Mixed sex wards and trans women.

[sarsleypage]

I've opened a new account as the old one was too full of personal bits and someone could've connected the dots.

I am a medical student and we have a diversity lecture coming up, so I had a look at the LGBT slides. A lot of this seems to focus on trans.

I got curious about the requirements for sex-segregated wards, as I know this has been an issue for a while. Women want single-sex wards, both on wards for physical illness and those for mental illness, because they see themselves as vulnerable to abuse from men, especially whilst ill.

Fine. Nobody seems to oppose this, and it's become a requirement in pretty much all hospitals.

And then you see this: uktrans.info/attachments/article/5/trasngender_booklet_low%20res.pdf

"• Trans people should be accommodated according to
their presentation: the way they dress, and the name
and pronouns that they currently use.
• This may not always accord with the physical sex
appearance of the chest or genitalia;
• It does not depend upon their having a gender
recognition certificate (GRC) or legal name change;
• It applies to toilet and bathing facilities (except, for
instance, that pre-operative trans people should not
share open shower facilities); "

There's an example in the leaflet of a young female nurse refusing to wash a trans person because it was against her religion. This is held up as an example of trans discrimination.

I am struggling to square this away with feminism. In fact, I don't think it does square. Women have fought for this segregated space, based on female sexual characteristics (not a preference for make-up, long hair, but XY/vaginas/generally smaller in stature and weaker). But now, apparently, if you decide you feel like a woman, you're entitled to be on a woman's ward when women are at their most vulnerable.

It means if you're sectioned under the mental health act and a trans woman with a penis is on the ward, you have no legal argument to get them removed to make you feel safer.

How is this right?

It appears that the answer to "What is a woman?" now includes being permanently aroused by our own bodies.

I ask because a lot of mnetters don't agree with trans women (men) in women's only spaces, which is what I would class a mobile breast screening unit as.

Prawnofthepatriarchy

According to the website I was linked to today, being attracted to men, does not preclude autogynephilia. The idea of being a woman is still arousing, and being 'courted' by a man augments it.

Yes, the figures on sexual attraction among transwomen are, as I recall, 27% who are exclusively attracted to men, with the other 73% roughly evenly split between being exclusively attracted to women and bisexual.

Men with AGP are often heterosexual pre-transition but will have sex with men post-transition because it validates their new womanly identity. It appears to be common that late transitioners are heavily into forms of kink: sissification, forced feminization, BDSM, among others. They may describe themselves as pansexual or plain desperate.

There's also the angle that, having transitioned for sexual motives, many transwomen find it very difficult to find partners. I've seen numerous articles, blogs and videos by transwomen complaining that mean lesbians won't sleep with them and that straight men are only interested in occasional no strings sex. These complaints are usually couched in terms of the intolerance and transphobia of the uncool people who aren't open-minded enough to expand their dating pool.

I read these whines as coming from privileged white men who don't understand that the world doesn't see them as the women they claim to be. There's a strong flavour of magical thinking about it: "I believe I'm a beautiful, sexy woman so you must see me as one too."

Men, and society at large, think that men are entitled to sex. Men "have needs" and this is used to justify anything from porn to prostitution. Post transition, the difficulties transwomen face in finding sexual partners comes as a very nasty shock, and their outrage and sense of entitlement comes across loud and clear.

MasterWench - the mobile unit I've used, you have total privacy with the nurse performing the mammogram. You're not in a vulnerable position with respect to others being screened. While some womens spaces need defending, I'm not sure this one does - bearing in mind also that it would only be relevant for transwomen on hormones not the self-identifying 'feelz' types.

Breast screening is totally private. It's carried out in a little cubicle. No nudity until you're in the cubicle, plus there are numerous female HCPs around. There's no reason for sex segregation. A few men have enhanced risk and I would have no problem whatsoever at them being around.

Much less vulnerable than a loo or a changing room.

There are no men allowed in the mobile screening units though. There are signs up everywhere stating that and the mammographers will tell you the same. It is a women's only space.

I have never been in a mobile screening unit (always did my mammographies at the hospital) but I don't believe that you are ever alone with any other patient at any . So not at all comparable to female changing space of a swimming pool, female toilets, or any other female-only safe area.

You are left alone with other patients. Two mammographers on the mobile unit (in my area anyway) one is interviewing a patient in a quiet room and the other is x-raying at the same time.

I wonder where men get their breast cancer screening done then?

Given the small number of men who get breast cancer I know three, I might ask them, but I suspect it's in hospital rather than mobile units.

Men don't get offered screening for breast cancer.

Of course.

So there would be no need for a MtT to attend a screening unit. The point is therefore moot.

But MtT ARE invited for screening. Those that are on hormones will have breast tissue the same as women. Therefore have the same risk of developing breast cancer.

"Those that are on hormones will have breast tissue the same as women. Therefore have the same risk of developing breast cancer."

Not true.

A retrospective study of 2,307 Dutch transgender women treated at a single center found an estimated incidence of 4.1/100,000 person-years, in comparison to the incidence of 155/100,000 person-years in the general Dutch non-transgender female population. (From here.

Yes, they will have a risk (and that after 5-10 years on HRT) but it is nowhere near the same as women's.

Still enough of a risk to offer them 3 yearly screening mammograms.

Was there a part of my post that you didn't understand?

Yes, there is a breast cancer risk for transwomen after many years of HRT. No, it is not 'the same risk" as that of women, which was your erroneous claim.

Once every 3 years is proof enough that their risk is lower. Most women are told to have mammographies once every 2 years, and some with higher risk do it every year.

One hopes that the data for women and transwomen is recorded separately re incidence of breast cancer, so that trends can be reviewed and the effectiveness of the current screening programs considered. In other words, transwomen are shooting themselves in the foot if it turns out that they do have an enhanced risk of breast cancer after, say, 20 years on hormone therapy that requires a different screening schedule, but that information is completely obscured because it has been lumped in (clumsy pun not intended) with the data on women.

There's also the old chestnut about HCPs: can I refuse to have my mammogram performed by a transwoman?

According to [[http://www.cancerresearchuk.org/sites/default/files/cstream-node/inc_asr_gb_f_breast_2.pptCancer Research UK stats for male breast cancer]] the UK male incidence is ~1.3 per 100,000 versus about 165 per 100,000 in women For a screening service to be cost effective, you need to be detecting and treating tumours early enough individuals to reduce mortality & morbidity. Effective screening schemes also need high levels of uptake, which is why there is no digital rectal prostate screening programme (patient acceptability is a factor - there was a review in the 90s.) It seems from the Dutch study above that transwomen's rates are little higher than men's & we do not routinely screen men. Ergo, we should not routinely screen transwomen for breast cancer. Regular self-examination & vigilance is likely to be more effective for transwomen TBH.

Should have previewed my post. Suffice it to say, there is lots of useful data on the Cancer Research UK site with male/female splits (sex, not gender...)

I worry a bit about transwomens medical stats being put down as female. Could very well mean stats on things such as cervical cancer are wrong and lose funding as a drop is shown and so on..and tats not as crazy as it sounds, transwomen are actually invited for smear tests :/

Same with crime stats. Violence committed by women will be on the rise with the rising number of people who 'identify' as trans.

Also trans people need seperate stats gathered in order to fully determine the effects of long term hormone use and stuff. We will never know if its actually safe or increases risks of certain diseases significantly if we just pretend that trans people actually are their 'chosen' sex.

Once every 3 years is proof enough that their risk is lower. Most women are told to have mammographies once every 2 years

The breast screening programme in the UK for women aged between 50-70 is screening every three years.

I agree Wanking. There just isn't a reasonable sized longitudinal data set at the moment. Because I'm not in fact a nasty transphobe who wishes ill on others, I would have thought it would be really useful to know if (for example, completely made up theories) using puberty blockers increased the risk of cervical cancer in transmen to the extent that they should consider a total hysterectomy; or long term hormone use was safe for transwomen for 15-20 years but after 20+ years the risk of developing breast cancer and osteoporosis shot up. Or indeed if there are any unexpected side effects of long term hormone use that could have therapeutic benefits elsewhere, or simply if there is an optimum time to begin a physical transition to minimise the long term risks.

Collecting that kind of longitudinal data is so important for optimising health outcomes and reducing harm it seems madness to not have a meaningful way of tracking trans health interventions.