Alexis Light

Feasibility of Vaginal Hysterectomy for Female-to-male Transgender Men

OBJECTIVE To describe the hysterectomy data among a cohort of transgender men and nontransgender (ie, cisgender) women with a particular goal to evaluate the feasibility of vaginal hysterectomy among transgender men. METHODS This cohort study includes all hysterectomies performed for benign indications on transgender men and cisgender women at a single academic county hospital from 2000 to 2012. Hysterectomy cases and patient gender were identified by billing records and confirmed by review of medical records. Primary study outcome was the hysterectomy route among transgender men compared with cisgender women. We also examined risk factors and operative outcomes. Student two-sided t tests, χ analysis, and descriptive statistics are presented; sensitivity analyses using regression techniques were performed. RESULTS Hysterectomies for benign gynecologic procedures were performed in 883 people: 33 on transgender men and 850 on cisgender women. Transgender men were younger, had fewer pregnancies and deliveries, and smaller uteri. The leading indication for hysterectomy differed significantly: pain (85%) was most common among transgender men (compared with 22% in cisgender women; P<.001), whereas leiomyomas (64%) was most common for cisgender women (compared with 21% in transgender men; P<.001). Vaginal hysterectomies were performed in 24% transgender men and 42% of cisgender women. Estimated blood loss was less among transgender men (P=.002), but when uterine size and route of hysterectomy were considered, the difference between gender groups was no longer significant. There was no difference in patients experiencing complications between the groups. CONCLUSION Transgender men and cisgender women have different preoperative characteristics and surgical indications. Vaginal hysterectomies have been successfully completed among transgender men. Because vaginal hysterectomy is a viable procedure for this population, it should be considered in surgical planning for transgender men.

What young people with spina bifida want to know about sex and are not being told

OBJECTIVE The aim of this paper was to examine sexual knowledge, concerns and needs of youth with spina bifida (SB) to inform the medical community on ways to better support their sexual health. METHODS As part of the Video Intervention/Prevention Assessment (VIA) - transitions, a prospective cohort study, 309 h of video data were collected from 14 participants (13-28 years old) with SB. Participants were loaned a video camcorder for 8-12 weeks to shoot visual narratives about any aspects of their lives. V/A visual narratives were analysed with grounded theory using NVivo. RESULTS Out of 14 participants, 11 (six women) addressed issues surrounding romantic relationships and sexuality in their video clips. Analysis revealed shared concerns, questions and challenges regarding sexuality gathered under four main themes: romantic relationships, sexuality, fertility and parenthood, and need for more talk on sexuality. CONCLUSIONS Youth with SB reported difficulties in finding answers to questions regarding their sexuality, romantic relationships and fertility. This study revealed a need for help from the medical community to inform and empower youth with SB in the area of sexual health. Through sexual and reproductive health education with patients and parents starting at an early age, medical providers can further encourage healthy emotional and physical development in adolescents transitioning into adulthood.

Vaginal Hysterectomy as a Viable Option for Female-to-Male Transgender Men

INTRODUCTION: According to the 2011 Institute of Medicine Report and emphasized by the American College of Obstetricians and Gynecologists Committee Opinion, transgender individuals encounter significant healthcare barriers. The American College of Obstetricians and Gynecologists charges obstetrician–gynecologists to help eliminate these barriers to care by creating nondiscriminatory practices and assisting with transitioning. This includes supporting social, medical, and surgical aspects of the gender affirmation process. Obstetrician–gynecologists are able, without additional training, to perform hysterectomies for transgender men, and total vaginal hysterectomies are the least morbid and most cost-effective form of hysterectomy. METHODS: We present data from a retrospective chart review of all hysterectomies performed for benign indications at a single urban county hospital from 2000 to 2012. Primary area of interest is a case series of hysterectomies performed on female-to-male transgender men. RESULTS: A total of 948 hysterectomies were performed for benign indications. Of those, 34 were for female-to-male transgender men. Compared with women with carcinoma in situ (CIS), female-to-male transgender men were younger, had fewer pregnancies and deliveries, had smaller uteri, had lower body mass index, were usually on testosterone before surgery, and were more likely to have concurrent oophorectomies. The primary indication for hysterectomy for female-to-male transgender men was pain (53%) compared with bleeding (46%) for women with CIS. Total vaginal hysterectomies were performed in 24% of female-to-male transgender men compared with 39% of women with CIS. There was no difference in complication or conversation rates between the two groups. CONCLUSION: Total vaginal hysterectomy is a safe, viable, and cost-effective option to consider for female-to-male transgender men and gender affirmation surgery and encourage obstetrician–gynecologists to consider total vaginal hysterectomy as a minimally invasive option in serving female-to-male transgender men to encourage nondiscrimination and augment access to care.

Reproductive and Obstetrical Care for Transgender Patients

Purpose of ReviewThe purpose of this article is to briefly summarize some of the available reports regarding fertility, reproduction, and obstetrical care for transgender patients, as well as address some of the ethical and legal considerations.Recent FindingsTransgender individuals desire reproductive options but reproductive desires among individuals vary significantly. Some options for cross-gender hormones can permanently affect one’s ability to biologically reproduce. Current standard of care is to offer fertility preservation prior to transitioning, but emerging research suggests that there may not be a high uptake in these options. Transgender men seek out culturally competent obstetrical care.SummaryReproductive care for the transgender population involves issues such as the effects of cross-sex hormones on fertility, fertility preservation, reproductive options, pregnancy outcomes as well as psychosocial, ethical, and legal considerations. Many of these areas are understudied, leaving exciting opportunities for future research on how to best care for this patient population.

Decision satisfaction among women choosing a method of pregnancy termination in the setting of fetal anomalies and other pregnancy complications: A qualitative study

OBJECTIVE The decision to undergo a surgical or medical method of second-trimester termination for pregnancy complications should be preference-sensitive. Decision satisfaction has not been described in this population; understanding how women describe decision satisfaction in this setting could inform decision support efforts. METHODS We conducted qualitative interviews with women one to three weeks after termination who chose either a surgical or medical termination for fetal anomalies, pregnancy complications or fetal demise. We analyzed transcripts using modified grounded theory in an iterative manner with a generative thematic approach. RESULTS We interviewed 36 women (24 surgical and 12 medical). Subjects connected decision satisfaction with counseling experiences and their personal values, including (1) importance of adequate information, (2) autonomous decision making, and (3) choosing the method that facilitates coping. CONCLUSION Offering women a choice between surgical and medical termination procedures in the setting of pregnancy complications is integral to decision satisfaction. Women in our study reported wanting this decision to be driven by their personal values. PRACTICE IMPLICATIONS Women should be able to choose between surgical and medical termination based on preference and not availability of services. Decision support from womens health providers should be based on values clarification and providing accurate information.

Family planning and contraception use in transgender men

OBJECTIVES Female-to-male (FTM) transgender men (affirmed males) can experience planned and unplanned pregnancy during and after testosterone therapy. We conducted an exploratory study to understand current contraceptive practices and fertility desires among transgender men during and after transitioning. STUDY DESIGN Self-identified transgender and transmasculine individuals assigned female at birth, ages 18-45, completed an anonymous online survey derived from standardized family planning surveys. We recruited participants from LGBT health centers, online listservs, and online groups for transgender men and used a mixed-methods analysis to evaluate quantitative and qualitative data. RESULTS Of the one hundred and ninety-seven participants included in the study, the median age was 30 years old, most respondents were white, and 86% were taking masculinizing hormones (testosterone). Of the 60 pregnancies reported, 10 (17%) pregnancies occurred after stopping testosterone, 1 (1.6%) while taking testosterone irregularly, and 5 of 7 abortions occurred in participants who had been using testosterone in the past. Over half of the respondents desired at least one child, and a quarter reported fears of not getting pregnant. The majority of participants reporting using contraception (n=110, 60.1%), with condoms and pills used most commonly (n=90, 49.2% and n=62, 33.9% respectively). Methods of contraception used did not differ between testosterone users and non-users, except for hormonal IUDs (20% testosterone versus 7% non-testosterone). Thirty participants (16.4%) believed that testosterone was a form of contraception, and 10 (5.5%) participants reported that their healthcare providers advised testosterone as contraception. CONCLUSION Transgender men use contraception and can experience pregnancy and abortion, even after transitioning socially and hormonally. Transgender men need counseling and care regarding reproductive health, including contraceptive and conception counseling. IMPLICATIONS Providers should be aware that transgender men may desire pregnancy and use contraception; this study highlights the need for further research regarding fertility, fertility desires, and optimal contraception among transgender men.

Reproductive and gynecologic health after uterine artery embolization for postabortion hemorrhage.

a Division of Gynecology, Department of Obstetrics, Gynecology and Reproductive Science, University of California San Francisco, CA, USA b Division of San Francisco General Hospital, Department of Obstetrics, Gynecology, and Reproductive Science, University of California San Francisco, CA, USA c Tulane University School of Medicine, New Orleans, LA, USA d Department of Interventional Radiology, University of California San Francisco, CA, USA