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Lowik A, Al-anzi SMF, Amarasekera A, Chan A, Rana M, Salter A, Nath R, Ybarra M, Saewyc E. Transgender Youth's Perspectives on Factors Influencing Intended and Unintended Pregnancies. WOMEN'S REPRODUCTIVE HEALTH (PHILADELPHIA, PA.) 2023; 10:572-590. [PMID: 38435846 PMCID: PMC10906744 DOI: 10.1080/23293691.2023.2186812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/27/2023] [Indexed: 03/05/2024]
Abstract
Drawing on data from focus groups with 152 trans youth aged 14-18 years in the United States, this article explores the factors that the participants understood as contributing to adolescent pregnancy among trans youth. Youth posited that unintended pregnancies occur due to barriers to contraceptives; a lack of gender-affirming sexual health education; sexual assault and dating violence; and mental health-influenced sexual risk-taking. Participants suggested that intended pregnancies may be a self-development strategy; a self-directed effort to repress/change gender modality or identity; and due to the perceived incompatibility between pregnancy and transition, where pregnancy must occur prior to transitioning.
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Affiliation(s)
- A.J. Lowik
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Shams M. F. Al-anzi
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Anurada Amarasekera
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Ace Chan
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Monica Rana
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Allison Salter
- Center for Innovative Public Health Research, San Clemente, California
| | - Ronita Nath
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
| | - Michele Ybarra
- Center for Innovative Public Health Research, San Clemente, California
| | - Elizabeth Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia, Vancouver, Canada
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General Approaches to Medical Management of Menstrual Suppression: ACOG Clinical Consensus No. 3. Obstet Gynecol 2022; 140:528-541. [PMID: 36356248 DOI: 10.1097/aog.0000000000004899] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
SUMMARY The purpose of this document is to review currently available management options, general principles, and counseling approaches for reproductive-aged patients requesting menstrual suppression. It includes considerations for unique populations, including adolescents, patients with physical or cognitive disabilities or both, and those with limited access to health care. Gynecologists should be familiar with the use of hormonal therapy for menstrual suppression (including combined oral contraceptive pills, combined hormonal patches, vaginal rings, progestin-only pills, depot medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine device, and the etonogestrel implant). Approaches to counseling should be individualized based on patient preferences and goals, average treatment effectiveness, and contraindications or risk factors for adverse events. Counseling regarding the choice of hormonal medication for menstrual suppression should be approached with the utmost respect for patient autonomy and be free of coercion. Complete amenorrhea may be difficult to achieve; thus, obstetrician-gynecologists and other clinicians should counsel patients and caregivers, if applicable, about realistic expectations.
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Reynolds CA, Charlton BM. Pregnancy prevention and unintended pregnancy across gender identity: a cross-sectional study of college students. Sex Health 2021; 18:441-443. [PMID: 34731596 DOI: 10.1071/sh21103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022]
Abstract
Using data from the Fall 2015 through Spring 2018 National College Health Assessment, we examined receipt of pregnancy prevention information and unintended pregnancy by gender identity among participants aged 18-25years who were assigned female at birth (n=185658). Non-binary students were more likely than cisgender students to report wanting (adjusted risk ratio [ARR]: 1.12; 95% CI: 1.08-1.16), receiving (ARR: 1.09; 95% CI: 1.04-1.13), and having an unmet need for (ARR: 1.10; 95% CI: 1.02-1.19) pregnancy prevention information from their school. Transmasculine students did not significantly differ from cisgender students for these outcomes. Non-binary and transmasculine students were as likely as cisgender students to have a past-year unintended pregnancy. Non-binary and transmasculine young people are at risk for unintended pregnancy and need access to comprehensive sexual education, reproductive health counseling, and care.
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Affiliation(s)
- Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; and Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Brittany M Charlton
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; and Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; and Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Reynolds CA, Charlton BM. Sexual Behavior and Contraceptive Use Among Cisgender and Gender Minority College Students Who Were Assigned Female at Birth. J Pediatr Adolesc Gynecol 2021; 34:477-483. [PMID: 33838331 DOI: 10.1016/j.jpag.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/12/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Our objective was to describe sexual behavior and contraceptive use among assigned female cisgender and gender minority college students (ie, those whose gender identity does not match their sex assigned at birth). DESIGN Cross-sectional surveys administered as part of the fall 2015 through spring 2018 administrations of the National College Health Assessment. SETTING Colleges across the United States. PARTICIPANTS A total of 185,289 cisgender and gender minority assigned females aged 18-25 years. MAIN OUTCOME MEASURES Recent vaginal intercourse; number and gender of sexual partners; use of contraception; use of protective barriers during vaginal intercourse. RESULTS Both gender minority and cisgender students often reported having male sexual partners, but gender minority students were more likely to report having partners of another gender identity (eg, women, trans women). Gender minorities were less likely than cisgender students to report having vaginal intercourse (adjusted odds ratio [AOR]: 0.86; 95% confidence interval [95% CI]: 0.80, 0.93). Gender minorities were less likely than cisgender students to report using any contraceptive methods (AOR: 0.86; 95% CI: 0.73, 1.03), and were less likely to consistently use barrier methods (AOR: 0.72; 95% CI: 0.64, 0.81) or emergency contraception (AOR: 0.56; 95% CI: 0.48, 0.65). However, gender minorities were more likely to use Tier 1 and Tier 3 contraceptive methods than cisgender women. CONCLUSIONS Providers must be trained to meet the contraceptive counseling needs of cisgender and gender minority patients. Providers should explicitly ask all patients about the sex/gender of the patients' sexual partners and the sexual behaviors in which they engage, to assess sexual risk and healthcare needs.
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Affiliation(s)
- Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
| | - Brittany M Charlton
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Evans S, Crawley J, Kane D, Edmunds K. The process of transitioning for the transgender individual and the nursing imperative: A narrative review. J Adv Nurs 2021; 77:4646-4660. [PMID: 34252206 DOI: 10.1111/jan.14943] [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: 01/23/2021] [Revised: 05/14/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
AIMS The objectives of this study were to bring the experience of the transitioning process for the transgender population to the nursing profession and address the lack of knowledge to promote improved patient outcomes. DESIGN This study used a narrative review using the literature matrix method. Because of the dearth of trans specific literature, editorials and monologues were included. DATA SOURCE A broad search was undertaken across all databases including CINAHL, PubMed, PsycINFO, Ovid MEDLINE, ProQuest Nursing & Allied Health and Google Scholar. Literature from June 1994 to May 2020 was appraised. Non-peer reviewed literature and published texts were procured via Google Alerts. REVIEW METHODS Selection for inclusion was based on credibility and relevance from a variety of social science disciplines. A narrative analysis was used to identify common themes, incongruencies in schools of thought and perspectives that require consideration. RESULTS Analysis of the literature revealed the following themes: (a) literature and terminology evolution, (b) transitioning as a process, (c) medicalization of transitioning, (d) generational views on transitioning and (e) needs during transition. CONCLUSION This review highlights key issues about the transitioning process imperative to nursing when meeting the needs of the transgender population. IMPACT This review addresses the lack of trans specific literature and lack of consistency in the literature about the understanding of the transitioning process for the transgender population. Main findings? Terminology to explain the transitioning process is ever evolving. Future studies about transitioning need to go beyond the medical lens. Generational views differ in the approach to transitioning, and there are needs unique to this population required during the process. Where and whom will the research impact? The review has significant implications for change in health delivery, nursing policy and formulating nursing practice and education to improve trans competent care.
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Affiliation(s)
| | | | - Debbie Kane
- University of Windsor, Windsor, Ontario, Canada
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Voss RV, Simons L. Supporting the Health of Transgender and Gender-Diverse Youth in Primary Care Settings. Prim Care 2021; 48:259-270. [PMID: 33985703 DOI: 10.1016/j.pop.2021.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Transgender and gender-diverse youth represent approximately 2% of all youth in the United States. Given that gender diversity usually develops during childhood and adolescence, primary care providers must be equipped to recognize and support youth exploring gender identity or experiencing gender dysphoria. This article provides an overview of gender diversity and reviews strategies for creating a welcoming clinical space, discussing gender during the office visit, providing affirming primary care, and supporting youth and their families during gender identity exploration and gender transition.
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Affiliation(s)
- Raina V Voss
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161b, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Lisa Simons
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161b, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Gomez AM, Đỗ L, Ratliff GA, Crego PI, Hastings J. Contraceptive Beliefs, Needs, and Care Experiences Among Transgender and Nonbinary Young Adults. J Adolesc Health 2020; 67:597-602. [PMID: 32527572 DOI: 10.1016/j.jadohealth.2020.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE This qualitative study explores the contraceptive health-care needs of transgender and nonbinary young adults assigned female sex at birth. METHODS Qualitative interviews were conducted with 20 transgender and nonbinary young adults assigned female sex at birth (ages 22-29 years), recruited via online platforms and community agencies. Semistructured interviews elicited information on participants' gender and reproductive histories, health-care experiences, sexual practices, and contraceptive use and decision-making processes. Interviews were transcribed and coded using thematic analysis. RESULTS Primary thematic domains centered on contraceptive experiences and needs, testosterone as contraception, and experiences with reproductive health care. Participants generally did not use hormonal contraception to prevent pregnancy; in situations where pregnancy was possible, participants relied on condoms. Some participants believed testosterone use would prevent pregnancy and subsequently did not use a contraceptive method. Participants described the lack of knowledge, among themselves and providers, of the impacts of testosterone on pregnancy risk and interactions with hormonal contraception. They described reproductive health-care experiences in which providers were unfamiliar with the needs of transgender and nonbinary patients; made assumptions about bodies, partners, and identities; and lacked adequate knowledge to provide effective contraceptive care. CONCLUSIONS Patient-centered reproductive care requires that providers be sensitive to the stress of gender-affirming care and engage with contraceptive counseling that addresses patients' behavior, risks, and reproductive functions. In particular, providers should understand and communicate the impacts of testosterone therapy on pregnancy risk.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California.
| | - Lotus Đỗ
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - G Allen Ratliff
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Pau I Crego
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Jen Hastings
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California; Gender Spectrum, Berkeley, California
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Abstract
Fertility awareness, or general knowledge about one's fertility, is low in adolescents and in adult women as well. Misconceptions about reproduction contribute to high rates of unplanned pregnancy in the United States, as well as delayed childbearing and infertility. Alhough primary care providers caring for adolescents have historically focused on contraception and reduction of sexually transmitted infections during their sexual and reproductive health conversations with adolescents and young adult women, fertility awareness counseling would help these women optimize their future fertility and make informed reproductive choices throughout their life. This is particularly true for adolescents with chronic medical conditions, certain gynecologic conditions, or a history of therapies that could potentially affect fertility, for whom preemptive conversations about fertility are needed, but often overlooked. [Pediatr Ann. 2019;48(2):e86-e91.].
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