Español Reproductive and sexual health among transgender people at global level
DOI:
https://doi.org/10.22370/revmat.1.2024.4010Keywords:
Transgender persons, Health services for transgender persons, Sexual health, Reproductive healthAbstract
Objective: to assess the status of sexual and reproductive health care available to and received by transgender individuals globally, in line with the dimensions of care outlined in the Standards of Care v.8 by the World Professional Association for Transgender Health (WPATH).
Methods: a scoping review was conducted from January 2015 to March 2023 across four databases: EBSCOHost-CINAHL Complete, Scielo, Lilacs, and Google Scholar. Additionally, a search was conducted on Google to identify relevant grey literature.
Results: a total of 124 articles were included in the review. Research about transgender individuals comes from the United States. The methodologies adopted in these studies are relatively evenly distributed among qualitative, quantitative, and review designs. The articles examined encompassed the standards of care dimensions prescribed by WPATH's.
Conclusion: the transgender community faces significant vulnerabilities in the realm of sexual and reproductive health care, which it is attributed to cultural, political, and ideological barriers that impede their access to health services. Such impediments increase the risk of contracting HIV and other sexually transmitted infections (STIs), the potential for unplanned or unwanted pregnancies, and correlate with deteriorating mental health. Despite the existence of clinical guidelines tailored for the care of transgender individuals concerning these matters, many health professionals remain inadequately acquainted with them.
Keywords: Transgender Persons, Health Services for Transgender Persons, Sexual Health, Reproductive Health.
Downloads
References
Organización Mundial de la Salud: Salud sexual [Internet]. Who.int. [Consultado el 9 de Junio de 2022]. Disponible en: https://www.who.int/es/health-topics/sexual-health
Obach A, Sadler M, Aguayo F, Bernales M. Salud sexual y reproductiva de hombres jóvenes en Chile: resultados de un estudio cualitativo. Rev Panam Salud Publica [Internet]. 2018 ;42:1–7. Disponible en: https://www.scielosp.org/pdf/rpsp/2018.v42/e124/es [Consultado el 9 de junio de 2022]
Feliciano Silva J, Cavalcanti Costa GM. Health care of sexual and gender minorities: an integrative literature review. Rev Bras Enferm [Internet]. 2020 ;73(suppl 6):e20190192. Disponible en: http://www.revenf.bvs.br/scielo.php?script=sci_arttext&pid=S0034-71672020001300300 [Consultado el 9 de junio de 2022]
Day M. La discriminación que enfrentan personas trans y no binarix en servicios de salud en Santiago, Chile [Internet]. Otdchile.org. 2017. Disponible en: https://dev.otdchile.org/wp-content/uploads/2018/06/MORGAN-DAY-Informe-final-redaccio%CC%81n-ok.-.pdf [Consultado el 9 de junio de 2022]
Sevilla FJ. Análisis de la calidad de la atención en salud sexual y reproductiva de la población trans en los hospitales públicos de la cuidad de Neuquén [Internet]. [Córdova, Argentina]: Universidad Nacional de Córdova; 2016. Disponible en: http://lildbi.fcm.unc.edu.ar/lildbi/tesis/sevilla-francisco-jesus2016.pdf [Consultado el 9 de junio de 2022]
Zapata Pizarro Antonio, Díaz Díaz Karina, Barra Ahumada Luis, Maureira Sales Lorena, Linares Moreno Jeanette, Zapata Pizarro Franco. Atención de salud de personas transgéneros para médicos no especialistas en Chile. Rev. méd. Chile [Internet] 2019; 147( 1 ): 65-72. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872019000100065&lng=es [Consultado el 08 de Junio de 2022]
Universidad De Los Lagos, Dirección De Igualdad De Género. Binarismo de género. Disponible en: https://direcciondegenero.ulagos.cl/definiciones/binarismo-de-genero/ [Consultado el 08 de junio de 2022]
Joanna Briggs Institute. (2017). Checklist for systematic reviews and research syntheses. https://joannabriggs.org/ebp/critical_appraisal_tools
Critical Appraisal Skills Programme. (2018). CASP systematic review checklist. https://casp-uk.net/casp-tools-checklists/
Page MJ, McKensie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an update guideline for reporting systematic reviews. BMJ 2021; 372n71. doi: 10.1136/bmj.n.71
Hammond MEH, Stehlik J, Drakos SG, Kfoury AG. Bias in medicine: Lessons learned and mitigation strategies. JACC Basic Transl Sci [Internet]. 2021; 6(1):78–85. Disponible en: http://dx.doi.org/10.1016/j.jacbts.2020.07.012 [Consultado el 20 de junio de 2022]
Providing Transgender-Inclusive Healthcare Services [Internet]. Plannedparenthood.org. [citado el 15 de octubre de 2023]. Disponible en: https://www.plannedparenthood.org/files/4414/0606/9716/PPSFL_Providing_Transgender_Inclusive_Healthcare_Handbook.pdf
Scheim AI, Santos G-M, Arreola S, Makofane K, Do TD, Hebert P, et al. Inequities in access to HIV prevention services for transgender men: results of a global survey of men who have sex with men. J Int AIDS Soc [Internet]. 2016;19:20779. Disponible en: http://dx.doi.org/10.7448/ias.19.3.20779
Rodriguez A, Agardh A, Asamoah BO. Self-reported discrimination in health-care settings based on recognizability as transgender: A cross-sectional study among transgender U.s. citizens. Arch Sex Behav [Internet]. 2018 [citado el 15 de octubre de 2023];47(4):973–85. Disponible en: http://dx.doi.org/10.1007/s10508-017-1028-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891571/
Loo S, Almazan AN, Vedilago V, Stott B, Reisner SL, Keuroghlian AS. Understanding community member and health care professional perspectives on gender-affirming care—A qualitative study. PLoS One [Internet]. 2021;16(8):e0255568. Disponible en: http://dx.doi.org/10.1371/journal.pone.0255568
Müller A, Spencer S, Meer T, Daskilewicz K. The no-go zone: a qualitative study of access to sexual and reproductive health services for sexual and gender minority adolescents in Southern Africa. Reprod Health [Internet]. 2018 [citado el 15 de octubre de 2023];15(1) . Disponible en: http://dx.doi.org/10.1186/s12978-018-0462-2
Asia Pacific Transgender Network (APTN). What they don’t tell you in sex ed! – A resource for transgender and gender diverse communities on sexual and reproductive health [Internet]. Weareaptn.org. [citado el 15 de octubre de 2023]. Disponible en: https://weareaptn.org/resource/what-they-dont-tell-you-in-sex-ed-a-resource-for-transgender-and-gender-diverse-communities-on-sexual-and-reproductive-health/
Lock L, Anderson B, Hill BJ. Transgender care and the COVID-19 pandemic: Exploring the initiation and continuation of transgender care in-person and through telehealth. Transgend Health [Internet]. 2022 [citado el 17 de julio de 2023];7(2):165–9. Disponible en: http://dx.doi.org/10.1089/trgh.2020.0161
A toolkit on patient centered transgender care for nurse practitioner faculty and clinicians. J Nurse Pract [Internet]. 2019;15(7):502–5. Disponible en: https://www.sciencedirect.com/science/article/pii/S155541551930203X
Whitman-Walker Health Human rights campaign foundation. Safer sex for trans bodies [Internet]. Hrc.org. [citado el 17 de julio de 2023]. Disponible en: http://assets2.hrc.org/files/assets/resources/Trans_Safer_Sex_Guide_FINAL.pdf
Spencer S, Meer T, Müller A. “The care is the best you can give at the time”: Health care professionals’ experiences in providing gender affirming care in South Africa. PLoS One [Internet]. 2017;12(7):e0181132. Disponible en: http://dx.doi.org/10.1371/journal.pone.0181132
Dhillon N, Oliffe JL, Kelly MT, Krist J. Bridging barriers to cervical cancer screening in transgender men: A scoping review. Am J Mens Health [Internet]. 2020;14(3):155798832092569. Disponible en: http://dx.doi.org/10.1177/1557988320925691
Hanauer OFD, Hemmi APA. Caminhos percorridos por transexuais: em busca pela transição de gênero. Saúde em Debate [Internet]. 2019 [citado el 17 de julio de 2023];43(spe8):91–106. Disponible en: https://www.scielosp.org/article/sdeb/2019.v43nspe8/91-106/
Lee H, Park J, Choi B, Yi H, Kim S-S. Experiences of and barriers to transition-related healthcare among Korean transgender adults: focus on gender identity disorder diagnosis, hormone therapy, and sex reassignment surgery. Epidemiol Health [Internet]. 2018 [citado el 17 de julio de 2023];40:e2018005. Disponible en: http://dx.doi.org/10.4178/epih.e2018005
Hillman J. The sexuality and sexual health of LGBT elders. Annu Rev Gerontol Geriatr [Internet]. 2017;37(1):13–26. Disponible en: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121429603&lang=es&site=ehost-live
Van Schuylenbergh J, Motmans J, Defreyne J, Somers A, T’Sjoen G. Sexual health, transition-related risk behavior and need for health care among transgender sex workers. Int J Transgend [Internet]. 2019 [citado el 15 de octubre de 2023];20(4):388–402. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913627/
Center of Desease Control and Prevention. Patient-centered care [Internet]. Cdc.gov. 2022 [citado el 17 de julio de 2023]. Disponible en: https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/affirmative-care.html
Hodax JK, Wagner J, Sackett-Taylor AC, Rafferty J, Forcier M. Medical options for care of gender diverse and transgender youth. J Pediatr Adolesc Gynecol [Internet]. 2020;33(1):3–9. Disponible en: https://www.sciencedirect.com/science/article/pii/S1083318819302062
Harb CYW, Pass LE, De Soriano IC, Zwick A, Gilbert PA. Motivators and barriers to accessing sexual health care services for transgender/genderqueer individuals assigned female sex at birth. Transgend Health [Internet]. 2019;4(1):58–67. Disponible en: http://dx.doi.org/10.1089/trgh.2018.0022
Crissman H, Stroumsa D. Gynecologic care considerations for transmasculine people: Transgender and non-binary people face discrimination and stigma, along with other barriers, in accessing health care. Contemp Ob Gyn [Internet]. 2020;65(8):20–4. Disponible en: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=145176958&lang=es&site=ehost-live
United Nations Office on Drugs and Crime, TECHNICAL BRIEF: TRANSGENDER PEOPLE AND HIV IN PRISONS AND OTHER CLOSED SETTINGS [Internet]. Unodc.org. [citado el 15 de octubre de 2023]. Disponible en: https://www.unodc.org/documents/hiv-aids/publications/Prisons_and_other_closed_settings/22-03088_Transgender_HIV_E_ebook.pdf
De Santis JP, Hauglum SD, Deleon DA, Provencio-Vasquez E, Rodriguez AE. HIV risk perception, HIV knowledge, and sexual risk behaviors among transgender women in south Florida. Public Health Nurs [Internet]. 2017;34(3):210–8. Disponible en: http://dx.doi.org/10.1111/phn.12309
Andrzejewski J, Dunville R, Johns MM, Michaels S, Reisner SL. Medical gender affirmation and HIV and sexually transmitted disease prevention in transgender youth: Results from the survey of today’s adolescent relationships and transitions, 2018. LGBT Health [Internet]. 2021;8(3):181–9. Disponible en: http://dx.doi.org/10.1089/lgbt.2020.0367
Rosenberg S, Callander D, Holt M, Duck-Chong L, Pony M, Cornelisse V, et al. Cisgenderism and transphobia in sexual health care and associations with testing for HIV and other sexually transmitted infections: Findings from the Australian Trans & Gender Diverse Sexual Health Survey. PLoS One [Internet]. 2021;16(7):e0253589. Disponible en: http://dx.doi.org/10.1371/journal.pone.0253589
Santana AD da S, Araújo EC de, Abreu PD de, Lyra J, Lima MS de, Moura JW da S. Health vulnerabilities of transgender sex workers: An integrative review. Texto Contexto Enferm [Internet]. 2021 [citado el 17 de julio de 2023];30:e20200475. Disponible en: https://www.scielo.br/j/tce/a/WKCPGCjjQSkgsbpgjRVGZLS/?lang=en
Fauk NK, Merry MS, Putra S, Sigilipoe MA, Crutzen R, Mwanri L. Perceptions among transgender women of factors associated with the access to HIV/AIDS-related health services in Yogyakarta, Indonesia. PLoS One [Internet]. 2019;14(8):e0221013. Disponible en: http://dx.doi.org/10.1371/journal.pone.0221013
Logie CH, Lacombe-Duncan A, Brien N, Jones N, Lee-Foon N, Levermore K, et al. Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study. J Int AIDS Soc [Internet]. 2017;20(1):21385. Disponible en: http://dx.doi.org/10.7448/ias.20.1.21385
World Health Organization: Hiv and young transgender people [Internet]. Who.int. [citado el 15 de octubre de 2023]. Disponible en: https://iris.who.int/bitstream/handle/10665/179866/WHO_HIV_2015.9_eng.pdf
Tun W, Pulerwitz J, Shoyemi E, Fernandez A, Adeniran A, Ejiogu F, et al. A qualitative study of how stigma influences HIV services for transgender men and women in Nigeria. J Int AIDS Soc [Internet]. 2022;25(S1). Disponible en: http://dx.doi.org/10.1002/jia2.25933
Monteiro S, Brigeiro M. Experiências de acesso de mulheres trans/travestis aos serviços de saúde: avanços, limites e tensões. Cad Saude Publica [Internet]. 2019 [citado el 17 de julio de 2023];35(4):e00111318. Disponible en: https://www.scielosp.org/article/csp/2019.v35n4/e00111318/
World Health Organization WHO. Policy brief: Transgender people and HIV [Internet]. 2015 [citado el 17 de julio de 2023] Disponible en: https://apps.who.int/iris/bitstream/handle/10665/179517/WHO_HIV_2015.17_eng.pdf
Center of Desease Control and Prevention: HIV Testing, Prevention and Care for transgender people [Internet]. Cdc.gov. 2021 [citado el 15 de octubre de 2023]. Disponible en: https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/prevention-and-care-data.html
Moseson H, Fix L, Hastings J, Stoeffler A, Lunn MR, Flentje A, et al. Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey. Int J Transgend Health [Internet]. 2021;22(1–2):30–41. Disponible en: http://dx.doi.org/10.1080/26895269.2020.1841058
Cooper HC, Long J, Aye T. Fertility preservation in transgender and non-binary adolescents and young adults. PLoS One [Internet]. 2022 [citado el 15 de octubre de 2023];17(3):e0265043. Disponible en: http://dx.doi.org/10.1371/journal.pone.0265043
Armuand G, Dhejne C, Olofsson JI, Rodriguez-Wallberg KA. Transgender men’s experiences of fertility preservation: a qualitative study. Hum Reprod [Internet]. 2017;32(2):383–90. Disponible en: http://dx.doi.org/10.1093/humrep/dew323
Castilla-Peón MF. Manejo médico de personas transgénero en la niñez y la adolescencia. Bol Med Hosp Infant Mex [Internet]. 2019 [citado el 15 de octubre de 2023];75(1). Disponible en: https://www.bmhim.com/frame_esp.php?id=4
Nahata L, Chen D, Quinn GP, Travis M, Grannis C, Nelson E, et al. Reproductive attitudes and behaviors among transgender/nonbinary adolescents. J Adolesc Health [Internet]. 2020;66(3):372–4. Disponible en: https://www.sciencedirect.com/science/article/pii/S1054139X19304513
Boudreau D, Mukerjee R. Contraception care for transmasculine individuals on testosterone therapy. J Midwifery Womens Health [Internet]. 2019;64(4):395–402. Disponible en: http://dx.doi.org/10.1111/jmwh.12962
Lai TC, Davies C, Robinson K, Feldman D, Elder CV, Cooper C, et al. Effective fertility counselling for transgender adolescents: a qualitative study of clinician attitudes and practices. BMJ Open [Internet]. 2021 [citado el 18 de julio de 2023];11(5):e043237. Disponible en: http://dx.doi.org/10.1136/bmjopen-2020-043237
Mayhew Veronica Gomez-Lobo A. Fertility Options for the Transgender and Gender Nonbinary Patient. [citado el 17 de julio de 2023]; Disponible en: https://academic.oup.com/jcem/article/105/10/3335/5892794?login=false
Paula Amato, MDFertility options for transgender persons [Internet]. Ucsf.edu. [citado el 15 de octubre de 2023]. Disponible en: https://transcare.ucsf.edu/guidelines/fertility
Cheng PJ, Pastuszak AW, Myers JB, Goodwin IA, Hotaling JM. Fertility concerns of the transgender patient. Transl Androl Urol [Internet]. 2019 [citado el 15 de octubre de 2023];8(3):209–18. Disponible en: http://dx.doi.org/10.21037/tau.2019.05.09
Feigerlová E, Pascal V, Ganne-Devonec M-O, Klein M, Guerci B. Fertility desires and reproductive needs of transgender people: Challenges and considerations for clinical practice. Clin Endocrinol (Oxf) [Internet]. 2019;(cen.13982). Disponible en: http://dx.doi.org/10.1111/cen.13982
Moseson H, Fix L, Hastings J, Stoeffler A, Lunn MR, Flentje A, et al. Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey. Int J Transgend Health [Internet]. 2021;22(1–2):30–41. Disponible en: http://dx.doi.org/10.1080/26895269.2020.1841058
Cooper HC, Long J, Aye T. Fertility preservation in transgender and non-binary adolescents and young adults. PLoS One [Internet]. 2022 [citado el 18 de julio de 2023];17(3):e0265043. Disponible en: http://dx.doi.org/10.1371/journal.pone.0265043
Moseson H, Fix L, Ragosta S, Forsberg H, Hastings J, Stoeffler A, et al. Abortion experiences and preferences of transgender, nonbinary, and gender-expansive people in the United States. Am J Obstet Gynecol [Internet]. 2021;224(4):376.e1-376.e11. Disponible en: https://www.sciencedirect.com/science/article/pii/S0002937820311261
Gomez AM, Đỗ L, Ratliff GA, Crego PI, Hastings J. Contraceptive beliefs, needs, and care experiences among transgender and nonbinary young adults. J Adolesc Health [Internet]. 2020;67(4):597–602. Disponible en: https://www.sciencedirect.com/science/article/pii/S1054139X2030104X
Falck F, Frisén L, Dhejne C, Armuand G. Undergoing pregnancy and childbirth as trans masculine in Sweden: experiencing and dealing with structural discrimination, gender norms and microaggressions in antenatal care, delivery and gender clinics. Int J Transgend Health [Internet]. 2021;22(1–2):42–53. Disponible en: http://dx.doi.org/10.1080/26895269.2020.1845905
Hahn M, Sheran N, Weber S, Cohan D, Obedin-Maliver J. Providing patient-centered perinatal care for transgender men and gender-diverse individuals: A collaborative multidisciplinary team approach. Obstet Gynecol [Internet]. 2019 [citado el 18 de julio de 2023];134(5):959–63. Disponible en: http://dx.doi.org/10.1097/aog.0000000000003506
Berger AP, Potter EM, Shutters CM, Imborek KL. Pregnant transmen and barriers to high quality healthcare. Proc Obstet Gynecol [Internet]. 2015 [citado el 17 de julio de 2023];5(2):1–12. Disponible en: https://pubs.lib.uiowa.edu/pog/article/3565/galley/112471/view/
Moseson H, Fix L, Gerdts C, Ragosta S, Hastings J, Stoeffler A, et al. Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States. BMJ Sex Reprod Health [Internet]. 2022;48(e1):e22–30. Disponible en: https://srh.bmj.com/content/familyplanning/48/e1/e22.full.pdf
Rachel Wamboldt Shirley Shuster Bikrampal S Sidhu. Lactation Induction in a Transgender Woman Wanting to Breastfeed: Case Report. The Journal of Clinical Endocrinology & Metabolism [Internet]. mayo de 2021 [citado el 17 de julio de 2023];106. Disponible en: https://academic.oup.com/jcem/article/106/5/e2047/6123860?login=false
Gomez I, Ranji U, Salganicoff A, Dawson L, Rosenzweig C, Kellenberg R, et al. Update on Medicaid coverage of gender-affirming health services [Internet]. KFF. 2022 [citado el 17 de julio de 2023]. Disponible en: https://www.kff.org/womens-health-policy/issue-brief/update-on-medicaid-coverage-of-gender-affirming-health-services/
Johnston CD, Shearer LS. Internal medicine resident attitudes, prior education, comfort, and knowledge regarding delivering comprehensive primary care to transgender patients. Transgend Health [Internet]. 2017;2(1):91–5. Disponible en: http://dx.doi.org/10.1089/trgh.2017.0007
Zapata Pizarro A, Muena Bugueño C, Quiroz Nilo S, Alvarado Villarroel J, Leppes Jenkis F, Villalón Friedrich J, et al. Percepción de la atención de salud de personas transgénero en profesionales médicos y médicas del norte de Chile. Rev Chil Obstet Ginecol [Internet]. 2021 [citado el 15 de noviembre de 2023];86(1):61–7. Disponible en: https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-75262021000100061&lang=es
Zapata Pizarro A, Díaz Díaz K, Barra Ahumada L, Maureira Sales L, Linares Moreno J, Zapata Pizarro F. Atención de salud de personas transgéneros para médicos no especialistas en Chile. Rev Med Chil [Internet]. 2019 [citado el 15 de octubre de 2023];147(1):65–72. Disponible en: https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872019000100065&lang=es
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Contemporary Midwifery Journal

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
__