Female pelvic medicine and reconstructive surgery fellows' exposure to transgender health care.

We administered an anonymous survey to FPMRS fellows during a fellows’ meeting at the 2015 American Urogynecologic Society Annual Meeting. In the absence of a validated tool, we developed the survey based on our experience with fellowship training and in caring for trans-gender patients. One of the authors (Y.G.-C.), who has expertise in GCS, reviewed the survey for content validity. Survey items included demographics as well as educational and clinical exposure to transgender health care. Fellows were asked about their ability to perform female-to-male (FTM) GCS, defined as hysterectomy with bilateral salpingooophorectomy, and comfort with counseling and caring for patients after GCS. We performed statistical analyses using software (SAS 9.4; SAS Institute Inc, Cary, NC). The institutional review board approved this study.

In all, 76 of 97 fellows (78%) who received the survey responded. In 2015, there were 155 FPMRS fellows in training. Most fellows reported no experience with inpatient (84%) or outpatient (74%) care of transgender patients. At institutions where FTM GCS was performed, 88% of fellows believed that they would be able to provide a FTM hysterectomy with salpingo-oophorectomy after training, compared to 33% at institutions where FTM GCS was not performed ( P <.001). Most fellows (70%) reported that they had no didactics on transgender health care during fellowship. Fellows who had at least 1 hour of didactic training were significantly more likely to report that they would be comfortable managing surgical complications from FTM GCS (74%) compared to those who had not (47%; P =.047) ( Table ).

The American Congress of Obstetricians and Gynecologists stated that obstetrician-gynecologists “should be prepared to assist or refer transgender individuals with routine treatment and screening, as well as hormonal and surgical therapies.” 1 , 2 Surgical therapies include gender confirmation surgery (GCS) to phenotypically align a person’s sexual characteristics with their gender identity. A survey of obstetrician-gynecologists demonstrated that 80% did not receive training in residency on the care of transgender individuals. 3 Our objective was to assess exposure to patients who are transgender among female pelvic medicine and reconstructive surgery (FPMRS) fellows.

We distributed our survey to a convenience sample of the 155 FPMRS fellows in 2015. Although we did not assess experience or interest in transgender health care before fellowship, our data are encouraging and suggest that minimal exposure to transgender health care may increase trainee comfort in providing surgical and medical management to trans-gender individuals. Our findings are consistent with a survey that showed medical students with more familiarity with lesbian, gay, bisexual, and transgender terminology had more positive attitudes toward these patients. 4 The reticence that some fellows reported in caring for transgender individuals underscores the need for training programs to incorporate transgender health care into the educational curriculum, and is echoed by the American College of Physicians in their statement to include lesbian, gay, bisexual, and transgender health care into medical education. 5 Fellows have completed obstetrics and gynecology residency and have the surgical skills to perform a hysterectomy, one of the most common operations performed by obstetrician-gynecologists. If the anatomy is normal, performing a hysterectomy for GCS is generally technically straightforward compared to hysterectomy for many other benign indications, such as fibroid uteri or endometriosis. While the reason for the trainees’ reluctance warrants further research, it can be postulated that it is because fellows do not feel adept at managing the psychosocial and health care needs of transgender individuals, as opposed to their lack of surgical skills, that they believe they would be unable to perform a hysterectomy for gender confirmation. Incorporating education in transgender health care into FPMRS fellowship may empower trainees in caring for patients who are transgender.