Do Transgender and Gender Diverse Individuals Receive Adequate Gynecologic Care? An Analysis of a Rural Academic Center

Abstract

The transgender population faces disparities accessing gynecologic health care services, especially in rural settings. There is limited knowledge among medical providers regarding transgender-specific gynecologic care. Methods: A retrospective chart review of 255 transgender and gender diverse patients at a rural, academic center and associated ambulatory clinics was performed. Demographics, insurance status, and utilization rates of screening services, including cervical cancer, breast cancer, human papillomavirus (HPV) vaccination status, and contraceptive status, were analyzed using descriptive statistics. These rates were compared with national rates of cisgender individuals. Chi-square tests were performed to assess the association of insurance status with receipt of services. Results: Prevalence of HPV vaccination was lowest among transgender men (20%) compared with transgender women (60%) and gender nonbinary/nonconfirming and gender diverse individuals (60%), p < 0.001. Our cohort was significantly less likely to receive Papanicolaou smears (51% vs. 81%, p < 0.05) and contraception (48% vs. 65%, p < 0.05) than cisgender individuals. Around 18% of transgender women had a documented pelvic examination in the past year. There was no significant difference in utilization rates based on insurance status. Conclusion: In our rural setting, there is lower utilization of gynecologic services among transgender and gender diverse individuals. Although participants in our study had high rates of access to insurance and health care providers, they still had lower rates of gynecologic screening and prevention services. To address these disparities, we advocate for developing transgender-specific gynecologic health maintenance guidelines, robust provider education, and an inclusive electronic medical record to ensure appropriate gynecologic health screening.

Genetic counselors' experiences with transgender individuals in prenatal and preconception settings

“…Limited choices on standard intake forms and within medical record systems, such as binary sex options and legal names, may also impact patient care and research. (Deutsch & Buchholz, 2015; Deutsch et al., 2013; Dutton et al., 2008; Hoffkling et al., 2017; Stewart et al., 2020). There may also be unspoken discriminators, such as gendered signage, posters, artwork, pamphlets, and magazines, which may inhibit the clinic from promoting a safe healthcare environment for all (Deutsch, 2016; Hoffkling et al., 2017).…”

Barriers to Accessing Health Care in Rural Regions by Transgender, Non-Binary, and Gender Diverse People: A Case-Based Scoping Review

“…In a survey of 1,014 U.S. rural residing LGBTQ+ individuals (169 of the respondents were trans with a mean age of 32.2), higher anticipated and experienced stigma correlated with poorer reported health among trans people ( 44 ). In particular, assigned female at birth (AFAB) trans people avoid important sexual health services (e.g., contraceptives, PAP tests) and accept health risks if they lack access to specific and trans-informed clinics ( 45 , 46 ). An illustrative example is offered by HPV vaccination recommendations and HPV vaccination: rural residing US trans individuals are primarily offered treatments based on their sex assigned at birth according to an analysis with 660 LGBTQ+ respondents (ages 18-34; 7% identified as trans man, 4% as trans woman, 6% reported a non-binary gender identity), rather than providing the vaccination to everyone right away ( 47 ).…”

The process of transitioning for the transgender individual and the nursing imperative: A narrative review

“…Support systems are so important that transgender individuals develop a family of choice referred to as patchwork family or fictive kin (Collazo et al, 2013) if they experience rejection from their family of origin (Love et al, 2018). Preventative and promotional health interventions decrease rates of disease, as transwomen may require prostate exams and transmen pelvic exams with pregnancy tests (Pan & Honig, 2018; Stewart et al, 2020). Despite challenges that transition interventions (hormones/surgeries) may bring for transgender individuals, they are lifesaving and need to be expedited (Bailey et al, 2014).…”