Browsing by Subject "Gender identity"
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Item Autologous Testicle Construction With Buried Metoidioplasty Correction(Wolters Kluwer, 2024-12-06) Sparks, Payton J.; Moit, Harley L.; Tom, Alan; Roth, Joshua; Hadad, Ivan; Surgery, School of MedicineGender-affirming surgery is essential for transgender individuals seeking alignment between their physical appearance and gender identity. Metoidioplasty is a masculinizing option for those assigned female at birth and often includes vaginectomy, urethral lengthening, scrotoplasty, creation of a neophallus, and testicular prostheses, typically implanted during a second-stage procedure. We describe a 39-year-old transgender man who initially underwent a laparoscopic hysterectomy, metoidioplasty, and tubularized plate urethral lengthening 19 months earlier. Although the patient could achieve an erection and orgasm, he struggled with standing urination due to the penis being buried by the mons pubis and upper labia majora. In addition, he feared superior migration of the testicular prostheses, which could diminish the prominence of the neophallus. We elected to perform a monsplasty with resection and rearrangement of excess upper labial tissue to mimic testicles. This approach helps avoid the risks associated with prostheses, using the patient's own tissues instead. This second-stage operation enhances the appearance of the neophallus and creates the cosmetic appearance of testicles using the patient's own tissues, offering a safe and effective surgical option. Although metoidioplasty offers significant benefits in terms of appearance and sensation, it has limitations, including the challenge of achieving standing urination due to the typically shorter length of the neophallus. We aimed to present the effectiveness and associated patient satisfaction with this innovative approach, showing its viability as a safe surgical option.Item Difference‐Makers for Collecting Sexual Orientation and Gender Identity Data in Oncology Settings(Wiley, 2025) Pratt-Chapman, Mandi L.; Miech, Edward J.; Mullins, Megan A.; Chang, Shine; Quinn, Gwendolyn P.; Maingi, Shail; Schabath, Matthew B.; Kamen, Charles; Emergency Medicine, School of MedicinePurpose: The purpose of this analysis was to identify key difference-making conditions that distinguish oncology institutions that collect sexual orientation and gender identity (SOGI) data across a sample of American Society of Clinical Oncology (ASCO) members. Methods: From October to November 2020, an anonymous 54-item web-based survey was distributed to ASCO members. Coincidence analysis was used to identify difference-making conditions for the collection of SOGI data. Results: ASCO members' responses to just three items consistently distinguished practices that reported collecting both SO and GI data (n = 25) from those who did not (n = 20): (1)."Do you ask your patients what pronouns they want you to use for them?"; (2) "Institutional leadership supports collecting SOGI data from patients"; and (3)"Does the electronic health record (EHR) at your institution have a specific section to collect information about patients' SOGI?" The positive model exhibited both reliability (consistency = 0.87, or 20/23) and explanatory breadth (coverage = 0.80, or 20/25). The negative model for SOGI data collection consisted of different responses to the same three items and likewise showed both reliability (consistency = 0.94, or 16/17) and explanatory breadth (coverage = 0.80, or 16/20). Conclusions: Specific levels of leadership support, frequency of asking patients about pronouns, and the presence or absence of EHR record structure were difference-makers for collecting SOGI data in this sample. The study underscores the importance of leadership support, structured data fields, and attention to patient pronouns, which are aligned with the ASCO and National Institutes of Health calls to action.Item Epidemiologic Features of the Monkeypox Outbreak and the Public Health Response — United States, May 17–October 6, 2022(Center for Disease Control, 2022-11-11) Kava, Christine Marie; Rohraff, Dallas M.; Wallace, Bailey; Mendoza-Alonzo, Jennifer L.; Currie, Dustin W.; Munsey, Anna E.; Roth, Nicole M.; Bryant-Genevier, Jonathan; Kennedy, Jordan L.; Weller, Daniel L.; Christie, Athalia; McQuiston, Jennifer H.; Hicks, Peter; Strid, Penelope; Sims, Emily; Negron, Maria E.; Iqbal, Kashif; Ellington, Sascha; Smith, Dawn K.; Pediatrics, School of MedicineOn May 17, 2022, the Massachusetts Department of Health announced the first suspected case of monkeypox associated with the global outbreak in a U.S. resident. On May 23, 2022, CDC launched an emergency response (1,2). CDC's emergency response focused on surveillance, laboratory testing, medical countermeasures, and education. Medical countermeasures included rollout of a national JYNNEOS vaccination strategy, Food and Drug Administration (FDA) issuance of an emergency use authorization to allow for intradermal administration of JYNNEOS, and use of tecovirimat for patients with, or at risk for, severe monkeypox. During May 17-October 6, 2022, a total of 26,384 probable and confirmed* U.S. monkeypox cases were reported to CDC. Daily case counts peaked during mid-to-late August. Among 25,001 of 25,569 (98%) cases in adults with information on gender identity,† 23,683 (95%) occurred in cisgender men. Among 13,997 cisgender men with information on recent sexual or close intimate contact,§ 10,440 (75%) reported male-to-male sexual contact (MMSC) ≤21 days preceding symptom onset. Among 21,211 (80%) cases in persons with information on race and ethnicity,¶ 6,879 (32%), 6,628 (31%), and 6,330 (30%) occurred in non-Hispanic Black or African American (Black), Hispanic or Latino (Hispanic), and non-Hispanic White (White) persons, respectively. Among 5,017 (20%) cases in adults with information on HIV infection status, 2,876 (57%) had HIV infection. Prevention efforts, including vaccination, should be prioritized among persons at highest risk within groups most affected by the monkeypox outbreak, including gay, bisexual, and other men who have sex with men (MSM); transgender, nonbinary, and gender-diverse persons; racial and ethnic minority groups; and persons who are immunocompromised, including persons with advanced HIV infection or newly diagnosed HIV infection.Item Experiences of Gender Discrimination and Sexual Harassment Among Residents in General Surgery Programs Across the US(American Medical Association, 2021) Schlick, Cary Jo R.; Ellis, Ryan J.; Etkin, Caryn D.; Greenberg, Caprice C.; Greenberg, Jacob A.; Turner, Patricia L.; Buyske, Jo; Hoyt, David B.; Nasca, Thomas J.; Bilimoria, Karl Y.; Hu, Yue-Yung; Surgery, School of MedicineImportance: Mistreatment is a common experience among surgical residents and is associated with burnout. Women have been found to experience mistreatment at higher rates than men. Further characterization of surgical residents' experiences with gender discrimination and sexual harassment may inform solutions. Objective: To describe the types, sources, and factors associated with (1) discrimination based on gender, gender identity, or sexual orientation and (2) sexual harassment experienced by residents in general surgery programs across the US. Design, setting, and participants: This cross-sectional national survey study was conducted after the 2019 American Board of Surgery In-Training Examination (ABSITE). The survey asked respondents about their experiences with gender discrimination and sexual harassment during the academic year starting July 1, 2018, through the testing date in January 2019. All clinical residents enrolled in general surgery programs accredited by the Accreditation Council for Graduate Medical Education were eligible. Exposures: Specific types, sources, and factors associated with gender-based discrimination and sexual harassment. Main outcomes and measures: Primary outcome was the prevalence of gender discrimination and sexual harassment. Secondary outcomes included sources of discrimination and harassment and associated individual- and program-level factors using gender-stratified multivariable logistic regression models. Results: The survey was administered to 8129 eligible residents; 6956 responded (85.6% response rate)from 301 general surgery programs. Of those, 6764 residents had gender data available (3968 [58.7%] were male and 2796 [41.3%] were female individuals). In total, 1878 of 2352 female residents (79.8%) vs 562 of 3288 male residents (17.1%) reported experiencing gender discrimination (P < .001), and 1026 of 2415 female residents (42.5%) vs 721 of 3360 male residents (21.5%) reported experiencing sexual harassment (P < .001). The most common type of gender discrimination was being mistaken for a nonphysician (1943 of 5640 residents [34.5%] overall; 1813 of 2352 female residents [77.1%]; 130 of 3288 male residents [4.0%]), with patients and/or families as the most frequent source. The most common form of sexual harassment was crude, demeaning, or explicit comments (1557 of 5775 residents [27.0%] overall; 901 of 2415 female residents [37.3%]; 656 of 3360 male residents [19.5%]); among female residents, the most common source of this harassment was patients and/or families, and among male residents, the most common source was coresidents and/or fellows. Among female residents, gender discrimination was associated with pregnancy (odds ratio [OR], 1.93; 95% CI, 1.03-3.62) and higher ABSITE scores (highest vs lowest quartile: OR, 1.67; 95% CI, 1.14-2.43); among male residents, gender discrimination was associated with parenthood (OR, 1.72; 95% CI, 1.31-2.27) and lower ABSITE scores (highest vs lowest quartile: OR, 0.57; 95% CI, 0.43-0.76). Senior residents were more likely to report experiencing sexual harassment than interns (postgraduate years 4 and 5 vs postgraduate year 1: OR, 1.77 [95% CI, 1.40-2.24] among female residents; 1.31 [95% CI, 1.01-1.70] among male residents). Conclusions and relevance: In this study, gender discrimination and sexual harassment were common experiences among surgical residents and were frequently reported by women. These phenomena warrant multifaceted context-specific strategies for improvement.Item Social patterns and pathways of HIV care among HIV-positive transgender women(2015-06-23) Hines, Dana Darnell; Draucker, Claire Burke; Habermann, Barbara; Rawl, Susan M.; Wright, Eric R.; Foote, Carrie ElizabethTransgender women have the highest HIV prevalence rates of all gender and sexual minorities, yet are less likely to enter and be retained in HIV care. As a result, they are at high risk for HIV-related morbidity and mortality. This study aimed to describe the illness career of transgender women living with HIV and to describe how interactions with health care providers and important others influenced their illness trajectory. The findings are a theoretical model that includes four stages: Having the world come crashing down, shutting out the world, living in a dark world, and reconstructing the world. Relationships within the social network (family, friends, and romantic partners) and the network of health care providers provided the context of the women's illness careers. Pivotal moments marked movement from one phase to the next. Having the World Crashing Down was the first stage that occurred when the participants were diagnosed with HIV. They felt that their lives as they knew them had been destroyed. They indicated that the "whole world just shattered" the moment they found out they had HIV. Shutting Out the World occurred next. During this stage, many participants experienced withdrawal, denial, social isolation and loneliness. As they struggled with their diagnosis, they often avoided HIV care and avoided contact with important others. During the third stage, Living in a Dark World, participants descended into a dark phase of self-destructive life and health-threatening behaviors following their diagnosis. During the fourth stage, Reconstructing the World, participants began to reestablish themselves in the world and found new ways to reengage with important others and resume meaningful life activities. Findings confirm that the illness careers of HIV-positive transgender women are influenced by the social context of the health care setting and interactions with health care providers and important others.