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Providing Compassionate and Competent Care to LGBTQ+ Patients

Brianna Durand, PT, DPT is the author and instructor of Inclusive Care for Gender and Sexual Minorities, a new remote course. Brianna's first course date is June 12-13, 2021.

Over the last five years, there has been a groundswell in the recognition that healthcare for those in the LGBTQ+ community has been, at best, incredibly lacking & the world of physical therapy is no exception. Fortunately, this growing awareness is being followed by tangible efforts to improve the quality of care provided to this population as evidenced by the formation of PT Proud, a Catalyst Group in the APTA, & a growing body of research to address the unique needs of LGBTQ+ patients. Hermann & Wallace is even offering its first-ever 2-day course solely focused on treating patients who are gender diverse! 

However, it is not uncommon for people to feel overwhelmed by all of the changing terminology & fear of accidentally offending someone. Thus, despite good intentions, many providers find themselves avoiding education & discussion of this topic altogether. The problem with this is that every clinician will inevitably encounter someone who is LGBTQ+ & merely “treating everyone the same '' may inadvertently end up causing harm. This is especially pertinent to pelvic health practitioners as we work on highly personal & vulnerable areas of the body. There are countless reasons why it is a worthwhile endeavor to share your knowledge on this topic which is discussed more thoroughly in a blog post I wrote a few years ago (here), but this post will focus more on practical takeaways that you can implement in your practice.

As mentioned earlier, the terminology can be intimidating; let's break them below into two categories: gender and sexual minorities:

  • Sex - biological characteristics of chromosomes & anatomy (ie. male, female, intersex)
  • Gender - societal & cultural categorization based on one’s sex (ie. man, woman, non-binary)
  • Cisgender - one who identifies with the gender assigned to them at birth
  • Intersex- someone born with aspects of both male & female anatomy (i.e. external vulva & internal testes)
  • Transgender - one whose gender does not match the sex they were born with (maybe abbreviated trans; this includes people who are non-binary)
  • AFAB- assigned female at birth
  • AMAB- assigned male at birth
  • Transwoman/MTF - assigned male at birth & identifies female
  • Transman/FTM - assigned female at birth & identifies male
  • Non-binary- one who identifies as neither male nor female; may use gender-neutral pronouns (they/them)
  • Top surgery - breast removal (typically FTM) or augmentation (typically MTF)*
  • Bottom surgery - reassigning one’s genitalia to the anatomy they identify with
  • Gender identity - the gender that someone associates with internally
  • Gender expression - the external gender that someone conveys through appearance & behavior

*Non-binary folks may also undergo various gender affirmation surgeries & /or take hormones.

  • Sexual orientation - the gender(s) that one is attracted to. (Transgender is not a sexual orientation.)
  • Lesbian- a woman attracted to other women
  • Gay- a man attracted to other men
  • Bisexual- a person attracted to both men and women
  • Pansexual- someone attracted to people regardless of their gender identity
  • Asexual- a person who is not sexually attracted to others; may still experience romantic attraction
  • Queer- an umbrella term that applies to all LGBTQ+ people; used as a sexual orientation when other labels are not accurate; may be perceived as a derogatory slur, especially among older individuals

There can be many combinations of the terms above. Someone could identify internally as male but live outwardly as a woman for a variety of reasons including safety, cost of transition, etc. Also, gender & sexual orientation do not always pair up in a heteronormative fashion. A person could be cisgender & bisexual (a woman AFAB attracted to both men & women) or transgender & lesbian (a transwoman AMAB attracted to women). Furthermore, not all people who are transgender have surgery or undergo hormone therapy, but this does not change their gender identity. Some helpful visuals to understand these ideas are the Gender Unicorn (here) & the Genderbread Person (here).

Now that you have some context to work with, what else can you do to put patients at ease?

  • Consider having a rainbow flag in the waiting room to let patients know they are in a safe space
  • Wear a small pin indicating that you are an ally.
  • Have inclusive intake forms with a blank space to enter gender rather than a checkbox for male or female.
  • If applicable, know where gender-neutral bathrooms are located & inform patients.

Ultimately, the best method to providing compassionate and competent care is to minimize your assumptions. There are many things you can do in your day-to-day interactions with patients to convey that you are trying to open up your worldview. For example, if you find yourself assuming someone’s gender identity based on their name or appearance, I’d challenge you to practice using the gender-neutral they/them pronoun until you learn how they identify. If you are unsure, it is okay to privately ask them! This is far less triggering than misgendering someone. Another common microaggression is assuming a patient’s partner’s gender based on heteronormative values. Try using the terms “spouse” or “partner” when talking to a patient about their loved one(s). It may seem banal to you, but your LGBTQ+ patients will notice.

Disclaimer: I can only represent the part of the community that I identify with. The views expressed are my informed opinions & may not be generalizable to all LGBTQ+ persons. I am thankful to be given a platform to address a topic that is so rarely discussed, but if I have made any errors or misrepresentations, please correct me!

My new course will provide a safe space to ask all the questions about caring for LGBTQ+ patients and practicing the skills needed to help advance your practice. Join me for Inclusive Care for Gender and Sexual Minorities.

Pelvic Patient to Pelvic PT
Working with Survivors of Sexual Assault

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Upcoming Continuing Education Courses

Yoga for Pelvic Pain - Remote Course

May 15, 2021 - May 16, 2021
Location: Replacement Remote Course

Oncology of the Pelvic Floor Level 1 - Remote Course

May 15, 2021 - May 16, 2021
Location: Replacement Remote Course

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

May 15, 2021 - May 16, 2021
Location: Replacement Remote Course

Sacral Nerve Manual Assessment and Treatment - Remote Course

May 15, 2021 - May 16, 2021
Location: Replacement Remote Course

Male Pelvic Floor - Self Hosted

May 15, 2021 - May 16, 2021
Location: Self-Hosted Course

Male Pelvic Floor - Ann Arbor, MI Satellite Location (SOLD OUT)

May 15, 2021 - May 16, 2021
Location: Probility Physical Therapy

Male Pelvic Floor - Athens, GA Satellite Location

May 15, 2021 - May 16, 2021
Location: Thrive Integrated Medicine

Male Pelvic Floor - Richmond, VA Satellite Location

May 15, 2021 - May 16, 2021
Location: Pivot Physical Therapy

Breathing and the Diaphragm - Remote Course

May 15, 2021 - May 16, 2021
Location: Replacement Remote Course

Male Pelvic Floor - Livonia, MI Satellite Location

May 15, 2021 - May 16, 2021
Location: Mendelson Kornblum Physical Therapy

Male Pelvic Floor - Oakland, CA Satellite Location (SOLD OUT)

May 15, 2021 - May 16, 2021
Location: Kaiser Permanente

Male Pelvic Floor - Gilbert, AZ Satellite Location (SOLD OUT)

May 15, 2021 - May 16, 2021
Location: OneAccord Physical Therapy

Athletes & Pelvic Rehabilitation - Remote Course

May 22, 2021 - May 23, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Wallingford, CT Satellite Location (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2A - Grand Haven, MI Satellite Location (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2A - Lisle, IL Satellite Location (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2A - Los Angeles, CA Satellite Location (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Origin Physical Therapy

Pelvic Floor Level 2A - Worcester, MA Satellite Location (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Central Mass PT & Wellness

Pelvic Floor Level 2A - Mill Creek, WA Satellite Course (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Premier Physical Therapy

Pelvic Floor Level 2A - Greenville, SC Satellite Course (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: His Therapy

Pelvic Floor Level 2B - Self-Hosted

May 22, 2021 - May 23, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Burlington, NC Satellite Course (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Stewart Physical Therapy

Pelvic Floor Level 2A - Bedford, TX Satellite Course

May 22, 2021 - May 23, 2021
Location: Beyond Therapy and Wellness PLLC

Pediatric Functional Gastrointestinal Disorders - Remote Course

May 22, 2021 - May 23, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Idyllwild, CA Satellite Course

May 22, 2021 - May 23, 2021
Location: Moving Lively

Pelvic Floor Level 2A - Self-Hosted

May 22, 2021 - May 23, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - Orland Park, IL Satellite Location (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Palos Community Hospital

Pelvic Floor Level 1 - Belle Chasse, LA Satellite Location

May 22, 2021 - May 23, 2021
Location: Rehab Access Belle Chasse

Pelvic Floor Level 1 - Buffalo, NY Satellite Location (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Advanced Care Physical Therapy of WNY

Pelvic Floor Level 1 - Manchester, NH Satellite Location (SOLD OUT)

May 22, 2021 - May 23, 2021
Location: Franklin Pierce University