Today’s blog has been written by my newest physiotherapist, Samantha Richter who has trained firstly as sonographer, then an osteopath and finally a Doctor of Physiotherapy specialising in pelvic health. Samantha relocated from Darwin at the end of last year, but is actually a Brisbane girl originally. She has settled into our practice beautifully and I am thrilled she is able to share this blog with us today based on her special knowledge and understanding of people in the LBGTQIA+ community.
Dr Sam Richter
I have had the privilege of working with people in the LBGTQIA+ community for over a decade and while research into this particular area is still lacking, we are slowly seeing an understanding of people’s needs in healthcare, social and economic diversity within this population.
Let’s start with a basic understanding of sexual orientation and gender identity: understanding the diverse spectrum of gender and sexual orientations and expressions is paramount. Sexual orientation and gender identity is not as simple as one might think.
Sexual orientation is the preferred term (over sexuality) – and describes a person’s enduring physical, romantic, and/or emotional attraction to another person.
Gender identity is your own, internal, personal sense of being a man or a woman, or as someone outside of that gender binary. The ‘gender binary ‘ is a system that allow for the existence of only two genders. An individual may identify as ‘nonbinary’ – so neither man, nor woman, nor any other gender. Just as the acronym LGBTQIA+ is ever changing, the concept of ‘gender’ and gender identity is also ever changing and evolving, which includes for an individual themselves, whose gender identity may change throughout the course of their lifetime.
Sexual and gender discrimination can have a profoundly negative effect on the emotional and mental wellbeing of the LBGTQIA+ community.
As I have mentioned before gender expression and sexual orientation can be mutual exclusive and on a spectrum. Not all transgender or gender diverse elect to have procedures, surgeries and other medical interventions performed in order to transition to a gender that better matches their identity.
Gender affirming surgeries include facial reconstruction surgeries, chest reconstruction/contouring – also known as “top” surgeries, and surgeries for genital reconstruction – also known as “bottom or lower” surgeries.
Types of Gender Diverse surgeries (usually two categories – Top and Lower surgeries)
Chest contouring: Top surgery that removes breast tissue and shapes the chest in way that is seen as more masculine.
Breast augmentation: Top surgery that enlarges the breasts.
Orchiectomy: Lower surgery that removes the testicles.
Vaginoplasty: Lower surgery that removes the penis, scrotum and testes, and creates a vulva and vagina.
Hysterectomy with bilateral salpingo-oophorectomy: Lower surgery that removes the uterus, ovaries and fallopian tubes.
Clitoral release: Lower surgery to create a penis from the clitoris by cutting ligaments to release the clitoris and add length to the shaft.
Metoidioplasty: Lower surgery to create a penis from the clitoris through clitoral release and grafting skin around the shaft to add girth. Sometimes, the urethra is also lengthened to allow urination from the shaft, and a scrotum is created.
Phalloplasty: Surgery to create a penis, scrotum and testes using graft tissue from elsewhere on the body (like a forearm or thigh). Phalloplasty usually involves one surgery to create the penis and scrotal shaft, and follow-up surgeries to add scrotal implants and implants to cause penile erection (if desired).
How can your physiotherapist help with Gender Affirming Care?
Your physiotherapist with an understanding of the change specific to diverse affirming care can:
- Assist with preparation and recovery from surgery
- Minimize the side effects of binding, including back pain, chest pain, poor posture, shoulder pain, numbness, and scarring
- Help with urinary changes associated with using stand-to-pee devices, packing and/or tucking
- Decrease pelvic pain associated with medications and surgeries.
Words and language matter: Equality vs equity
While treating everyone the same is ‘equality’ and is definitely a step up from giving less to someone because you are discriminating against them, (which unfortunately still does happen in health care settings), it is now not the preferred approach. While it gives equally to all, it does not provide equal outcomes for all. That is the basis of equity.
In equity, sometimes we need to give extra support by doing some things differently to provide equal outcomes for all – by providing cues of safety for example, or by learning more about the lives and experiences of those in our communities. Ultimately it will be better if the system can change, but until then we all need to create safe and inclusive spaces.
With my knowledge, compassion and understanding, I am creating this safe and inclusive space at Sue Croft Physiotherapy.
If anything, you have read has triggered in any way or you are looking for LBTGQIA+ providers please seek help:
Brisbane
Holdworth House, Fortitude Valley.
Stonewall Medical Centre, Windsor
Gladstone Road Medical Centre, Highgate Hill.
We acknowledge Aboriginal and Torres Strait Islander peoples as the First Peoples of Australia and we pay our respects to their elders past, present and emerging.
We are also a safe space for all clients including LGBTQIA+.
Thank you Sam for this blog – I look forward to you enriching our knowledge and continuing to support all our patients with your expertise.
