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Falck FAOK, Dhejne CMU, Frisén LMM, Armuand GM. Subjective Experiences of Pregnancy, Delivery, and Nursing in Transgender Men and Non-Binary Individuals: A Qualitative Analysis of Gender and Mental Health Concerns. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1981-2002. [PMID: 38228983 PMCID: PMC11106200 DOI: 10.1007/s10508-023-02787-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
Studies of how gender-diverse individuals experience pregnancy, childbirth, and nursing remain few, mainly focus on the US and contain scarce information about mental health concerns peri-partum. This hinders informed reproductive health decisions and counseling. We used in-depth interviews to examine how gestational gender-diverse individuals in Sweden experience the process of planning and undergoing pregnancy, delivery, and nursing. In total, 12 participants, identifying on the masculine side of the gender spectrum or as non-binary, who had attended Swedish antenatal care and delivered a live birth, were included in the study. Data were analyzed using qualitative thematic content analysis. The analysis resulted in one overarching theme: sustaining gender congruence during pregnancy and three main categories: (1) considering pregnancy; (2) undergoing pregnancy and childbirth; and (3) postnatal reflections. The association between childbearing and being regarded as female permeated narratives. Participants renegotiated the feminine connotations of pregnancy, accessed gender-affirming treatment, and concealed their pregnancy to safeguard their gender congruence. Mis-gendering and breast enlargement triggered gender dysphoria. Social judgment, loneliness, information shortages, hormonal influence and cessation of testosterone increased gender dysphoria and strained their mental health. Depression exacerbated gender dysphoria and made it harder to claim one's gender identity. Dissociation was used to handle a feminized body, vaginal delivery, and nursing. Pregnancy was easier to envision and handle after masculinizing gender-affirming treatments. The results deepen the understanding of gender dysphoria and may be used to inform reproductive counseling and healthcare development. Research outcomes on mental health concerns provide a basis for further research.
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Affiliation(s)
- Felicitas A O K Falck
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Psychiatry Southwest, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
| | - Cecilia M U Dhejne
- ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Louise M M Frisén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gabriela M Armuand
- School of Health and Welfare, Faculty of Health Sciences 1, Dalarna University, Falun, Sweden
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Seiger KW, McNamara B, Berrahou IK. Gynecologic Care for Sexual and Gender Minority Patients. Obstet Gynecol Clin North Am 2024; 51:17-41. [PMID: 38267126 DOI: 10.1016/j.ogc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Sexual and gender minority (SGM) people, including lesbian, gay, bisexual, transgender, and queer individuals, are a diverse population with a wide spectrum of gynecologic needs. Institutionalized cisheteronormativity, stigmatization, lack of provider training, and fear of discrimination contribute to health disparities in this patient population. In this article, we review key topics in the gynecologic care of SGM patients and provide strategies to enable gynecologists to provide SGM people with equitable and inclusive full spectrum reproductive health care.
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Affiliation(s)
- Kyra W Seiger
- Yale University School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA
| | - Blair McNamara
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Iman K Berrahou
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, Suite 302 FMB, New Haven, CT 06520-806, USA.
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Song S, Park KM, Parmeshwar N, Dugi D, Schechter L, Berli JU, Kim EA. Developing Gender-Affirming Surgery Curricula for Plastic Surgery Residency and Fellowship via Delphi Consensus. Plast Reconstr Surg 2024; 153:160e-169e. [PMID: 37075281 DOI: 10.1097/prs.0000000000010569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Gender-affirming surgery (GAS) is a rapidly growing field within plastic surgery, and residents and fellows must receive appropriate training. However, there are no standardized surgical training curricula. The objective of this study was to identify core curricula within the field of GAS. METHODS Four GAS surgeons from different academic institutions identified initial curricular statements within six categories: (1) comprehensive GAS care, (2) gender-affirming facial surgery, (3) masculinizing chest surgery, (4) feminizing breast augmentation, (5) masculinizing genital GAS, and (6) feminizing genital GAS. Expert panelists consisting of plastic surgery residency program directors and GAS surgeons were recruited for three rounds of the Delphi-consensus process. The panelists decided whether each curriculum statement was appropriate for residency, fellowship, or neither. A statement was included in the final curriculum when Cronbach α value was greater than or equal to 0.8, meaning that 80% or more of the panel agreed on inclusion. RESULTS A total of 34 panelists (14 plastic surgery residency program directors and 20 GAS surgeons representing 28 US institutions) participated. The response rate was 85% for the first round, 94% for the second, and 100% for the third. Out of 124 initial curriculum statements, 84 reached consensus for the final GAS curricula, 51 for residency, and 31 for fellowship. CONCLUSIONS A national consensus on core GAS curriculum for plastic surgery residency and GAS fellowship was achieved by a modified Delphi method. Implementation of this curriculum will ensure that trainees in plastic surgery are adequately prepared in the field of GAS.
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Affiliation(s)
| | - Keon Min Park
- the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco
| | - Nisha Parmeshwar
- the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco
| | | | - Loren Schechter
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center
| | - Jens Urs Berli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Sciences University
| | - Esther A Kim
- the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco
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Rezaei SJ, Miranda N, Bene NC, Ganor O. The Current State of Transgender Health Curricula in Graduate Surgical Education: A Systematic Review of Survey Data. JOURNAL OF SURGICAL EDUCATION 2023; 80:1826-1835. [PMID: 37658003 DOI: 10.1016/j.jsurg.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/29/2023] [Accepted: 08/02/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVES Transgender and gender diverse (TGD) individuals in the U.S. face significant healthcare disparities, which can be further exacerbated by providers' unfamiliarity with this population's specific needs. ACGME currently does not have requirements for gender-affirming surgery (GAS) in the residency programs of surgical specialties that are responsible for providing this care. This systematic review evaluates gender-affirming care (GAC) and GAS training in surgical residency programs in the U.S. through the analysis of survey respondent data. METHODS Six databases (PubMed, Embase, Web of Science and Scopus, Cochrane Library and Google Scholar) were searched in December 2022 and May 2023. The search process ultimately yielded 22 survey-based studies, published between 2015 and 2023, with responses from 3020 respondents (2582 trainees and/or attending physicians, 438 program directors). RESULTS Six different surgical specialties were the focus of included studies, and common questions revolved around GAS training availability, comfort in treating TGD patients, and the importance of GAS in graduate surgical education (GSE). Less than half of trainees indicated that they received some form of previous GAC or GAS training, and less than half of program directors indicated that their residency or fellowship program offered such training. CONCLUSIONS While comfort levels around treating TGD patients ranged, the studies indicated an overall perceived importance of GAS training. These findings highlight the need to incorporate GAS training into graduate surgical education to improve access to and quality of care for TGD patients.
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Affiliation(s)
- Shawheen J Rezaei
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; Stanford University School of Medicine, Stanford, California.
| | - Noah Miranda
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; UMass Chan Medical School, Worcester, Massachusetts
| | - Nicholas C Bene
- Division of Plastic Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Oren Ganor
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts
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Soltani A, Baban S, French K, Annand K, Pelle A, Stifani BM. LGBTQI content on obstetrics and gynecology residency websites. BMC MEDICAL EDUCATION 2023; 23:854. [PMID: 37953272 PMCID: PMC10642032 DOI: 10.1186/s12909-023-04624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 08/28/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND In the United States (US), many obstetrics & gynecology (OB-GYN) trainees feel unprepared to care for lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) individuals, but interest in this topic is rising. Residency program websites are one way that directors can advertise whether this training is offered within their program. We aimed to describe the extent to which LGBTQI content is currently featured on OB-GYN residency websites across the country. METHODS We identified all OB-GYN residency programs in the United States using a publicly available database. We systematically searched for select LGBTQI keywords on program websites. We collected data on mentions of LGBTQI didactics and rotations. We also searched whether LGTBQI keywords were included in diversity, equity, and inclusion (DEI) statements. We used multivariable logistic regression to compare the characteristics of programs that do and do not include this content. We used STATA SE Version 16.0 for all analyses and set the level of significance at 5%. RESULTS We included 287/295 US OB-GYN residency programs in our analysis (97.3%) and excluded 8 that did not have websites. We identified any LGBTQI content on 50 program websites (17.4%), and specific mention of didactics or rotations on 8 websites (2.8%). On multivariable analysis, programs in the West were more likely to include any LGBTQI content compared to programs in the South (OR 2.81, 95%CI 1.04-7.63), as were programs with 1 or 2 fellowships (OR 3.41, 95%CI 1.43-8.14) or 3 or more fellowships (OR 4.85, 95%CI 2.03-11.57) compared to those without fellowships. Programs in departments led by female chairs were also more likely to include LBTQI content (OR 3.18, 95%CI 1.55-6.51). CONCLUSIONS Academic programs, West Coast programs, and those with departments led by female chairs are more likely to mention LGBTQI keywords on their websites. Given the increasing interest in LGBTQI education for OB-GYN trainees, program directors should consider providing training opportunities and including this content on their websites.
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Affiliation(s)
- Amythis Soltani
- Department of Obstetrics & Gynecology, New York Medical College / Westchester Medical Center, Valhalla, NY, USA.
| | - Saman Baban
- Department of Obstetrics & Gynecology, New York Medical College / Westchester Medical Center, Valhalla, NY, USA
| | - Katherine French
- Department of Obstetrics & Gynecology, New York Medical College / Westchester Medical Center, Valhalla, NY, USA
| | - Kathryn Annand
- Department of Obstetrics & Gynecology, New York Medical College / Westchester Medical Center, Valhalla, NY, USA
| | - Annemarie Pelle
- Department of Obstetrics & Gynecology, New York Medical College / Westchester Medical Center, Valhalla, NY, USA
| | - Bianca M Stifani
- Department of Obstetrics & Gynecology, New York Medical College / Westchester Medical Center, Valhalla, NY, USA
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Ye A, Gray E, Bennis S, Rho M, Hwang S. Physical medicine & rehabilitation residents' perspectives on women's musculoskeletal health. PM R 2023; 15:1436-1444. [PMID: 36882609 DOI: 10.1002/pmrj.12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Women are either disproportionately or uniquely affected by certain musculoskeletal conditions but have limited access to providers of sex-specific musculoskeletal care. Few physical medicine & rehabilitation (PM&R) residencies offer women's musculoskeletal health training, and it is unknown whether PM&R residents feel prepared to care for women's musculoskeletal health concerns. OBJECTIVE To examine PM&R residents' perspectives and experiences in women's musculoskeletal health. DESIGN Cross-sectional survey developed through clinical expertise and consistent with sports medicine guidelines. SETTING Electronic survey sent to all accredited PM&R residency programs within the United States, distributed through program coordinators and resident representatives. PARTICIPANTS PM&R residents. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome was residents' perspective of comfort with women's musculoskeletal health. Secondary outcomes were exposure to formal education on women's musculoskeletal health topics, exposure to various learning formats for these topics; and residents' perspectives on desire for further education, access to field-specific mentors, and interest in incorporating women's musculoskeletal health into future practice. RESULTS Two hundred eighty-eight responses were included for analysis (20% response rate, 55% female sex residents). Only 19% of residents self-reported feeling comfortable providing care for women's musculoskeletal health conditions. Comfort did not significantly differ by postgraduate year, program region, or sex. However, with regression modeling, the number of topics learned formally in their curriculum had an increased odds of residents self-reporting comfort (odds ratio [OR] 1.18, confidence interval [CI] 1.08-1.30, adjusted p value .01). The majority of residents viewed learning women's musculoskeletal health as important (94%) and requested more exposure to the field (89%). CONCLUSIONS Many PM&R residents do not feel comfortable in caring for women's musculoskeletal health conditions despite their interest in the field. To improve health care access for patients seeking care for these sex-predominant or sex-specific conditions, residency programs may want to consider increasing exposure to women's musculoskeletal health for residents.
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Affiliation(s)
- Alice Ye
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elizabeth Gray
- Biostatistics Collaboration Center, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stacey Bennis
- Departments of Physical Medicine & Rehabilitation and Orthopedic Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Monica Rho
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Hwang
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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Kreines FM, Quinn GP, Cardamone S, Pi GE, Cook T, Salas-Humara C, Fino E, Shaw J. Training clinicians in culturally relevant care: a curriculum to improve knowledge and comfort with the transgender and gender diverse population. J Assist Reprod Genet 2022; 39:2755-2766. [PMID: 36355246 PMCID: PMC9790842 DOI: 10.1007/s10815-022-02655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To design a replicable simulation curriculum collaboratively with the transgender and gender diverse community to improve clinician knowledge and comfort with providing reproductive care to this population. METHODS This is a prospective, single arm pre-post analysis of obstetrics and gynecology residents at a single academic institution after completion of a novel simulation curriculum. The primary outcome was the change in resident comfort and knowledge in providing transgender and gender diverse patient care. A thematic analysis of learner and standardized patient free text responses was analyzed for insights on perceived learner experiences. RESULTS This curriculum was created with iterative feedback from the transgender community and involved only transgender and gender diverse-identified standardized patients. Thirty residents participated, with 22 responding to both the pre-and post-curriculum surveys, and 11 responding to a 6-month post-curriculum survey. There were significant improvements in learner comfort and knowledge after participation that were found to persist at 6 months. Qualitative analysis demonstrated that this was a positive and powerful learning experience for both residents and standardized patients. CONCLUSIONS This simulation curriculum may be an effective and impactful tool to increase trainee comfort and knowledge of transgender and gender diverse patient care, which is important given the lack of physician training in the care for these individuals. By building the foundation with resident learners, the ultimate goal is to enhance the pool of clinicians confident and capable of caring for transgender and gender diverse patients, to increase access to care, and to improve health outcomes in this vulnerable population.
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Affiliation(s)
- Fabiana Maria Kreines
- Department of Obstetrics and Gynecology, New York University Langone Health, NY, New York, USA.
- Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Langone Health, NY, New York, USA
| | - Stefanie Cardamone
- Department of Obstetrics and Gynecology, New York University Langone Health, NY, New York, USA
- Department of Obstetrics and Gynecology, Stony Brook Medicine, NY, Stony Brook, USA
| | - Guillermo E Pi
- Department of Pediatrics, New York University Langone Health, NY, New York, USA
- Department of Pediatrics, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tiffany Cook
- Office of Diversity Affairs, New York University Grossman School of Medicine, New York, NY, USA
- UMass Chan Medical School, Diversity and Inclusion Office, Worcester, MA, USA
| | - Caroline Salas-Humara
- Department of Pediatrics, Division of Adolescent Medicine, New York University Langone Health, New York, NY, USA
| | - Elizabeth Fino
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, USA
| | - Jacquelyn Shaw
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, NY, USA
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Sexual and Reproductive Health for Transgender and Gender-Diverse Patients. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00333-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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