This month, the American College of Obstetricians and Gynecologists released a set of recommendations by committee opinion, urging reproductive health care providers to improve their treatment of transgender people.
These new guidelines encourage ob-gyns to do the following: ask patients about their gender open-endedly on their patient intake forms rather than requiring they check “male” or “female,” to post LGBT-inclusive nondiscrimination policies visibly in their offices, and train staff to handle transgender patients professionally and with compassion. ACOG says that physicians must be prepared to offer gender-nonconforming patients the same basic preventive services as their cisgendered patients (those who identify as the gender they were assigned at birth), such as STD testing and cancer screenings.
This is a huge, much-needed victory in LGBT health and wellness. In October 2010, the National Center for Transgender Equality and the National Gay and Lesbian Task Force released the results of the largest survey of transgender people on healthcare discrimination to date, and the results were dismal. Not only are trans people at elevated risk for most of our nation’s worst health problems, but according to the report:
- Respondents reported more than four times the national average of HIV infection, 2.64 percent in our sample compared to 0.6 percent in the general population, with rates for transgender women at 3.76 percent, and with those who are unemployed (4.67 percent) or who have engaged in sex work (15.32 percent) even higher.
- Over a quarter of the respondents reported misusing drugs or alcohol specifically to cope with the discrimination they faced due to their gender identity or expression.
- A staggering 41 percent of respondents reported attempting suicide compared to 1.6 percent of the general population.
- Nearly 1 in 5 (19 percent) reported being refused care outright because they were transgender or gender non-conforming.
- Survey participants reported very high levels of postponing medical care when sick or injured due to discrimination and disrespect (28 percent).
- Harassment: 28 percent of respondents were subjected to harassment in medical settings.
- Significant lack of provider knowledge: 50 percent of the sample reported having to teach their medical providers about transgender care. (see Source)
Reproductive healthcare is often stressful for transgender patients even when they aren’t treated disrespectfully by their providers, because many transgender people experience gender dysphoria, a feeling of extreme discomfort and anxiety with their assigned genders. Gender dysphoria is what many trans people refer to when they talk about feeling “trapped in the wrong body,” and it frequently includes strong feelings of disgust about their sexual anatomy.
A transgendered man with strong feelings of revulsion and anxiety about the parts of his body that are still “female” would find receiving care for something like an ovarian cyst upsetting under the best of circumstances. The last thing this man should have to worry about is whether he’ll have to argue with health practitioners who insist despite his protests that they’re going to make every effort possible to preserve his ovaries because he “might want to be a mother someday.”
Hopefully the new recommendations from the American College of Obstetricians and Gynecologists will make that kind of transgender healthcare horror story a thing of the past – or at least a glaring anomaly. No one should have to receive health care in a hostile environment, and we commend ACOG for recognizing that ignorance and disrespect from providers is a serious and attention-worthy barrier to healthcare access.