation
accountability of envirionment
-Creating environment of accountability and respect requires everyone to work together
-Don’t be afraid to politely correct your colleagues if they make a mistake or make insensitive comments
-“Those kinds of comments are hurtful to others and do not create a respectful work environment.”
-“My understanding is that this patient prefers to be called ‘Jane’, not ‘John’.”
collection of gender identity data -all pts should be asked for following:
-chosen name
-given name
-current gender identity
-preferred pronouns
-practices can include a descriptive statement so to reduce or eliminate confusion for cisgender pts
-some EMRs do not have the flexibility to use these data
statistics: gender minority pts in US
-approx 150,000 youth and 1.4 million adults who identify as transgender, and approximately 1.2 million gender non-binary (GNB) adults
-These numbers may well underestimate the actual number of gender minority individuals
medical hx of the gender minority pt: what additional components
Past medical hx
Surgical hx: Includes but is not limited to gender-affirming surgical procedures
Organ inventory: AFAB vs AMAB
Medications:
-Prescribed medications- Hormone therapy
-Over-the-counter medications
-Alternative therapies
Family history:
-Diabetes mellitus
-Hypertension
-Thrombophilias
-Bleeding tendencies
-History of hormone-sensitive malignancies- Prostate carcinoma, Endometrial carcinoma, Ovarian carcinoma, Breast carcinoma (especially for AMAB)
Psychosocial history:
-Support- Family, friends and community
-Employment
-Housing
-Financial issues
Sexual history:
-Sexual orientation
-Sexual practices
-Need for contraception
organ inventory AFAB, AMAB
AFAB (assigned female at birth):
-Breasts
-Ovaries and Fallopian tubes
-Uterus
-Cervix
-Vagina
-Vulvar structures
AMAB (assigned male at birth):
-Prostate
-Penis
-Testicles
screening tests for the gender minority pt
-cervical carcinoma: AFAB gender minority pts with a cervix
-prostate carcinoma: AMAB gender minority pts with a prostate
-very hard to find a prostate is a transgender female on GAHT
-breast carcinoma:
-Transgender women on gender affirming hormone therapy (GAHT) at age 50+ with risk factors
-Estrogen and/or progestin use for >5 years, family hx, obesity -> breast exam and mammo
-AFAB gender minority pts who have not had bilateral mastectomy
tucking: what is it and sequelae
-Displacement of testes into inguinal canal and repositioning flaccid penis and scrotum between legs and posteriorly towards anus
-Tape, tight underwear or other devices maintain genitals in this
position
-Many pts AMAB find tucking to be gender affirming
-May also keep them safe as they are more often read as female
sequelae:
-Urinary reflux
-Testicular torsion
-Hernia
-Prostatitis
-Epididymitis
-Orchiitis
-Cystitis
-Local trauma to skin from tape
effects of feminizing hormones chart
effects of virilizing hormones
pre- and postoperative facial feminization
-forehead contouring
-tracheal shave
pre- operative and postoperative subcutaneous double mastectomy and chest reconstruction
