AUGS Position Statement: Gender Affirmation

The following position statement is meant to iterate our support for gender inclusion of both patients and health care providers. Our goal in writing this document is to be as all-encompassing as possible. Acknowledging the plethora and range of gender-related terminology, we will use “transgender and gender diverse.”

According to the 2015 U.S. Transgender Survey,1 transgender and gender-diverse (TGD) individuals are a minority group who face a multitude of challenges and barriers as they interface with the health care system. These barriers, which include episodes of harassment, acts of discrimination, denial of medical services, and lack of knowledge among health care workers, have short- and long-term detrimental effects on the physical and mental health of TGD individuals. To improve the health care outcomes of our patients, the American Urogynecologic Society (AUGS) commits to leading efforts to reduce health disparities and discrimination currently experienced among this historically marginalized population.

The American Urogynecologic Society supports how an individual expresses his/her true self. Science and evidence should be used to support how we, as clinicians, provide the best care for TGD individuals. To this end, AUGS is committed to advocating for best care practices for the TGD population. Although there are scientifically sound and accepted medical and surgical protocols, there remain several gaps in knowledge and societal support structures. The American Urogynecologic Society supports initiatives and programs aimed at closing these gaps.

UROGYNECOLOGY PROVIDERS ARE UNIQUELY POSITIONED TO CARE FOR TRANSGENDER AND GENDER-DIVERSE PATIENTS

Female pelvic medicine and reconstructive surgery/urogynecology is a board-certified subspecialty that focuses on surgical and nonsurgical management of pelvic floor disorders. As experts in pelvic and genital health urogynecology specialists are uniquely positioned to care for TGD patients who may experience pelvic symptoms during any stage of life, regardless of surgical history. Urogynecologists address common conditions, including urinary problems, pelvic organ prolapse, defecatory disorders, anal incontinence, pelvic pain, and pelvic floor dysfunction. These conditions are often addressed with a combination of behavioral strategies, physical therapy, and/or medical or surgical interventions. A urogynecologist has expert knowledge in pelvic evaluation and function and can assist in the diagnosis and care of these conditions. Urogynecology providers should be inclusive in their practices and create safe spaces for TGD patients so that they may feel comfortable in disclosing their pelvic floor symptoms. A safe space means asking patients about their gender identity and their preferred pronouns so that a proper organ inventory and assessment of symptoms can be done. In addition, many sequelae associated with genital gender affirmation surgery, such as complications of hysterectomy or lower urinary tract symptoms, dyspareunia, and fistula after genital reconstruction, fall under the purview of the urogynecology skillset. Therefore, those urogynecology providers comfortable with this type of care should consider extending their practices to TGD patients seeking treatment after gender affirmation surgery. The care of the TGD patient is multidisciplinary in nature, and AUGS advocates for urogynecologists to become active members of the teams established to care for this patient population.

Transgender and gender-diverse individuals have historically been a marginalized group due to discrimination. The American Urogynecologic Society strives to eliminate disparity by being inclusive and thoughtful about the needs of our members and patients. Therefore, AUGS is committed to advancing science in this field, improving access to care, and promoting education in TGD health.

ADDITIONAL RESOURCES

• The World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. 7th ed. 2012. Available at: https://www.wpath. org/publications/soc

• Human Rights Campaign. Glossary. Available at: https://www.hrc.org/ resources/glossary-of-terms

• GLMA. Transgender health resources. Available at: https://www. glma.org/index.cfm?fuseaction=Page.viewPage&pageId= 948&grandparentID=534&parentID=938

• AAFP. Join the conversation: member constituencies and discussion forums. Available at: https://www.aafp.org/membership/welcome-center/ involve/connect/constituencies-forums.html

• UCSF Prevention Science Department of Medicine. Resources: online learning. Available at: https://prevention.ucsf.edu/transhealth/resources

REFERENCE

1. The National Center for Transgender Equality. The report of the 2015 transgender survey. 2016. Available at: https://transequality.org/sites/default/ files/docs/usts/USTS-Full-Report-Dec17.pdf. Accessed July 1, 2022.

(Urogynecology 2022;28:735–737)

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