In today’s generation, doctors must be extremely familiar with the terminologies of Sex, Sexuality, Gender and Gender Identity. Sexual orientation and gender identity play a crucial role in determining a person’s sense of self. People should feel safe whenever they seek healthcare and not be discriminated against no matter what their sexual orientation or gender identity is.
MedPiper Technologies and JournoMed had conducted a Webinar Series to “Improve Healthcare Access for Transgender and Sexual Minorities For The Doctors and By The Doctors” with IRIA Kerala- Raksha, Shakthi, Social Wings, IMA Kerala and CARB. The first of the webinars, held on 18th July, 2022, covered the topic of “Gender and Sexuality-what a doctor should know” and the speaker was Dr. SK Harikumar.
Dr SK Harikumar, a Senior Consultant of Behaviour, Gender and Sexuality and CEO of CARB spoke about the research they perform in gender, sexuality and behavioural research. He discussed the topics of Sex, Sexuality, Gender and Behavioural Research, Transgender healthcare and sensitivity issues related to the transgender community.
Sex is the physiological difference in any individual. They can be either male, female or intersex. Characteristics assigned in the body that helps to distinguish between males and females are termed Sexual characteristics. There are two types. Primary characteristics are assigned at birth. Secondary sexual characteristics are not assigned at birth and develop later during puberty in any individual. These help to characterize males, females and intersex.
Eg: In males, there is the development of a moustache and broader chest. In females, there is the development of breasts, broad hips etc.
In India, 1.0 to 1. 7 % of children are born intersex, having a variation in the sex characteristics (chromosomes, gonads and genitals) and they can’t be distinctly stated as male or female.
Sexuality is the sexual interest, attraction or attitude towards others. It also includes the ability to have erotic experiences and responses. It is experienced and expressed as orientation, thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. Sexuality gets manifested through biological, physical, emotional, social or spiritual aspects. Sexuality in any individual is impacted by cultural, political, legal, philosophical, moral, ethical and religious factors.
Gender is the behavioral or social/cultural distinction of being a male, female or another gender. Most civil societies bring their children to binary gender congruent to sex through even corrective methods. Gender is mainly a social construct created by cultural/societal norms. Gender identity is a person’s sense of self as a member of a particular gender. Transgenders are those whose biological sex and chosen gender identity are different.
Doctors must recognize these sexual determinants and should know how much of it is influenced by societal norms. For determining the sex of any individual, an integral part of personality needs to be taken into consideration, not only considering the sexual acts. Sexual development is influenced by different factors and sexuality is linked to gender and age.
What are the four interlinked strands of Sexuality?
Sexual desire or attraction: To whom someone is physically or emotionally attracted in sex-related matters
Sexual activity or behaviour: The sexual activities can be either intercourse, masturbation, oral sex, sexual acts and fantasies that people like to do.
Sexual identity: Sexual identity determines how a person describes their sense of self as a sexual being namely homosexual (lesbian/gay), heterosexual, bisexual, pansexual, etc.
Sexual experience: The experience that one gain in sexuality-related encounters on different occasions in their life
These four dimensions place a crucial role in determining a person’s sexuality. If one can effectively explore these areas, they may be able to understand their sexuality more. Doctors must be aware of the sexual orientation and gender identity of an individual. They must recognize if the person is heterosexual, homosexual, bisexual, or asexual and based on the gender classification, the person can be either cis-gender, transgender, queer, gender-fluid or transsexual etc. Being aware of such factors can help doctors provide a safe space for their patients when they are being treated along with offering unconditional support and care.
Some recent specificities in Sexuality
A metrosexual is a heterosexual urban man who enjoys shopping, fashion and his interest is traditionally associated with women or homosexual men to enhance his appearance by following personal care, grooming and his interest allies in wearing fashionable clothes
Retrosexual is a heterosexual old-fashioned “ manly man” who is least bothered about appearance. He is considered the opposite of metrosexual
Gastrosexual is a man whose passion lies in cooking and trying to attract a romantic partner in the way the partner likes
Spornosexual is predominantly body conscious and sexually explicit as a heterosexual man. Unlike metrosexuals, spornosexuals focus less on clothes and more on their bodies including exposing the body.
Sapiosexual is a person who finds intelligence sexually arousing or attractive. Such people desire or try continuously to build an intimate relationship with those who are intellectually successful.
Gender and Sexuality in Healthcare
Few health complaints in transgender patients remain unrevealed as they involve sexuality dimensions and these issues lead to psychomatic illnesses. Barriers prevent clients from expressing their sexuality-related issues in usual healthcare settings. Gender transition and gender dysphoria-related issues are heavily reflected in adolescent morbidity patterns. Many medical doctors lack concept clarity on essential matters related to gender and sexuality.
Profile of LGBTQIA + groups
LGBTQIA + (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexuals) is a broader concept followed in many places including India. Doctors must know the terminology of the LGBTQIA+ groups and should be open to treating the people who belong to this community.
Profile of Transgender People
Transgender people have a gender identity or gender expression that differs from the sex that they were assigned at birth. Rather than physical appearance or dressing pattern, the difference truly lies in their emotion and cognition. Different subcategories of individuals come under the broad category of Transgender.
Trans-woman: Trans-woman is assigned male at birth and whose gender identifies later as female. She might use the term “ trans-woman”, “ male to female” or “ female” to describe her identity.
Trans-man: Trans-man is assigned female at birth and whose gender identifies later as male. He might use the term “trans-man”, “ female to male” or simply “ male to describe his identity.
Key problems faced by Transgenders
Transgenders in society face a lot of discrimination and abuse. Many face legal, social, economic and financial difficulties. Transgender fall under the LGBTQIA+ group and are generally marginalized. More often than not, people of the transgender community are rejected and socially excluded and silently harassed. (Despite Transgenders being worshipped and attributed a sacred power) The following are the key problems faced by Transgenders:
- Stigma/Discrimination and lack of family support
- Lack of Educational Facilities
- Lack of Medical Facilities/ Mental health
- Land ownership
- Civil entitlements
- Transgenders are challenged with complex and frequent emotional needs.
- Transgenders often do not live in safe and conducive social settings.
- Non-availability of supportive family members or friends
- Scarcity of service outlets like counselling centres to provide professional emotional support
- Even then, many professionals have a poor understanding of transgenders’ emotional health
- Stigma and discrimination at healthcare institutions or by providers
- Lack of updated information among healthcare providers on special treatments for transgenders.
- Issues with Hormone replacement therapy (HRT).
- Sex reassignment surgery (SRS) and treatment costs.
- Because of resource constraints, most males to female transgender people undergo illegal castration by unqualified doctors/quacks.
- Facilities for follow-up treatment are also rare in many states.
Sexual Health Challenges
Transgender communities face several sexual health issues including HIV. Transgender women are 49 times more likely to acquire HIV than all adults of reproductive age. The lack of skills and knowledge, difficulties to access services/commodities and supportive facilities are major risk factors. Doctors advise following safe sex behaviour for the transgender and the LGBTQIA+ community people so as to avoid HIV and other health related complications.
Transgenders face quite a number of challenges to lead a productive and respectable life in society. They face difficulties in accessing public facilities like washrooms as they are not positioned as male or female. On April 15th 2014, the Supreme Court of India brought many positive changes and granted a legal recognition to a third gender.
Failing to recognise Gender and Sexuality is the main issue which acts as a barrier to providing excellent healthcare. Even the attitudinal aspects of the healthcare providers need to be delivered smoothly and positively while treating the patients of the transgender and LGBTQIA + community. Inadequacy in clarity in gender and sexuality among healthcare providers is interfering with healthcare in most cases. Providing freedom for total gender expression will help get a conducive environment in a health setting. Uniqueness in sexuality and gender should be expected and explored in health settings for the care to be complete.
The beauty and essence of humans need to be well expressed when blended with their gender and sexuality. If providers could help them in expressing it wholeheartedly, the healthcare setting would serve as an ideal environment for the transgender and LGBTQIA + community.