Introduction: Medical providers will encounter transgender individuals in their practice, and it is important that they understand the unique needs and backgrounds of this population. We sought to characterize the challenges transfeminine individuals face in seeking urological care through a developed questionnaire.
Methods: IRB approval was obtained to develop (with feedback from the transgender community) and administer a 58-item questionnaire assessing urinary and sexual health. Participants were recruited from the local community and the Philadelphia Trans Wellness Conference and provided a $20 gift card for their time. We assessed demographic factors, therapies, surgeries, complications, and urologic care experiences of these participants and compared vaginoplasty and non-vaginoplasty patients.
Results: 53 transfeminine individuals (11 vaginoplasty, 10 orchiectomy, 32 no procedure) with mean age of 40 (range 21-80) completed the questionnaire. Of the 12 respondents who met age-based criteria for prostate cancer screening, 8 underwent screening, 4 did not undergo screening, and 2 were not offered screening. 30 (56%) patients were not offered sperm preservation counseling. Vaginoplasty complications were reported by 6 respondents (54%) with 3 reports of wound separation, numbness, or inadequate vaginal depth, and single occurrences of abnormal scarring, vaginal stenosis, meatal stenosis, rectovaginal fistula, and chronic pain (n=11). We noted that those who had undergone vaginoplasty were significantly more likely to see a provider for urinary complaints (p=0.042), with 3 (27%) of these patients electing to see a urologist. Of the 14 patients from the entire cohort who were not willing to see a urologist, 29% cited discomfort with discussing urinary or sexual issues, while 7% cited fear of being misgendered. Across both groups, 30 individuals (57%) reported that they experienced a lack of knowledge about transgender health needs from members of a urology practice.
Conclusions: Our findings illustrate the challenges transgender individuals face in obtaining care. We noted that participants who had vaginoplasty were more likely to see a urologist, which may reflect greater familiarity with the medical system. Many patients are reluctant to seek care due to discomfort or fear, and a majority experienced lack of knowledge about their health needs. This highlights a critical need for provider education on transgender issues in order to provide a safe and inclusive environment to better care for these patients.
Source of Funding: World Professional Association for Transgender Health