Jun 292015
 

Two_golden_wedding_ringsAs I’m sure you know by now, the United State Supreme Court has declared that same-sex marriage is legal in all of the United States. Why was marriage so important, anyway? And what’s next?

Marriage is a legal institution in the United States. There are legal rights and responsibilities for spouses. Marriage proponents were not arguing for the religious right to have a marriage ceremony. Anyone who wants to can have a ceremony. What mattered, and why they found so hard for so long, were the legal rights. Many of these rights have to do with taxes, estates, the right to adopt, and so on — areas that are somewhat outside the realm of this blog. There are some important medical-related rights that are covered by marriage, including…

  • The right to hospital visitation. If one spouse is in a restricted area of a hospital (such as an intensive care unit), the other spouse has the legal right to visit. While President Obama did issue an executive order ordering hospitals to allow visitation for same-sex couples, it only applies to hospitals that accept Medicare/Medicaid. Most hospitals do, but it isn’t all.
  • The right to make medical decisions
  • Giving consent for autopsies and burial arrangements
  • Medical insurance coverage for spouses
  • Family leave to take care of a sick or injured spouse

Individual institutions can and have granted some or all of these rights before. For example, Google is well-known for its equitable treatment of employees in same-sex relationships. And some hospitals have accepted medical power of attorney documents with no question for same-sex partners. But it wasn’t universal.

For a long time now people in same-sex relationships have been in a legal gray zone. They may be legally married in one state. But cross a state line and suddenly that state may not consider them to be married anymore. This was because of the Defense of Marriage act, which is now null thanks to the US Supreme Court.

The US Supreme Court not only ensured that all same-sex marriages be considered legal marriages at the Federal level, it ordered all states to issue same-sex marriage licenses and honor the same-sex marriages performed in other states.

This should ensure equal marriage rights for both same-sex and opposite sex couples.

As the Onion and Boing Boing jointly pointed out, there are many many more rights that LGBT people lack that they need. It’s not just marriage. Many states still do not allow same-sex couples to adopt. Others allow discrimination based on sexual orientation or gender identity in employment, schools, or housing. Men who have sex with men are still barred from giving blood at the federal level. In some states, transgender people lack access to legal name changes, protection from violence, health care coverage, and equal access to employment. There’s still a lot of legal work to be done.

And everybody needs access to knowledgeable, compassionate health care. No matter who they are, what they do, or who they do it with.

If you’re interested in medical organizations seeking to advance health care for all people, check these groups out:

  • GLMA: Gay and Lesbian Medical Association. Despite the name, covers all of “LGBT”. They are the premier medical advocacy group, and maintain a list of LGBT and LGBT-friendly providers.
  • WPATH: World Professional Association for Transgender Health. Creators of the Standard of Care, which give providers guidelines on best medical practices for transgender people around the world. Also has a list of providers.
  • TASHRA: The Alternative Sexualities Health Research Alliance​. A newer, smaller group “working to create a world where all kinksters have equal access to culturally competent, non-judgmental, and knowledgeable healthcare”.

And have a lovely rest of Pride month. We truly do have something to celebrate this year.

Jul 282014
 

Some news months are very quiet. But as it’s said, “It never rains but it pours”. These last two months flooded my inbox. Whew!

Alexandrite for June

Alexandrite for June news

Sexual orientation (LGB) news

  • A meta-analysis of women who identify as lesbian found that roughly 48% had experienced domestic violence of some sort in their lifetimes. 15% of lesbians surveyed were currently experiencing domestic violence. Most of the violence experienced was emotional (43% of lesbians). Source.
  • Even after a cancer diagnosis, gay men report poorer health habits than their heterosexual peers. Such habits include tobacco use, infrequent exercise, high levels of psychological stress, and substance use. Any difference between gay and straight men with regards to cancer diagnosis may be a result of different levels of HIV infection. Source.
  • Women who have sex with women are at higher risk for suicide than heterosexual women. The same was not seen for men. Non-heterosexual men and women did not appear to be at higher risk for death in general than their het peers. Source.
  • Gay and bisexual men appear to be underestimating their chances of acquiring HIV and may be missing out on preventative treatment. Source.
  • A study of ex-ex-gay men found that realizing that sexual orientation change was not possible was the reason for abandoning reparative therapy. Reparative therapy itself resulted in negative mental health and shame for these men. Source.
  • Rates of syphilis are going up among men who have sex with men. Remember to use protection and get tested! Source.

Transgender, gender identity, intersex news

  • A paper was published acknowledging that research on transgender youth was limited at best. This paper advocated for early identification and treatment for the health of the youth. Source.
  • A study of young trans men using subcutaneous testosterone found that subcutaneous testosterone is effective and safe in short-term use. Monthly bleeding stopped within 3 months and most men in the study reached cis male testosterone levels within 6 months. Source.
  • A list of clinics providing care for gender non-conforming and transgender children and youth was published. Source (PDF).
  • A summary article was published summarizing the current state of challenges facing transgender youth within medicine. Source. Another similar article, intended to familiarize a pediatrician with cross-sex hormone treatments, was published. Source.
  • In-person survey results may differ significantly from online survey results within the trans population. An analysis of data from the National Transgender Discrimination Study found that people who took the survey in person were more likely to be young, relatively poorer, trans women who also were more likely to report being HIV positive and use substances. Data from in-person vs online studies should be interpreted accordingly. Source.
  • An open access article was published exploring the lives of several waria, trans feminine people from Indonesia. Most felt that any potential risk in risky transition-related behaviors (e.g., taking hormonal contraception pills, silicone injection) was worth it. Source.
  • Quality of life for intersex people seems to vary widely, depending partially on where they received medical care as children. Source.
  • A review of the care of intersex children concluded that it “requires acceptance of the fact that deviation from the traditional definitions of gender is not necessarily pathologic”. The review also advocated integrated peer support for intersex individuals and the development of skilled and trained teams of professionals to assist families. Source.
  • A case report of a trans woman with BRCA1 was described. BRCA1 is one of the gene mutations that results in a high risk of breast cancer. This woman chose to have medical care as usual, and did not opt for a preventative mastectomy. BRCA1 presents a challenge for all women, but the combination of a BRCA1 gene and estrogen may accelerate a possible breast cancer. Source.
  • A case report of a trans woman developing psychosis when abruptly stopping hormone therapy was reported. Her psychosis resolved when she started hormone therapy again. Source.
  • For relationships between trans women and cis men, both partners may be at risk for increased psychosocial stress because of transphobia. Source.
  • A comparison of rural vs nonrural trans people was published, confirming that rural trans people need medical and mental health services too. Source (full text!)
  • Roughly 16% of trans women in the San Francisco Bay Area were found to have used fillers such as silicone. Please don’t do this! It can, and does, cause death. Source.
Ruby for July

Ruby for July news

Sexuality, minority sexual behavior news

  • A pair of case reports of urethral sounding came out, this time from Korea. As a reminder: electrical cables and magnets do not make for good sounding instruments. No matter how embarrassing, remember to get medical care when you need it! Thankfully for these two men the objects were removed, though one removal did require surgery. Source (NSFW images).
  • A review of changes to the paraphilia section of the DSM-V found that some of the changes make it more likely that someone will be falsely diagnosed with a paraphilia. Source.
  • Another study on personality traits of people diagnosable with paraphilias was published. The abstract isn’t really detailed enough to really see what the results were, but this is one to keep an eye on… Source.
  • An exploration of the psychological and sexual sides to apotemnophilia (desire to have an amputation of a healthy limb) was published. Source.
  • Comparison of self-identified swingers and self-identified polyamorous people found that both groups were more likely to seek psychological care when they needed it than the general population. Poly folk and swingers were also more likely to report that they were satisfied with life. Source (full text!).
  • Debates continue on the definition of paraphilias, and their inclusion in the DSM. Source.
  • A study of some in the Adult Baby/Diaper Love communities found that few in those communities have problems with their interests. Source.
  • A case of inability to urinate was presented. The cause? A sex toy that had been accidentally left in her vagina 10 years previously. Retained objects like that can cause fistulas (holes – either between the rectum and the vagina or the bladder and the vagina). The woman in the case had surgery. Source.
  • Among opposite-sex couples vasectomy was found to increase sexual satisfaction for both partners. Source.

Miscellaneous and general news

  • A number of Hispanic medical organizations came out in support of LGBT health. Source.
  • Almost half of LGBT people living in Nebraska had considered suicide in their lifetime. Source.
  • Some 80% of German medical students express interest in learning about human sexuality. Despite efforts to increase education for decades, only half of those students were able to correctly answer questions on human sexuality. Source.
Jun 032014
 

6763959_10420a4b6a_mThe biggest news for May of 2014 is really that Medicare lifted the blanket ban on covering genital surgeries for trans people. The National Center for Transgender Equality has a good summary (PDF) of what the decision actually means. If you’re trans and interested in surgery and are a Medicare recipient, I recommend calling the physician who’s prescribing your hormones and consulting with them about next steps. The news was covered in multiple outlets including the NY Times and CNN.

The other piece of news I spotted that is not getting as much traction as I’d like is this: Urine is NOT sterile! For a long time it’s been believed that urine produced by healthy people is sterile – at least until it passes through the urethra. Turns out not to be the case. Something to keep in mind if you have contact with urine. Source

Interested in the other news? Read on!

  • Work continues on the possibility of three-parent babies. While much of the research and reporting talks about preventing mitochondrial diseases, I still think it opens a wonderful door for three-parent poly households. The latest news is fairly political, but supportive.
  • Another study out of Europe indicates that transgender hormone therapy is safe. This was a 1-year study of both men and women, just over 100 people total No deaths or serious adverse reactions were reported. Highly recommend you skim the abstract for yourself! For US readers, please do note though that the hormones used in the study were different formulations than those used in the US. Source.
  • A published case study reminds us that not all “odd” physical things during medical transition are related to transition. This was a case of a trans man who had undiagnosed acromegaly from a benign brain tumor. Eek! He was correctly diagnosed and treated, thankfully. Source.
  • A Swedish review of transgender-related records found a transition regret rate of 2.2%. Other prevalence data, including the usual male:female ratios, are included. Source.
  • A study of gay men found that they have worse outcomes from prostate cancer treatments than straight men. Source.
May 082014
 

CC BY 2.0) - flickr user stevendepoloA little belated, but here’s the GSM health news that came out around April this year, in no particular order…

  • There was a new meta analysis of intestinal vaginoplasties published in April. This meta analysis overall found that rate and severity of complications was “low”, with stenosis the most common complication. There were no reports of cancer. Sexual satisfaction was high, but there were no quality of life measures reported. Quality of studies were reported to be low, though, and there was a distinct lack of use of standardized measures. Source.
  • Oncology Times released a review of cancer and cancer screenings in transgender people. Highly recommend you take a look at the source.
  • A study finds that trans men on testosterone have lower levels of anxiety, depression and anger than trans men not on testosterone. Source.
  • A review of current hormonal transition effects and aging determined that, based on current data, “Older [trans people] can commence cross-sex hormone treatment without disproportionate risks.” They note that monitoring for cardiovascular health is especially important for trans women, especially those who are on progesterones. Strength or type of hormones may need to be modified in order to minimize risk. Source.
  • As much of the sex positive community has known for a long time, the BMI of cis women is (in general) not correlated with sexual activity. Source.
  • In Croatian medical students knowledge about homosexuality was correlated with positive attitudes. Source.
  • Science is awesome! The Lancet reported success in engineering vaginas for 4 women with MRKHS. No complications over the 8 years of follow up, and satisfaction with sexual functioning. Fingers crossed that this technique can be used in the future for many more women! Source.
  • Remember that sexual orientation is not the same as behavior? In a recent analysis of previously collected data, 11.2% of heterosexual-identified sexually active (presumably cisgender) women reported ever having a same-sex partner. Another way of looking at it: 1 in 10 straight women have had sex with another woman. Source.
  • Don’t forget about aftercare and cuddling! Post-sex affection appears to be correlated with relationship satisfaction. Source.
  • Unsurprising but sad: Young LGB people are more likely to binge drink alcohol when they’ve been exposed to discrimination and homophobia. Source.

 

Mar 062014
 

A little late, but here’s some GSM health news from February 2014!

CC BY 2.0 - UCL Mathematical and Physical SciencesTransgender

  • A literature review found that “There is a notable lack of published research regarding hormone therapy in the transgender population” and came to the very reasonable conclusion that “Although there is currently considerable focus on sexually transmitted infections in the MTF transgender population, a more comprehensive approach to health care is required, including education for transgender people and the health professionals who attend to them regarding appropriate hormone therapy.” Ayup.  Source.
  • A study found that European pre-transition trans people, both men and women, were likely to have androphilic (attracted to men) partners. I admit I’m a bit baffled by the abstract on this paper – what about bisexuals? If anyone could find and grab a copy of the full paper I’d be grateful. Source.
  • For binary-identified trans people, connection to a trans community appears to be correlated with less suicidality, lower feelings of fearfulness and higher feelings of comfort. No effect was detected for non-binary identified trans people in this study. Source.

Gay, Lesbian, Bisexual

  • The greater the anti-gay sentiment, the less long the non-heterosexuals in a community seem to live. Source.
  • Gay youths are more likely than straight youths to have factors which increase their cancer risks, such as: low rates of exercise, smoking tobacco, and drinking alcohol at a young age. Source.
  • A study found that mood and safe sex behaviors were correlated for gay men in New York – the more depressed they were, the less likely they were to use safe sex techniques. Source.
  • Gay and bisexual male adolescents are more likely to use anabolic steroids than their heterosexual peers. Source.

Other

  • Two studies indicate that BDSM activities are associated with changes of consciousness. But why didn’t the researchers compare their results with other intense activities? Source.
  • A case report of a rectovaginal fistula showed up in my feeds this month. In this case it was in a cis woman. A fistula is a hole – in this case, it was a hole between her vagina and rectum, and was caused by penile intercourse. It’s fairly rare, but can and does happen. In the case, the woman was lucky enough that some stitches were all she needed. She fully recovered and was able to resume vaginal intercourse. Source.
  • Just like cis men, cis women can also experience priapism: prolonged, unwanted erection. A case study of a cis woman with painful priapism lasting 5 days showed up in the emergency room and was reported as a case study. Surprisingly enough, she was successfully treated with pseudoephedrine – aka SudaFed. Go figure. Source.

As always…  Stay healthy, stay safe, and have fun!