By Maeve Pond and Laura Jessick
Transgender (trans) and gender non-confirming (GNC) people are people whose gender identity is not the same as the sex that they were assigned at birth (National LGBT Health Education Center, 2016). Cisgender people are people whose gender identity is the same as the sex they were assigned at birth. According to End the Backlog, transgender people are nearly two times more likely than cisgender people to experience sexual violence (Swavola, 2014). Even though it’s clear that many transgender people experience sexual violence, less than 50% of survivors who are transgender report their assault to the police (Swavola, 2014). People belonging to some communities cannot report to the police without experiencing fear or threat of retaliation or institutional harm. We know that transgender and GNC folks experience discrimination, and we know that they experience many barriers to receiving adequate care by multiple institutions. Here are some proactive steps healthcare professionals such as Forensic Nurse Examiners (FNEs), hospital staff, physicians, and advocates can take to create a gender-affirming environment before, during, and after a forensic exam.
Addressing patients by their name and pronouns is a significant aspect of gender-affirming healthcare. It is important to not make assumptions about a patient's gender identity based on their appearance or voice, but to simply ask patients how they identify as you introduce yourself and get to know the patient. You can help encourage patients to state their pronouns by including your pronouns when you introduce yourself. This demonstrates to the patient that you understand the importance of gender affirmation and indirectly lets them know they are in a safe place to disclose their gender identity.
Sometimes the name and gender listed on a person’s medical records will not match their pronouns and name. If this occurs, FNEs and medical providers can ask patients if their medical chart may be under a different name. It’s important to remember not to ask an individual if their information is under their “real” name, as this often refers to their birth name, a name many transgender people no longer identify with. This is also sometimes called their dead name.
Hospital staff and medical providers can confirm patient identity by cross-checking the medical chart with other information, such as address or date of birth (National LGBT Health Education Center, 2016). When completing medical paperwork for the visit, such as the Maryland Sexual Assault Reimbursement Unit Sexual Assault Forensic Exam Reimbursement Form (SSRF), FNEs and medical staff should recognize that they may be required to use an individual's birth name, or dead name, for legal purposes. Patients may not understand why this is required, so it is important for providers to validate the patients preferred name and gender verbally and explain why their dead name is required for paperwork. The initial validation that you, as a provider, recognize their true identity, can be incredibly valuable.
However well-intentioned, it is still possible that a healthcare professional may misgender or use someone's dead name. Misgendering occurs when someone “intentionally or unintentionally refers to a person, relates to a person, or uses language to describe a person that does not align with their affirmed gender" (Clements, 2018). Deadnaming occurs when someone intentionally or unintentionally refers to a person by the name they used prior to their transition, often their birth name, which they no longer identify with. If a healthcare professional accidentally misgenders or deadnames a patient, they should acknowledge the mistake and genuinely apologize. (National LGBT Health Education Center, 2016).
Trans and GNC folks’ experiences may be positively impacted by a genuine apology. This shows that the providers is open and receptive to accounting for a mistake. Healthcare professionals can practice using pronouns by introducing themselves with their pronouns, encouraging others to do so as well, and using each individual’s pronouns in their day to day interactions. If a healthcare professional doesn’t know someone’s pronouns, they can use gender neutral language by referring to the individual as “they”, or address them with a descriptor, such as patient. For example, instead of saying “he is here for his appointment,” you can say “the patient is in the waiting room.”
Listening to and prioritizing transgender and GNC folks’ medical concerns is another method to provide gender-affirming healthcare. Transgender and GNC individuals may have multiple concerns and priorities when receiving care like a SAFE. When a survivor is sharing their narrative, FNEs should consider the multiple types of psychosocial and physical trauma that the survivor endured (Safer, 2017). FNEs should also be aware of the possibility that a trans or GNC survivor has completed surgeries or procedures to transition and inquire about or recognize their specific health needs (Safer, 2017). For example, if a patient has shared that they are transitioning or have transitioned with the use of hormone replacement therapy (HRT), FNEs should consider interactions HRT may have when selecting medicines such as emergency contraceptives, STI prophylaxis, or antibiotics to administer to the patient. (Safer, 2017).
As an FNE or a provider who is giving a Sexual Assault Forensic Exam to a survivor, acknowledging and considering the layers of harm that transgender and GNC folks are considering when requesting a SAFE is vital to creating a trauma-informed and gender-affirming environment. Not only do transgender and GNC survivors experience interpersonal violence at higher rates from partners and members of institutions alike, they also experience many barriers when actively requesting medical care, including outright denial of insurance coverage or refusal of care (Safer, 2017). These factors make it that much more important that FNEs create a gender-affirming environment during a SAFE, and that FNEs consider the needs and concerns of transgender and GNC folks while they are receiving care from the SAFE Program and FNEs, including offering gender-affirming community-based and psychological resources.
For more resources about gender, check out the article from Understanding Gender from Gender Spectrum. The article Affirmative Care for Transgender and Gender Non-conforming People: Best Practices for Frontline Health Care Staff includes best practices and key phrases healthcare professionals can use with all clients. For a definition of pronouns and a list of multiple pronouns folks may have, check out this article from the LGBT Life Center and the Pronoun Guide from GLSEN.
References
DuMont, J., Saad, M., Kosa, S., Kia, H., & Macdonald, S. Providing trans-affirming care for sexual assault survivors: An evaluation of a novel curriculum for forensic nurses. Nurse Education Today. Retrieved from https://www.sciencedirect.com/science/article/pii/S0260691720302252
KC Clements (2018). What Does it Mean to Misgender Someone? Healthline. Retrieved from https://www.healthline.com/health/transgender/misgendering
Liz Swavola (2014). Justice for All: Testing Rape Kits in LGBTQ Cases. End the Backlog. Retrieved from https://www.endthebacklog.org/blog/justice-all-testing-rape-kits-lgbt-cases
National LGBT Health Education Center: A Program of the Fenway Institute (2016). Affirmative Care for Transgender and Gender Non-conforming People: Best Practices for Frontline Health Care Staff. Retrieved from https://www.lgbtqiahealtheducation.org/wp-content/uploads/2016/12/Affirmative-Care-for-Transgender-and-Gender-Non-conforming-People-Best-Practices-for-Front-line-Health-Care-Staff.pdf
Safer, Joshua D, Coleman, Eli, Feldman, Jamie, Garofalo, Robert, Hembree, Wylie, Radix, Asa, and Sevelius, Jae. (2017). Barriers to Health Care for Transgender Individuals. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802845/
