Gynecological Care Of The Transgender Men

Introduction

Transgender men are a group of people at risk who have difficulty achieving their healthcare needs due to ignorance in identifying the population and limited research on their healthcare. Few studies show that transgender men are highly prone to experiencing violence, contracting HIV (human immunodeficiency virus), developing polycystic ovarian syndrome, and committing suicide. Many members of the transgender community often use drugs to overcome social discrimination, are involved in prostitution for income, and share needles to administer sex hormones which puts them at high risk of HIV exposure. Hence, the need for easily accessible and compassionate medical care is very important. Gynecological care holds an important position in the health care of transgender men, especially for those who have not undergone gender-affirming surgery.

What Are the Factors to Consider While Providing Gynecological Care to Transgender Men?

The following factors should be considered while providing gynecological care to transgender men. They are:

• The patient should feel comfortable and welcomed when they approach a healthcare provider for gynecological care. Gender-neutral language should be used, and gendered language should be removed from intake forms and signage.

• Psychological trauma due to the difference between sex assigned at birth and gender identity should be reduced in transgender men during gynecological examination by informing them about the physical examinations in advance. Routine screenings should be performed in transgender men who have breast tissue, ovaries, or uterus. A transgender man having a cervix and uterus should undergo consistent pelvic examinations and pap smears, whereas transgender men having breast tissue should undergo regular mammograms after the age of 40.

• The patient should be informed prior about the side effects of hormone therapy. Few people may experience abnormal vaginal bleeding during testosterone therapy which usually suppresses after a few months of therapy. A transvaginal ultrasound scan may be required in some patients who experience irregular vaginal bleeding.

• Some transmen undergo transition through hormone therapy, while others undergo transition through surgery. The gender-affirming surgeries may include chest reconstruction, hysterectomy, vaginectomy, or phalloplasty. The doctor should stay updated on the latest outcomes and recommendations to guide surgery according to the need of the patient, eligibility, and other criteria.

• Transmen above the age of 50 who have not undergone mastectomy (a procedure of removing breast tissue to treat or prevent breast cancer) should conduct regular self-examinations and undergo mammography (an X-ray imaging procedure used to detect cancer and other diseases of the breast).

• Counseling about contraception and sexually transmitted diseases plays an important role in the gynecological care of transgender patients. This is of great significance in patients who retain ovaries and the uterus and engage in penetrative intercourse.

• Health insurance plans which discriminate against transgender people by denying to cover gender-affirming medical care are considered to be illegal. Hence, ensuring insurance coverage with the help of a signed letter from the doctor for procedures like pelvic examinations and pap smears may help transgender men meet their expenses for gynecological care.

What Are the Areas Involved Under Gynecological Care of Transgender Men?

• Pelvic Health: The risk of cancer in the uterus, ovaries, or cervix is the most important area of concern in pelvic health. The following tests may be advised by the doctor for good pelvic health. They are:

• Pap Test: The Pap test involves collecting the cells from the cervix of the patient and the doctor using a small and soft brush. The cells are observed under a microscope to detect the signs of cancer. The presence of human papillomavirus (HPV), which is an indicator of cervical cancer, is also checked.

• Pelvic Exam: A pelvic exam includes the examination of the ovaries, uterus, cervix, and vagina. During the procedure, the doctor observes the genitals and feels inside the vagina. Uncomfortable patients can opt for examination under sedation.

• Test for Sexually Transmitted Infections: Sexually transmitted infections may include gonorrhea, syphilis, hepatitis, herpes, human papillomavirus (HPV) infection, and acquired immunodeficiency syndrome (AIDS). These infections can be transmitted through oral, vaginal, or anal sex. The doctor may advise regular screening tests for these infections based on the history and symptoms of the patient.

Breast Tissue Health:

Breast tissue health mainly involves detecting the presence of cancer. Chances of breast cancer may be present even in transmen who have undergone masculinizing chest surgery. The doctor may inquire about the patient's family history of breast cancer and may recommend breast cancer screenings and mammograms. If a mammogram is not possible in transmen who have undergone masculinizing chest surgery, methods like magnetic resonance imaging (MRI) or ultrasound may be recommended.

• Testosterone Usage: The menstrual cycle is usually stopped in patients after three to four months of testosterone usage. If a patient experiences bleeding even after four months of testosterone usage, the doctor may evaluate the presence of any other medical condition that may be the cause of bleeding. If there is no underlying medical problem, the patient may be advised to take a three-month course of progesterone to stop the bleeding. Testosterone may lead to increased sexual drive, a larger clitoris, and thin vaginal walls, which might increase pain and bleeding during sex. Hence water-based lubricants and creams may be advised by the doctor to ease symptoms.

• Body Image Issues: Many transmen undergo surgery to change their bodies due to the pressure experienced by society to look a certain way. Such patients who have body imaging concerns should seek counseling or join a support group after discussing the issues with the doctor.

• Fertility Issues: Transmen who wish to give birth can decide to have children before starting hormone therapy or gender-affirming surgery. They can even opt for methods like collecting and freezing ovarian tissue or unfertilized eggs for future use. Transmen with ovaries and a uterus have a chance of getting pregnant even if they take testosterone or do not have a menstrual cycle. Hence, transmen who do not wish to have children should not depend on testosterone therapy for birth control. Birth control methods like barrier methods such as condoms, hormone birth control measures such as estrogen intake, intrauterine devices, or surgery can be opted for.

What Are the Preventive Measures for Gynecological Problems in Transmen?

The following measures can be adopted to prevent gynecological problems in transmen. They are:

• Using a condom during vaginal or anal sex, a latex glove during digital penetration, or a latex barrier during oral sex. Usage of petroleum jelly, hand lotions, or oil-based products instead of water-based lubricants may weaken latex condoms leading to breakage, which may increase the risk of sexually transmitted infections.

• Avoiding unprotected sex by making sure that the sexual partner is tested for sexually transmitted infections. People with infections like HIV may take up to three months after being infected to show positive blood results.

• In case of having unprotected sex with a partner who has an HIV infection, medications that can prevent the possibility of developing an HIV infection can be taken under the guidance of a doctor.

• Getting vaccinated prevents infections like hepatitis A, hepatitis B, and HPV infections which can be transmitted through sexual contact.

• Transmen who do not want to conceive can opt for permanent surgical birth control measures like tubal ligation or complete removal of the fallopian tubes. Temporary birth control can be achieved by using intrauterine devices that contain the hormone progestin, barrier methods like condoms, or birth control pills.

• Transmen who use chest compression ways like binders to hide breasts can discuss with the doctor and take guidance to yeast infections or rashes of the skin.

Conclusion

Like other people, transmen also have sensitive and complicated healthcare needs which need to be taken care of by doctors. Gynecological care is an integral part of their healthcare needs which needs to be given importance. Hence, with the support of society and well-trained healthcare professionals, transmen also can lead a normal life by achieving their healthcare needs.