Transcript LGBTQRST Int Med Grand Round Jan 2013x

LGBTQRST…Making
Sense of Sexual
Minority Health
Katie Imborek, MD
Clinical Assistant Professor
Department of Family Medicine
January 17th, 2013
Disclosures
• No financial disclosures
• Non-FDA approved medications
• Cis-gender
• Lesbian
Objectives
• Increase awareness about our LGBTQ Clinic
Tuesday evenings at IRL
• Describe terminology and concepts related to
LGBTQ healthcare
• Understand the relationship between behavior,
identity and attraction
• Tips and tricks for taking a sensitive and
comprehensive history from your LGBTQ patient
UIHC LGBTQ Clinic
• Lesbian, Gay, Bisexual, Transgender, Queer, and/or
Questioning Clinic
• Tuesdays from 5-8 PM at Iowa River Landing
• Culturally competent staff
• Comprehensive Primary Care
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Ages 10 and above including OB care
Health Maintenance Exams
Acute visits
Contraception
STI testing and treatment
Hormones
LGB Demographics
• 2006-2008 National Survey of Family Growth
(ages 15-44)
• Identity
• Identify as lesbian/bisexual: 4.6%
• Identify as gay/bisexual: 2.8%
• Behavior
• MSM 5.2%
• WSW 12.5%
Chandra et al. Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006-2008
National Survey of Family Growth. Natl Health Stat Report. 2011 Mar 3;(36):1-36.
LGB Demographics: 2010 Census
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Transgender Patients: Barriers
to Healthcare
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34 states without non-discrimination policies1
Refusal of care: 19%2
Violence in physician’s offices: 2%2
Lack of Provider knowledge: 50%2
Postponing medical care: 28%2
1 Transgender
Issues: A Fact Sheet.
http://www.transgenderlaw.org/resources/transfactsheet.pdf.
2Grant
JM et al. National Transgender Discrimination Survey Report on Health and
Health Care. National Center for Transgender Equality and the National Gay and
Lesbian Task Force. Oct 2010.
Transgender Healthcare:
Medically Necessary?
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American Medical Association
American Psychiatric Association
American Psychological Association
American Academy of Family Physicians
National Association of Social Workers
National Commission on Correctional Health Care
World Professional Association for Transgender Health
American Public Health Association
American College of Obstetricians and Gynecologists
LGBTQ Language: Sex
• Sex (Assigned at birth)
• Based on appearance of
physical anatomy
• Chromosomes,
reproductive organs and
their functions
• Male
• Female
• Intersex
LGBTQ Language: Gender
• Gender Expression
• Cis-gender
• Clothing, mannerisms,
voice
• Man
• Woman
• Gender Role
• Social and cultural
expectation of expression
• Gender Identity
• Personal sense of maleness
or femaleness
• Transgender
• Trans man
• Trans woman
• Non-binary
Trans*
• Incongruity between sex
assigned at birth and
gender identity
• Does not conform to
societal norms for:
• Gender identity
• Gender expression
LGBTQ Language: Gender
Transsexual
Transgender
Gender Queer
Drag King/
Cross Dresser Queen
Transsexual
• Trans* person with an
overwhelming desire to
fully live their gender
identity
• Hormone therapy
• Gender affirming surgery
• Consider by some to be
pejorative and/or a
misnomer
Transsexual/Transgender Terms
• Trans man: Female To Male
• Trans woman: Male To Female
• Transition
• Process of moving from one gender to another
• May no longer identify as trans* after transitioning to
affirmed gender
• “Pre-op” and “post-op” are outdated and should be
avoided
Gender Queer
• Reject binary gender
• Third gender
• Androgynous
• Gender fluidity
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She, her, hers
He, him, his
They, them, theirs
Ze, zir, zirs
Ne, nem, nirs
Pronouns
• Emily is a 37 yo gender queer person, sex assigned at birth
male. They complain of abdominal pain that has affected
them for the past month. Emily states that they have tried
Tums without relief of their pain.
• Jordan is a 24 yo gender queer person, sex assigned at birth
female. Ze complains of abdominal pain that has affected zir
for the past month. Jordan states that ze has tried Tums
without relief of zirs pain.
Cross Dresser
• Desire to wear clothing, jewelry, or make-up that
is traditionally worn by the opposite sex
• Most often there is no desire to change their
gender
• Not reflective of gender identity or sexual
orientation
• Expression of masculinity/femininity, erotic
enjoyment, artistic expression
• Transvestite is outdated
Drag King & Drag Queen
• Exaggerated theatrical
expression of gender
• Separate from sexual
orientation and gender
identity
LGBTQ Language: Sexuality
• Identity/Orientation
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Heterosexual
Homosexual
Bisexual
Lesbian
Gay
Pansexual
Asexual
Queer
Questioning
• Behavior
• MSM
• WSW
• Trans* patient
• Detailed history
• Trans* partner(s)
• Sex assigned at birth
Reprinted with permission from The National LGBT Health Education Center.
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Reprinted with permission from The National LGBT Health Education Center.
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The Olson-Ashbrook Gender Abacus©
LGBTQ Self Identity Matrix
Gender
Sexuality
LGBTQ- Defined
• Lesbian
• Gay
• Bisexual
• Transgender
• Queer
• Questioning
Getting to Know Your LGBTQ Patient
• Get to know your patient as a person
• Partners, children, jobs
• Validates normalcy
• Ask open ended questions
• Who lives at home with you
• Are you involved in a relationship
• Tell me about yourself
Talking with LGBTQ Patients
• Instead of asking “Are you married” or “Do you
have a boyfriend/girlfriend?” ask:
• “Do you have a partner or spouse?”
• “Are you currently in a relationship?”; If yes, “Tell me about
it.”
• Do not make assumptions
• Recognize your own heterocentric and ciscentric beliefs
• Identity≠Behavior≠Attraction
• Listen to the language the patient uses
• Wife/husband
• Queer
Talking with Trans* Patients
• Ask about preferred name and pronoun
• Honor name and pronoun
• Use pronouns consistent with presentation
• If you make a mistake: apologize and move on
Terms to Avoid
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+/- Queer
+/- Homosexual
Hermaphrodite
Transvestite
Transgendered
+/- Transsexual
She-Male, Tranny
MTF, FTM
Pre-Op, Post-Op
Take Home Points
• UIHC LGBTQ Clinic Tuesdays 5-8 at IRL
• Understand your patient’s identity: sex, gender,
sexuality
• LGBTQ = Lesbian, Gay, Bisexual, Transgender,
Queer, and/or Questioning
• Treat LGBTQ patients just like non-LGBTQ
patients
• Ask, honor, and apologize
Questions