Available online 25 November 2023

Author links open overlay panel, , , ABSTRACTStudy Objective

This study aims to identify factors that influence the first pelvic exam experiences of sexual and gender minority (SGM) adolescents and young adults who were assigned female at birth (AFAB).

Methods

Using purposive sampling, we recruited SGM AFAB individuals, ages 18 to 24, who had at least one pelvic examination. Semi-structured interviews and an iterative approach allowed for the emergence of factors influencing the first pelvic exam experience. Items included in the final code directory had Krippendorff's alpha intercoder reliability score > 0.7. Interviews were analyzed using ATLAS.ti.

Results

Thirty participants completed interviews. Fourteen participants identified as bisexual, two gay, one lesbian, three pansexual, eight queer, and two straight/heterosexual. Sixteen participants identified as cisgender, nine genderqueer/gender nonconforming, and five transgender. Factors influencing the first pelvic exam experience were organized as patient or clinician level factors. Patient Level Factors: Gender identity, sexual orientation, history of sexual trauma, and participant's relationship to their body were central factors influencing the exam experience. Speculum insertion during the exam induced anxiety and pain for some. Clinician Level Factors: Clinicians’ gender, age, and race or ethnicity influenced the exam experience. Most participants preferred detailed communication. Participants offered recommendations to ensure gender-affirming, patient-centered care during the first pelvic exam.

Conclusion

SGM AFAB individuals identify patient and clinician-level factors influencing their first pelvic exam experiences. This study underscores the need for changes in medical education and health systems to ensure SGM AFAB individuals have their needs met and feel comfortable in reproductive health settings.

Section snippetsINTRODUCTION

Sexual and gender minorities (SGM) who were assigned female at birth (AFAB) experience disparities in sexual and reproductive health (SRH) services.1, 2, 3, 4, 5, 6, 7 Patients cite concerns about clinician discrimination and incompetency in addressing lesbian, gay, bisexual, transgender, and queer (LGBTQ) health issues as reasons for these disparities.2, 3, 4,8,9 The impact of these disparities on health outcomes is not well documented, given the absence of sexual orientation and gender

METHODS

The study team conducted semi-structured interviews with adolescents and young adults who identified as SGM AFAB. Participants were recruited from the South Side of Chicago and surrounding communities between April and December 2020 via flyers in LGBTQ organizations and SRH clinics, social media posts from LGBTQ organizations, e-mails to student organizations, and snowball recruiting. Participants initiated contact with the study team via email or phone.

Participants were screened by phone for

RESULTS

Seventy-six individuals contacted the study team, 46 completed screening, and 30 completed interviews (Table 1). Participant identities and age at study enrollment are presented with each quote. Participants elucidated patient and clinician-level factors influencing the first pelvic exam and recommendations to improve the experience for SGM AFAB individuals (Table 2). The themes that emerged from interview analysis are organized herein into two overarching categories (1) Patient Level Factors

DISCUSSION

Reproductive health disparities among SGM AFAB individuals create an imperative for healthcare clinicians and systems to engage in patient centered SRH care that addresses the specific needs and concerns of SGM AFAB patients. Our research contributes knowledge to the limited literature on early gynecologic experiences of SGM AFAB individuals. Through an iterative approach allowing for the emergence of a plurality of narratives, participants described how their first pelvic exam experiences were

Declaration of Competing Interest

The authors report no conflicts of interest.

Acknowledgment of support

We would like to thank Rae Goodman, MS for helping us craft the interview questionnaire, train our interviewers, and review our manuscript.

REFERENCES (34)P Fiddes et al.Attitudes towards pelvic examination and chaperones: a questionnaire survey of patients and providers

Contraception

(2003)

M Agénor et al.Gender identity disparities in Pap test use in a sample of binary and non-binary transmasculine adults

J Gen Intern Med

(2018)

J Potter et al.Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians

J Gen Intern Med

(2015)

KH Mayer et al.Sexual and gender minority health: what we know and what needs to be done

Am J Public Health

(2008)

SM Peitzmeier et al.Enacting power and constructing gender in cervical cancer screening encounters between transmasculine patients and health care providers

Cult Health Sex

(2020)

J. Obedin-MaliverTime to Change: Supporting Sexual and Gender Minority People—An Underserved, Understudied Cancer Risk Population

J Natl Compr Canc Netw

(2017)

CK Bates et al.The Challenging Pelvic Examination

J Gen Intern Med

(2011)

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© 2023 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.