Transgender Medicine: CONTEXTUAL TRANS GYNECOLOGY

Abstract

Transgender health care is not just gender-affirmative transitional care but committed to a superior objective, often beyond medical perspective: to create and maintain physical conditions for social functioning under the signs of the individually appropriate sex and to contribute to significantly reduce gender dysphoria. For these purposes it is a pre-requisite to have a distinct contextual understanding of the complex reality of trans people and knowledge about the numerous facettes of transgender healthcare.

Gynecology for transgender and gender diverse people does not differ greatly from gynecology for cis gender female patients exept goals and context. Relief from complaints derived from genital organs is of course of importance but for transpeople there always is an overarching gender dimension sometimes complicating treatment and might give rise to misunderstandings. Also minority stress caused by societal factors frequently impacts the mental and physical state of health negatively and needs to be considered.

This paper focusses on the context of trans gynecology and takes up various contentual aspects for both transmale patients having left genital organs in situ and for transfemale patients with gynecological demands. Gynecological topics are addressed, and how they are relevant for transgender and gender diverse people, from effects of supra- physiological androgen exposure on ovaries and uterus to vaginal bleeding and pelvic pain under testosterone treatment, from benign gynecological disorders as clinical manifestation may appear differently and treatment may be more burdensome to screening policies, and from reproductive issues to obstetrical care.