Transgender and non-binary individuals often struggle to find healthcare providers who are both respectful and knowledgeable about their specific medical needs. This is true across specialties, but imaging visits may cause the greatest distress. Common issues include misuse of pronouns, personal discomfort, and privacy concerns.
Imaging, especially pelvic ultrasound, can help these patients stay healthy through early detection and monitoring of various types of cancer. Healthcare providers can administer thoughtful and inclusive practices in an effort to ease the concerns of this community
A Thoughtful Approach to Pelvic Ultrasound Cancer Screening
Pelvic ultrasound can detect, assess, and monitor cancers like ovarian, endometrial, and prostate. Routine monitoring is vital for early cancer detection, especially for transgender and non-binary patients who may face unique risks from gender-affirming hormonal therapies and surgeries. Transgender and non-binary patients may also be at higher risk due to social and behavioral factors.
The lack of data on LGBTQ+ patients with cancer—especially for transgender and non-binary individuals—means that decisions to screen for prostate and gynecological cancers are nuanced. Healthcare professionals rely on an array of medical, behavioral, and social factors; this necessitates deep conversations with each patient. There's not one standard approach to meeting the health needs of your transgender and non-binary patients.
Preparing for a Pelvic Ultrasound
Many transgender people don't seek routine health screenings, and those who do may be reluctant to bring up "gender incongruent" organs. They may expect their providers to broach the subject. Healthcare professionals should proactively address these issues, emphasizing ultrasound's role in cancer detection and ensuring patient comfort. Sensitivity to their concerns is key, especially related to gender dysphoria and confidentiality. Conversations should occur in private settings. A complete health history should be obtained. Hormone therapies and surgeries need to be discussed because they can affect pelvic scans.
It's important to avoid gendering body parts and use the patient's preferred terminology to discuss their body. For example, some may prefer "genitals" to "vagina" or "penis" or "chest tissue" to breasts. Asking transgender and gender diverse people what terms they prefer shows consideration.
Flexible appointment scheduling accommodates patients who may have concerns about privacy and want to visit during less crowded times. Transvaginal ultrasound can be uncomfortable, even traumatic, for some transgender men—but sometimes it's essential for detecting endometrial cancer in men, so take time to ensure they understand the process. When it comes to the actual scan, address the patient's need for privacy and comfort, including appropriate draping. Discuss these measures with the patient and let them know their options.
These are just a few examples. The goal is to fully inform patients, mitigate anxiety, and make them as comfortable as possible.
Examples of Cancer Screenings Using Ultrasound
Ultrasound scans are ideal for endometrial, ovarian, and prostate cancer in transgender patients.
- Endometrial and ovarian cancers. Pelvic ultrasound is an effective first step in evaluating endometrial cancer in trans men. It's also an important tool for detecting ovarian cancer. Both endometrial and ovarian screening use transvaginal ultrasound. Transgender men who have undergone vaginectomy and require pelvic imaging may need a transrectal or transabdominal scan. The need for these screenings will vary. There have been few reports of ovarian and endometrial cancer among trans men, but more research is needed.
- Prostate cancer. Transwomen and non-binary individuals assigned male at birth can develop prostate cancer. Current research, however, indicates that transwomen have a lower risk of prostate cancer than do cisgender men. However, much remains unknown, including mechanisms through which transwomen develop prostate cancer. For transwomen who have undergone sex reassignment surgery, transvaginal ultrasound is a more effective tool for prostate examination than digital palpation, due to the anatomical positioning of the prostate anterior to the new vagina.
Sensitivity and Respect in Transgender Health
Healthcare providers must emphasize sensitivity and respect, especially during potentially invasive procedures like pelvic ultrasound. Gender-affirming healthcare is a process, and one that often requires changing traditional processes and procedures. Gender-neutral restrooms, visible signs of support for the LGBTQ+ community, and soliciting feedback can help foster a welcoming atmosphere.
Here are several other recommendations to help transgender patients feel secure and respected:
- Educate all staff on the significance of using the correct pronouns and names during patient interactions and in all documentation.
- Refrain from using gendered salutations like "sir" or "ma'am" with new patients. Instead, ask for their preferred form of address. When the patient provides their pronouns, make a note of it.
- Avoid using personal pronouns when referring to new patients.
- Include questions about gender identity and preferred pronouns on intake forms, but allow patients to opt out. These forms need to be inclusive, with options beyond binary gender choices and respectful language around anatomical descriptions.
- Protect patients' confidentiality regarding their transgender status. Some may not wish to divulge their identity and medical history due to past healthcare experiences. Never ask such questions in the reception area.
- Ask whether a patient's preferred name differs from their legal name, which may still appear on their medical records or insurance documents.
- Apologize for mistakes such as using the wrong pronouns.
- Involve transgender and gender diverse people in the development and implementation of services as well as in decisions about their health and well-being.
Helping Transgender Patients Navigate the Healthcare System
Trans patients often need guidance for navigating the healthcare system before and after a scan. For example, insurance often makes access to screenings more complex. A transgender woman with a prostate may not be covered for prostate cancer screening. You or a member of your team can help them obtain insurance authorization.
In addition, provide resources for trans and non-binary individuals undergoing cancer surveillance, and connect them with communities and peer support networks. Here are several resources to explore:
- The National LGBT Cancer Network offers:
- Cancer.net provides many resources for LGBTQ+ people with cancer
- Johns Hopkins Center for Transgender and Gender Expansive Health offers patient resources
Medically Effective and Emotionally Sound Gender-Affirming Care
Pelvic ultrasound supports the early detection and management of prostate and gynecological cancers, especially for transgender people. Its effectiveness, however, largely depends on the healthcare team's approach.
By implementing thoughtful practices—from respectful communication to privacy measures—healthcare providers can ensure that pelvic ultrasounds are not only medically effective but also emotionally supportive.
