Gender-affirming - reproductive care puts the power of choice in the patient’s hands
Reproductive health care is an important part of lifelong health for many people.
But for transgender and gender-diverse people, routine physical exams or pregnancy care can be uncomfortable or even distressing, accentuating feelings of gender dysphoria. Finding a provider who is sensitive to their experience and identity can make a huge difference for people who identify as transgender or gender diverse when they walk through those clinic doors.
At M Health Fairview, our care teams strive to provide an affirming experience for everyone – regardless of their sexual or gender identity. We sat down with three M Health Fairview reproductive and pregnancy experts to learn how they create positive and inclusive experiences for their gender-diverse patients.
Inclusive language matters.
Gender-affirming care in our clinics starts before the patient even enters the exam room, no matter if you need an annual pelvic exam, prenatal or postnatal care, or something else entirely. When each patient checks in at an M Health Fairview clinic, they can let us know how they identify on their check-in form provided at the front desk. From there, our staff can help patients update their name and pronouns on their medical chart if they wish.
“We understand that sometimes a legal name may be used for check-in purposes during the initial appointment, but that’s not necessarily the name they prefer to use,” said Chelsea Thibodeau, DO, a family medicine obstetrician at M Health Fairview Clinic – Smiley's. “Making sure we use the correct pronouns for patients is crucial.”
Sarah Krueger, MD, an OB/GYN, sees patients at M Health Fairview Clinic - Riverside. Her approach? “Sometimes it’s as simple as asking what they are comfortable with.
“In our field we mostly see cisgender women, but we still have to recognize that not everyone fits that mold perfectly,” Krueger said. “I try to break down a lot of assumptions in practice that are largely gender-based.”
Primary care and reproductive health clinics across M Health Fairview are well-positioned to support transgender and gender-diverse patients. Our physicians and staff partner closely with our Comprehensive Gender Care Program to ensure our patients have access to the full spectrum of care they need, including hormone therapy and other transition services. Many clinic staff and physicians participate in health equity training to understand how to be respectful and affirming in their interactions with gender-diverse patients.
Patients are in charge of their care.
Routine gynecological exams and screenings are important for everyday health and preventive care. These exams can be uncomfortable for anyone, but they can be particularly difficult for transgender and gender-diverse patients who may not identify with common gynecological terms used for body parts or procedures.
“A lot of times a pelvic exam warrants some degree of undress, which can be a very vulnerable moment,” said Krueger. “Patients always have the option to wait to undress until they are comfortable. For me it’s all about helping them feel respected.”
Caitlin Young, reproductive health coordinator at M Health Fairview Clinic – Smiley’s, always informs patients about their options at every step of their care. Our clinics offer alternatives to help people feel more at ease. For example, a “self-swab” method is available for individuals who would prefer more privacy during cervical cancer screening.
“Some may not like the term pap smear, even though it’s a common phrase,” said Young. “So we say ‘cervical cancer screening.’ Even if they don’t identify as a woman, they often still have a cervix and these are important exams for their health.”
Kruger echoes the same sentiments: “By spending time getting to know about our patients’ experiences, we can help address any anxiety they have.”
Patients’ past experiences impact their relationship with healthcare.
“Unfortunately, gender-diverse patients or LGBTQIA2S+ patients nationwide are more likely to have experienced healthcare-based trauma,” Thibodeau said. Some patients have had past negative experiences with insensitive care teams. Others have experienced serious incidents such as assault or domestic violence.
For those reasons, many of our M Health Fairview clinicians are well-versed in trauma-informed pelvic care. It starts by listening and being attentive to a patient’s behavior when in the exam room. By talking to patients before a pelvic exam, our providers open the door for honest discussion and an upfront chance for patients to share any concerns they have.
“Being misgendered is traumatizing. Having a painful pelvic exam can be traumatizing, not being listened to or having your symptoms ignored can be traumatizing,” Thibodeau said. “Trans masculine folks assigned female at birth may have additional dysphoria around pelvic care, so that’s another facet of why being trauma-informed is so important.”
Walking through a pelvic exam step-by-step can reduce anxiety for some patients. Explaining what they can expect, the tools used, and how it might feel are all ways our providers help patients feel comfortable during their appointment. We also offer a full array of procedural pain control options for patients who feel that would benefit them.
“Relationship building and having a medical space and a medical provider who you trust is very meaningful,” Thibodeau said. By offering inclusive methods and engaging patients at every step of the process, gender-affirming care makes routine or preventive care more accessible, which in turn helps our communities stay healthier, she added.
Our patients deserve care that affirms their identities and experiences inside and outside our clinics. Collaboration between our OB/GYN providers and the people they see is a guiding principle of equitable care.
