LGBTQIAP+ Issues Flashcards
Glossary and terms
Assigned Gender - Gender at birth based on genitals
Cisgender - a person whose gender identity is aligned to what they were assigned at birth
Gender Dysphoria - Description of emotional or mental dissonance between one’s desired concept of their body and what their body actually is, especially in reference to body parts/features that do not align or promote to one’s gender identity; 2) A term used in psychiatry to refer to the incongruence between an individual’s designated birth sex and their gender identity, with marked dissociation from one’s physical body.
Trans-man - a transgender person who identifies as a man
Trans-woman - a transgender person who identifies as a female
General principles of caring for sexual and gender minorities
Cultural humility, awareness
Patient-centered, cultural sensitive care
Use practice-level strategies to create a safe and welcoming climate
Remember that people who have same-sex partners may not identify as being a sexual minority
Practice level strategies to improve care
Visual cues that SGM patients are welcome
Work processes such as correct intake forms / records
Physical facilities that promote inclusivity
Communication that avoids normalizing language
Sexual minority
Sexual minority people are people whose capacity for romantic attraction and formation of intimate relationships (i.e., sexual orientation) is something other than exclusive attraction to people of the opposite sex. Gender minority people are people whose sense of being male, female, or another gender entirely (i.e., gender identity) is something other than their assigned biological sex. Sexual orientation and gender identity (SO/GI) are mutually exclusive constructs.
Care of lesbian women
Higher rate of mental and behavior problems
Higher risk of breast / ovarian cancer (but may be related to older age of first pregnancy)
Higher risk for STI (less protection use)
Higher risk of not having PAPs on schedule
Do not exclude pregnancy chances as they may have sex with men as well
STI risks exist still
Care of homosexual men
Higher rate of mental / behavior problems (especially teens)
Higher burden of STI (receptive anal sex is greater risk than penetrative anal sex)
Higher rate of substance abuse and IPV
HIV and STI screening is vital and PrEP
Social isolation in older
Care of bisexual people
Bisexual people face similar, if not worse, health disparities than gay men and lesbian women
Often do not disclose it to health care providers
Care of asexual people
lack of sexual attraction does not mean that there is a lack of romantic attraction. Sex researchers have distinguished between sexual attraction/lust and romantic/affectionate attraction for others. They may still be having sex with a romantic partner or be practicing abstinence although they may have a romantic partner who has a different sexual partner.
Lack of sexual attraction is not inherently unhealthy.
Care of transgender people
higher burden of depression and suicidality, victimization, negative experiences with health care, and housing instability.
Discrimination in accommodations and facilities are common
Gender dysphoria can start in early childhood but worsens in adolescence. Delaying puberty may help behavioral problems but is controversial and illegal in some places.
Provide the same screening and preventative services according to their sex organs as recommended.
Screening Issues and Transgender
Continue PAP/HPV and breast exams until gender affirming surgery removes them.
Five years after start of estrogen therapy, trans-women should get breast screenings at their current age and risk profile
Continue prostate / testicular screening until removed by gender affirming surgery.
Care of intersex people
Best practices for the care of intersex infants, children, and their families include a multidisciplinary team approach with care continuing throughout the lifespan
For a health care provider approaching the care of a newborn who has intersex genitalia, the only urgent clinical concern is to rule out congenital adrenal hyperplasia (CAH). This is the most common cause of atypical genitalia and comprises different adrenal disorders, some of which can result in salt-wasting adrenal crises.
Principles of hormone therapy and gender-affirming care
Two important principles to understand when caring for transgender people are that surgery is not an endpoint and inquiries regarding gender-affirming surgeries or the status of one’s genitalia can be traumatic. Discussions around an individual’s genitourinary anatomy should be limited to times when it is relevant to care being rendered
HIV Issues in this population
Transgender women are at high risk for all STIs, including syphilis and HIV. This is due to a variety of factors, including higher rates of need-based transactional sex (due to employment discrimination and housing instability) and unprotected receptive anal sex.
Minority Stress Theory
health disparities in sexual minority people are due to societal prejudice and hostility towards gay, lesbian, and bisexual people.
