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[–]terffany 37 insightful - 2 fun37 insightful - 1 fun38 insightful - 2 fun -  (17 children)

This poor person went to the gynecologist.........

Which makes me think, are gynecology programs offering courses focused on neovaginas? Cause I haven't heard about TRAs complaining that the field is "historically terfy"...

[–][deleted]  (16 children)

[deleted]

    [–]MarkTwainiac 41 insightful - 1 fun41 insightful - 0 fun42 insightful - 1 fun -  (15 children)

    Actually, in the USA lots of pressure has been placed on gynecologists for many years now to provide care for both TIMs and TIFs, and to "educate themselves" about how how to do this.

    I believe part of the reason for this is that most gynecologists nowadays are women - and women are seen as having a duty to take care of everyone, even those whose issues are clearly outside their practice area and training. Moreover, I believe that many TIMs insist on being seen by female gynecologists coz it's "validating" and arousing for them and gives them that extra special erotic thrill known as "gender euphoria," coz forcing female health providers who trained specifically to treat female patients exclusively to have to treat males - and deal with male genitals in an up close and personal way - is the ultimate male power and dominance play, and coz invading and marking off obstetrics-gynecology clinics and practices as territory that must accept and accommodate male patients is a major victory in the colonization project that is male transgenderism.

    Significantly, no similar or correspending pressure is being placed on male urologists and proctologists to expand their areas of knowledge and their medical practices to be inclusive of and take care of the health care needs of TIMs and TIFs. [edit: I was trying to say that urologists and proctologists are not being pressured to "educate themselves" to provide additional medical services to TIMs and TIFs that are outside what they and other specialists in their fields normally do and were trained to do.]

    From "Care of the transgender patient: the role of the gynecologist" in the American Journal of Obstetrics and Gynecology, published January 1, 2014:

    Male-to-female transsexuals sometimes prefer to see a gynecologist for their annual health care as this helps them to affirm their gender and also gives them the opportunity to share any gynecologic concerns such as recurrent neovaginal and urinary tract infections, problems with voiding, and pain with intercourse. Neovaginal prolapse as well as anatomic urinary tract dysfunction, while rare, does exist.Patients may initially seek the care of a gynecologist to address the problem and to determine the need for referral to a subspecialist. Additionally, some male to female patients prefer to have their annual breast examination with a gynecologist.

    Transgender men sometimes seek gynecologic care as many of these patients do not fully transition with sex reassignment and do not have their pelvic organs removed and need routine screening such as Pap smears and bimanual pelvic examinations. In addition, some patients may receive their hormonal treatments and surveillance through reproductive endocrinology specialists who may prefer to refer patients to gynecologists in their practice for routine health management to facilitate good continuity of care.

    For all the reasons above, gynecologists need to be familiar with the health care needs of these patients. Care should be rendered according to standard guidelines based on level-1 evidence for the general population, but then some alterations should be made with important considerations in mind including biological sex, surgical status, declared gender, and past or current use of hormonal therapy.

    Additionally, gynecologists should be aware of the most commonly used hormonal therapies, which ones are given preoperatively and then postoperatively, and how they can be changed if there are metabolic concerns. Although trained endocrinologists usually make adjustments to regimens, providers caring for these patients should have general knowledge to help guide their management in other aspects of their care.

    Gynecologists may play an important role in counseling (trans-identified male as well as female) patients about fertility or referring them to reproductive endocrinologists for care. The initial discussion may take place in the gynecologist's office. Feminizing and virilizing hormonal regimens have been shown to diminish fertility in patients. The significant challenge is that these discussions should take place prior to the initiation of hormonal therapy. If patients disclose that they are transgender during a routine office visit, they may require counseling regarding their transition options. During that initial discussion, options about fertility can also be addressed. Although there are no data on the rates of infertility among transsexual patients treated with hormones, data can be extrapolated from patients who have experienced damage to their gonads as a result of cancer treatments.

    Male-to-female patients should be given (by gynecologists) the option of sperm preservation in sperm banks prior to initiating hormones. If patients have already initiated hormones, there are data that report eventual recuperation of sperm count after a hormone-free period and so, these patients can be given the option to stop hormonal therapy temporarily to bank their sperm.

    There are also limited data on female-to-male preservation of fertility. These patients can consider oocyte or embryo cryopreservation prior to starting therapy, while those who have already initiated hormones have the option of interrupting their treatment to undergo ovarian stimulation with subsequent oocyte retrieval and freezing. Studies have shown that there has been some success in ovarian recovery after cessation of testosterone with subsequent successful pregnancies.

    Lastly, gynecologists should be aware of the barriers that transpatients face with regards to accessing care as well as feeling comfortable once they have found a provider. Simple things can be done within the office setting to ensure that patients understand that they are in a safe space and that they will receive the same care as other patients. Most importantly, they should feel safe disclosing their gender identity as well as their sex preferences so that the provider may take care of them and identify all possible risk factors for disease. This can be accomplished with an open-minded approach to patient care, use of screening questions that do not discriminate against any individual or group, and demonstration of knowledge of the general principles of transgender health.

    Note how the above is all about all the extra things that gynecologists must to do accommodate these patients because seeing a usually female gynecologist is what trans males and females prefer. Not coz it's what's medically best or even appropriate - it's coz it's what the trans patients prefer and want.

    Note that there is no mention of the fact that the extra duties usually female gynecologists are now expected to take up to make trans males and females happy are not what they were trained for, are clearly outside their standard practice area, and probably would not be covered under their malpractice insurance policies.

    Note as well that there is also no mention of how mostly female gynecologists feel about this, whether they have been consulted on this expansion of their duties, or whether female gynecologists should have the right to refuse to treat male patients and having to touch male genitals coz of the consent issues and coz that's clearly not what any gynecologist signed up to do. Many women go into gynecology to avoid having to deal with male patients, in fact. But now the thought leaders in their field are telling them tough shit, as a gynecologist it is your duty to treat a specific class of male patients who are very likely to be narcissistic sexual fetishists, misogynists and male supremacists with a host of mental health and anger problems. And who are likely to cry "bigot" and "hate" crime and to file human rights complaints and lawsuits if gynecologists or their staffs don't do what these male patients want, and if the gynecologists or their staffs perhaps commit a heinous offense like mentioning these patients' biological sex.

    https://www.ajog.org/article/S0002-9378(13)00522-X/fulltext#secd20271189e613

    [–][deleted] 30 insightful - 6 fun30 insightful - 5 fun31 insightful - 6 fun -  (6 children)

    This is spot on analysis, thank you!

    Yeah imagine you've spent twelve years plus, training in gynecology bc you have a passion for women's health, and then your professional journal telling you Welp, now you have to learn these surgeries that are done on males, relearn male endocrinology, and good god talk about sperm preservation?

    Noted this is from 2014 too.

    I can add that in my personal experience with TiM patients, they are super creepy. Always wanting to talk about their vaginas, look bruh we are here to talk about your banged up elbow and maybe a flu shot. No woman just sits there randomly talking about her vagina.

    [–]MarkTwainiac 27 insightful - 5 fun27 insightful - 4 fun28 insightful - 5 fun -  (4 children)

    I wrote a novel back in 2016 in which the protagonist is a longstanding ob-gyn in NYC whose women's health practice gets targeted first by TIM TRAs, then by TIFs. The TIMs demand that the ob-gyn accommodate their male health needs, and that she change her office decor, paperwork and staff so these men feel more "affirmed" and "validated" and "welcomed" for being the real women they claim they are. And of course, they demand she and her staff use their lingo, calling their penises and balls outie vaginas and ovaries, etc. Then the TIFs show up and demand that everything in the practice be made gender-neutral, that their vaginas be referred to as "front holes," and no mention be made of evil words like "mother" and "breasts" when the TIFs are pregnant, giving birth and feeding their infants... The upshot is that she gets publicly vilified as a transphobe and bigot and evil "TERF" and finally folds up her practice.

    It actually turned out to be pretty funny, in a horrifying way, but of course it's unpublishable.

    [–][deleted] 16 insightful - 2 fun16 insightful - 1 fun17 insightful - 2 fun -  (1 child)

    That's a bit prophetic! I would read it. Wait a couple years and sell it as historical drama.

    [–]redditbegay 10 insightful - 2 fun10 insightful - 1 fun11 insightful - 2 fun -  (0 children)

    Exactly! in 2028, people will wonder why it wasnt put in the historicals section.

    [–]grixit 8 insightful - 1 fun8 insightful - 0 fun9 insightful - 1 fun -  (0 children)

    I think it would make a great, and informative, graphic novel.

    [–]jjdub7Gay Male Guest Commentator 5 insightful - 1 fun5 insightful - 0 fun6 insightful - 1 fun -  (0 children)

    Prophetic, very much in the Larry Kramer-esque vein of LGBTQ+ meta-analysis.

    [–]pinkpaperplates 15 insightful - 1 fun15 insightful - 0 fun16 insightful - 1 fun -  (0 children)

    Always wanting to talk about their vaginas, look bruh we are here to talk about your banged up elbow and maybe a flu shot. No woman just sits there randomly talking about her vagina.

    It’s nutty (pun intended) how they go from casually talking about their penises to talking about their “vaginas,” they truly have no idea what it’s like to be a woman.

    [–]MarkTwainiac 21 insightful - 1 fun21 insightful - 0 fun22 insightful - 1 fun -  (4 children)

    Another example of the impossible situation mostly female gynecologists are being put in today:

    https://www.volusonclub.net/empowered-womens-health/when-caring-for-transgender-patients-heres-how-to-ensure-comfort-each-step-of-the-way/

    As you can see, in order to cater to TIFs who hate their bodies and are easily triggered by biological reality, gynecologists are being told to

    Avoid using gendered terms such as "well woman visit" for patients who do not identify as women. Consider updating all of the terminology and intake forms in your practice to be as gender neutral as possible.

    But in the very next breath, gynecologists are being told that they must call TIMs women and provide them with medical care, even to the point of providing them with prostate checks, a task that is clearly outside the bailiwick of any gynecologist:

    Gynecologists also play an important role in the lifelong follow-up of transfeminine patients, particularly those who have undergone vaginoplasty, or surgical creation of a vagina. Regular care for trans women can include a vaginal and vulvar exam, counseling on protection against STIs and instructions on the use of regular dilation to maintain the vaginal opening.

    Regular breast exams and mammography may be recommended for trans women who take supplemental hormones. Ultrasound can be useful for evaluating the risk of prostate disease in trans patients with a prostate: One study in Facts, Views and Vision found that transvaginal ultrasound had a higher clinical value (and often patient preference) than digital palpation for prostate examination in patients who have undergone vaginoplasty.

    My feeling is that if internal ultrasound probes designed for use in the human vagina are useful in prostate exams, then the male doctors who typically perform prostate exams should be training to use these devices. But that's not what's happening. Instead, an expectation is now being placed on gynecologists to do this. And not coincidentally, this is happening at precisely the time in history when female physicians have finally come to make up the majority - more than 60% - of practicing gynecologists in the USA, and when an even higher proportion - 85% - of med students and physicians still training to specialize in obstetrics and gynecology are female.

    [–][deleted] 29 insightful - 1 fun29 insightful - 0 fun30 insightful - 1 fun -  (3 children)

    Don't forget us GPs. In Canada we provide the bulk of well visits and specialists are consulted as needed. And we're mostly women. Preventive care is turning silly now. The wrong patients are being sent Pap reminders already.

    So if I have a TiM with prostate symptoms, I have to check him myself as I would any male patient. Thing is, normal men are embarrassed and often ask to just be referred to a male urologist, which is fine with me cause I'll have to anyway as my fingers aren't long enough to feel the whole prostate. TiMs are eager for it in a super creepy way, and if I do need to refer, they ask for a female urologist.

    Oh and referring a TiF to either gyne or urology for (as an example where either could be useful) prolapse is super fun to type out. I end up using no pronouns at all and just repeating Patient Name over and over.

    [–]kwallio 17 insightful - 1 fun17 insightful - 0 fun18 insightful - 1 fun -  (0 children)

    TiMs are eager for it in a super creepy way, and if I do need to refer, they ask for a female urologist.

    Oh god this creeps me out so much. I would hate to be a urologist or gynecologist in today's climate.

    [–]MarkTwainiac 13 insightful - 1 fun13 insightful - 0 fun14 insightful - 1 fun -  (1 child)

    So sorry you have to put up with this. It's madness.

    [–][deleted] 12 insightful - 1 fun12 insightful - 0 fun13 insightful - 1 fun -  (0 children)

    Thanks. It is bloody exhausting.