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Rahman E, Rao P, Webb WR, Philipp-Dormston WG, Sayed K, Almeida ART, Mosahebi A, Carruthers JDA, Carruthers A. Embracing Spectrum: Celebrating LGBTQIA+ Journeys in Aesthetic Medicine: A Kaleidoscope of Identity. Aesthetic Plast Surg 2024:10.1007/s00266-024-03923-4. [PMID: 38499877 DOI: 10.1007/s00266-024-03923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE This synaptic systemised review critically examines the provision of aesthetic medical care to LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more) individuals, assessing both the clinical practices and the educational frameworks that guide interactions with LGBTQIA+ patients in aesthetic settings. METHODS Following PRISMA-S guidelines, a comprehensive review was conducted, initially identifying 159 potentially relevant articles. Upon stringent full-text review, 33 studies met the inclusion criteria and were subject to an in-depth thematic analysis. The scope encompassed qualitative studies, quantitative analyses, and a cross section of interdisciplinary research, predominantly from Western settings. RESULTS The analysis distilled four principal themes: the imperative of identity affirmation in aesthetic interventions, substantial barriers to inclusive and empathetic care, the critical need for patient empowerment, and the existing deficiencies within medical education regarding LGBTQIA+ care. These themes highlight a complex interplay between the clinical aspirations of LGBTQIA+ individuals and the current capacity of aesthetic medicine to cater to this diversity. CONCLUSIONS There is a pressing need for a paradigmatic shift towards more inclusive, competent, and sensitive aesthetic medical care for LGBTQIA+ patients. It underscores the necessity of reform in medical education and advocates for policy changes that promote a more equitable healthcare environment. This research serves as a call to action, emphasizing the ethical imperative to integrate comprehensive LGBTQIA+ care competencies into aesthetic medicine curricula and practice. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Eqram Rahman
- Research and Innovation Hub, Innovation Aesthetics, London, WC2H 9JQ, UK.
| | - Parinitha Rao
- Aesthetic Dermatology Practice, The Skin Address, Bangalore, India
| | | | | | - Karim Sayed
- Nomi Clinic, Oslo, Norway
- University of South East Norway, Notodden, Norway
| | - Ada R T Almeida
- Dermatologic Clinic, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | | | - Jean D A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - Alastair Carruthers
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
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Heß J. [Psychiatric, socio-legal and perioperative aspects of vaginoplasty]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:51-57. [PMID: 38157067 DOI: 10.1007/s00120-023-02244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 01/03/2024]
Abstract
The number of scientific papers on gender-confirming surgeries as well as the surgeries themselves have increased by leaps and bounds in recent years. This leads to sometimes considerable waiting times for people seeking treatment. Social media and the internet do not always provide reliable and high-quality information. Therefore, it is necessary that both surgically and conservatively active urologists are familiar with topics regarding transgender persons. The establishment of structured training, the guarantee of minimum quality standards in the treatment of transgender persons and the further education and training of medical staff pose particular challenges. The German Society for Urology (DGU) and the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) have already founded their own working groups on the surgical side, which coordinate their work. Under the auspices of the professional societies DGU and DGPRÄC, a guideline on surgical procedures for gender incongruence was developed under the umbrella of the AWMF ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften") which is currently being finalised. For a long time, the health care of transgender people has been moving in a field of tension between the right of self-determination of those seeking treatment, on the one hand, and the fear of making the wrong medical decisions, on the other. In contrast to most other conditions in urology, the goal of treatment is largely determined by the person seeking treatment and does not necessarily follow predetermined schedules or content. The treatment should primarily aim at reducing the individual's suffering and promoting quality of life.
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Affiliation(s)
- Jochen Heß
- Klinik und Poliklinik für Urologie, Uroonkologie und Kinderurologie, Universitätsklinik Essen, Universitätsmedizin Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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Aryanpour Z, Nguyen CT, Blunck CK, Cooper KM, Kovac S, Ananthasekar S, Peters BR. Comprehensiveness of Online Information in Gender-Affirming Surgery: Current Trends and Future Directions in Academic Plastic Surgery. J Sex Med 2022; 19:846-851. [PMID: 35288048 DOI: 10.1016/j.jsxm.2022.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/05/2022] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite high rates of online misinformation, transgender and gender diverse (TGD) patients frequently utilize online resources to identify suitable providers of gender-affirming surgical care. AIM The objective of this study was to analyze the webpages of United States academic plastic surgery programs for the types of gender-affirming surgery (GAS) procedures offered and to determine how this correlates with the presence of an institutional transgender health program and geographic region in order to identify potential gaps for improvement. METHODS Online institutional webpages of 82 accredited academic plastic surgery programs were analyzed for the presence of the following: GAS services, specification of type of GAS by facial, chest, body and genital surgery, and presence of a concomitant institutional transgender health program. This data was analyzed for correlations with geographic region and assessed for any significant associations. OUTCOMES Frequencies of GAS services, specification of the type of GAS by facial, chest, body and genital surgery, presence of a concomitant institutional transgender health program, and statistical correlations between these items are the primary outcomes. RESULTS Overall, 43 of 82 (52%) academic institutions offered GAS. Whether an institution offered GAS varied significantly with the presence of an institutional transgender health program (P < .001) but not with geographic region (P = .329). Whether institutions that offer GAS specified which anatomic category of GAS procedures were offered varied significantly with the presence of an institutional transgender health program (P < .001) but not with geographic region (P = .235). CLINICAL IMPLICATIONS This identifies gaps for improved transparency in the practice of communication around GAS for both physicians and academic medical institutions. STRENGTHS & LIMITATIONS This is the first study analyzing the quality, content, and accessibility of online information pertaining to GAS in academic institutions. The primary limitation of this study is the nature and accuracy of online information, as current data may be outdated and not reflect actuality. CONCLUSION Based on our analysis of online information, many gaps currently exist in information pertaining to GAS in academic settings, and with a clear and expanding need, increased representation and online availability of information regarding all GAS procedure types, as well as coordination with comprehensive transgender healthcare programs, is ideal. Aryanpour Z, Nguyen CT, Blunck CK, et al., Comprehensiveness of Online Information in Gender-Affirming Surgery: Current Trends and Future Directions in Academic Plastic Surgery. J Sex Med 2022;19:846-851.
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Affiliation(s)
- Zain Aryanpour
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Christine T Nguyen
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Conrad K Blunck
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kasey M Cooper
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Stefan Kovac
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | | | - Blair R Peters
- Division of Plastic & Reconstructive Surgery, Oregon Health Sciences University, Portland, OR, USA; Department of Urology, Oregon Health Sciences University, Portland, OR, USA
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Genitalchirurgische Maßnahmen zur Feminisierung bei Geschlechtsdysphorie. Urologe A 2022; 61:205-213. [DOI: 10.1007/s00120-022-01783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sonnenblick EB, Chaudhry S, Lee KA, Jaffer S, Fang F, Ting J, Margolies LR. MRI Features of Free Liquid Silicone in the Transgender Female Breast. JOURNAL OF BREAST IMAGING 2021; 3:322-331. [PMID: 38424775 DOI: 10.1093/jbi/wbab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To define MRI features of free liquid silicone injection (FLSI) of the breast in transgender women considering surgical management. METHODS This study was IRB-approved. MRI images from transgender women with FLSI imaged between 2009 and 2019 were reviewed. Presence and location of fibrotic masses (FMs) in the breast(s) and pectoralis muscle and patterns of granulomas were correlated with clinicopathologic findings. Background enhancement was quantified. Comparisons were performed using two-tailed Fisher exact and Student's t test. RESULTS Of 21 transgender women with FLSI (mean age 46.8 years), 13/21 (61.9%) had a dominant FM measuring over 4 cm; these were limited to breast and pectoralis in 6/21 (28.6%), breast in 9/21 (42.9%), and pectoralis only in 2/21 (9.5%). Four of 21 patients (19.0%) had no FMs, and 4/21 (19.0%) had masses under 4 cm. Mean size of the dominant FM was 7.4 cm (range 4-12 cm). FMs were enhancing in 5/13 (38.5%) and contained T2 high signal granulomas in 8/13 (61.5%). While 18/21 (85.8%) of cases showed mild to moderate overall background enhancement, the majority 7/13 (61.5%) of dominant FM were non-enhancing. About half of cases (11/21, 52.4%) had diffuse foci, and half (10/21, 47.6%) had diffuse foci and masses throughout the breast and pectoralis muscle. These foci and masses displayed T2 high signal in 13/21 (61.9%). There were no occult carcinomas observed. CONCLUSION MRI performed on symptomatic FLSI patients considering surgical treatment is helpful in assessing the extent of silicone infiltration and fibrotic reaction of the breast and pectoralis muscle.
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Affiliation(s)
- Emily B Sonnenblick
- Icahn School of Medicine at Mount Sinai, Department of Diagnostic, Molecular, and Interventional Radiology, New York, NY, USA
| | - Shivani Chaudhry
- Icahn School of Medicine at Mount Sinai, Department of Diagnostic, Molecular, and Interventional Radiology, New York, NY, USA
| | - Karen A Lee
- Icahn School of Medicine at Mount Sinai, Department of Diagnostic, Molecular, and Interventional Radiology, New York, NY, USA
| | - Shabnam Jaffer
- Icahn School of Medicine at Mount Sinai, Department of Pathology, Molecular, and Cell Based Medicine, New York, NY, USA
| | - Frank Fang
- Icahn School of Medicine at Mount Sinai, Department of Plastic and Reconstructive Surgery, New York, NY, USA
| | - Jess Ting
- Icahn School of Medicine at Mount Sinai, Department of Plastic and Reconstructive Surgery, New York, NY, USA
| | - Laurie R Margolies
- Icahn School of Medicine at Mount Sinai, Department of Diagnostic, Molecular, and Interventional Radiology, New York, NY, USA
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Grimstad F, McLaren H, Gray M. The gynecologic examination of the transfeminine person after penile inversion vaginoplasty. Am J Obstet Gynecol 2021; 224:266-273. [PMID: 33039391 DOI: 10.1016/j.ajog.2020.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/11/2020] [Accepted: 10/02/2020] [Indexed: 01/11/2023]
Abstract
As more transfeminine patients (transgender and gender-diverse persons, sex assigned male at birth, who identify on the feminine spectrum of gender) are undergoing gender-affirming penile inversion vaginoplasty, gynecologists, as providers of vaginal care for both native and neovaginas, should be prepared to welcome these patients into their practice and offer long-term pelvic healthcare. Many parts of the anatomy, clinical examination, and aftercare differ from both native vaginas and other neovaginal surgical techniques. Transgender and gender-diverse patients cite a lack of clinician knowledge as a barrier to accessing affirming and competent healthcare. Although publications are emerging regarding this procedure, most focus on intraoperative and postoperative complications. These studies are not positioned to provide long-term pelvic health guidance or robust instruction on typical examination findings. This clinical opinion aims to address that knowledge gap by describing the gynecologic examination in the transfeminine person who has undergone a penile inversion vaginoplasty. We review the anatomic changes with surgery and the neovagina's physiology. We describe the examination of the vulva, vagina, and urethra and discuss special considerations for performing pelvic examinations on patients with a penile inversion vaginoplasty neovagina. We will also address common pathologic findings and their initial management. This clinical opinion originates from the expertise of gynecologists who have cared for high volumes of transfeminine patients who have undergone penile inversion vaginoplasties at tertiary care centers performing gender-affirming genital surgery, along with existing research on postpenile inversion vaginoplasty outcomes. Gynecologists should be familiar with the anatomic changes that occur with penile inversion vaginoplasty gender-affirming surgery and how those changes affect care. Providing transgender patients with comprehensive care including this sensitive examination can and should be part of the gynecologist's scope of practice.
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Affiliation(s)
- Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Hillary McLaren
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS
| | - Meredith Gray
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS
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Jackson Cullison SR, Jedrych JJ, James AJ. Porphyria cutanea tarda unmasked by supratherapeutic estrogen during gender-affirming hormone therapy. JAAD Case Rep 2020; 6:675-678. [PMID: 32637521 PMCID: PMC7327305 DOI: 10.1016/j.jdcr.2020.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Jaroslaw J Jedrych
- Department of Dermatology, The Johns Hopkins University, Baltimore, Maryland
| | - Alaina J James
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Abstract
Sexual and gender minority (SGM) individuals include, but are not limited to, those who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ). LGBTQ individuals are considered a marginalized and at-risk population, facing significant health care inequities when compared with heterosexual and cisgendered (ie, "gender-conforming") populations. They are more likely than heterosexual and cisgendered individuals to experience discrimination, bias, and dissatisfaction with the medical system. This article provides a broad overview of systemic inequalities confronting SGM patients.
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Affiliation(s)
- Erica Arnold
- Spring Street Dermatology, 73 Spring Street, Suite 303, New York, NY 10012, USA; University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nikhil Dhingra
- Spring Street Dermatology, 73 Spring Street, Suite 303, New York, NY 10012, USA; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Historical and Current State of Dermatologic Care for Sexual and Gender Minority Populations. Dermatol Clin 2019; 38:177-183. [PMID: 32115126 DOI: 10.1016/j.det.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The lesbian, gay, bisexual, transgender, and queer or questioning/sexual and gender minority (LGBTQ/SGM) community is a growing population with unique lifestyles, sexual practices, beliefs, health issues, and concerns. Although significant advances have been achieved in recent years to establish better care for LGBTQ/SGM patients, they still face insurmountable stigmatization and health care inequality. Dermatologists play an important role in LGBTQ/SGM patients' well-being because they not only treat their skin conditions, but also help them achieve desirable physical characteristics. This article discusses historical perspectives and current state of LGBTQ/SGM dermatology and attempts to define directions for future research and improvement.
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Fakhoury JW, Daveluy S. Incorporating Lesbian, Gay, Bisexual, and Transgender Training into a Residency Program. Dermatol Clin 2019; 38:285-292. [PMID: 32115139 DOI: 10.1016/j.det.2019.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) patients experience vast health care disparities. Numerous government and professional organizations have attempted to address these disparities by calling for improvement in LGBT health and increased research endeavors. Despite these initiatives, residents still receive inadequate education and training in LGBT health. Here, the authors review these shortcomings and provide a framework for how to improve resident education and training in LGBT health. They describe methods of curricular enhancements and departmental/institutional climate optimization to improve resident competency. Finally, they discuss how LGBT-competent physicians can publicize their expertise and improve overall LGBT health care delivery.
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Affiliation(s)
- Joseph W Fakhoury
- Department of Dermatology, Wayne State University School of Medicine, 18100 Oakwood Boulevard, Suite 300, Dearborn, MI 48214, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, 18100 Oakwood Boulevard, Suite 300, Dearborn, MI 48214, USA.
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Abstract
Sexual and gender minorities have unique risk factors that may increase their risk of developing skin cancer. In particular, sexual minority men report a higher prevalence of skin cancer (including both keratinocytes carcinomas and melanoma), higher rates of indoor tanning, and overall poorer sun protection behaviors. Sexual and gender minorities also have high rates of alcohol and tobacco use, and infection with human immunodeficiency virus and human papillomavirus, which may increase overall risk of developing skin cancer in these populations. In this review, we discuss the evidence surrounding skin cancer and associated risk factors among sexual and gender minorities.
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12
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Katz KA. Quality care for lesbian, gay, bisexual, transgender, and queer patients in pediatric dermatology. Pediatr Dermatol 2019; 36:594-595. [PMID: 31529639 DOI: 10.1111/pde.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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