Can we be honest about the need for affirmation?

[FortunateCookie]

I posted some of this on the misgendering thread but it was lost in amongst everything.

I asked on that thread whether refusing to affirm someone’s gender identity was a big deal or not, and many people thought it was, and that it could lead to mental health problems and possibly suicide.

If non- affirmation is so damaging then it also follows that positive affirmation would be extremely rewarding and fulfilling.

It seems obvious that this could lead to serious conflicts of interests. For example, in the case of the woman who asked for a female nurse to carry out her smear test, and was faced with a trans nurse.

Here, when the patients needs should be paramount, she instead becomes either a cause of huge distress, or a vehicle to experience the reward of validation. Either way, it is difficult to see how her needs could be centred against the pull of such a powerful motivation. Do eg hospitals, rape crisis centres recognise this dynamic?

Either it is a big deal that a trans person has their identity affirmed, in which case it should also be recognised that this can cause conflicts of interest in situations where affirmation or not is a factor (ie performing smear tests, working in a women’s refuge)

Or it’s not that big of a deal if a trans person has their identity affirmed and therefore they won’t be offended when a patient asks for a female nurse to carry out their smear.

Which is it?

I think there is an argument to be made here (re EqA exemptions) that blanket policy is preferable to ‘case by case’ (which I know is favoured at the moment.). I can’t quite compose it in my head right now, trying to play with toddler.

Fortunate I agree. It's not just favoured, it's government policy to deal with it on a case by case basis with a high bar.

You couldn't have a blanket ban on men doing cervical exams or gynocology because there are loads of very good male gynecologists.

To clarify, I’m not advocating the removal of male gynaecologists. I’m saying that a woman should be able to refuse a transwoman for a procedure that she feels she needs a female HCP for. I’m specifically thinking smears etc.

There should be no direct or indirect pressure on the patient. Direct pressure would be having to ask the person to leave - that’s putting the patient in a vulnerable position. Indirect would be a general fear of this happening and not wanting to appear bigoted. So for example if they knew this was likely to happen at their surgery.

no woman should be in a position where she feels she HAS to consent to something she really doesn’t want.

And that is her right - to force any woman to be intimately examined by, or to search etc a male is unconscionable.

On a side note, if you asked for a woman to do your smear and a transman or none binary biologic female attended, I think it would be transphobic to refuse that person.

I would argue that the patients right not to be intimately examined by a man takes precedence. How could you justify this to, for example, a woman being examined for samples and injuries after a rape?

noeffingidea
A woman's private parts are not an equal opportunity area.

Exactly! We have all meet many men who think that a woman's private parts should be an equal opportunity area

I think that Gib doesn't realise that the reason why there are so, so many MeTo stories is because all women above the age of 15 has at least one of those stories and many of us have hundreds and hundreds.

What Gib is spouting on this thread is A) very masculine B) very racist (Gibs sounds just like those a-holes who go on and on about how masculine they think Serena Williams is)

@GibbertyFlibbert

How would you feel about a male patient who requested a male HCP for an intimate procedure?

Do you feel they would have the right to refuse to he treated by a transman on the basis that the transman cannot know what it is like to have a prostate exam, for example?

has it been said on this thread already that sexual assault is about POWER and not ATTRACTION? just that way back on page 2 Gibb tried the "what about if the hcp was a lesbian" tactic. i think PL off the telly said similar very recently.

i would consider it sexual assault if a woman was given a smear test by a male bodied person if they had explicitly requested a female bodied person and if that request had been heard but over-ridden with no discussion. i will be having a smear test later in the year (yay lucky me). i am going to tell the practice i only consent for a female bodied person to carry it out.

Bowlofbabelfish

But you ask for a woman you get a woman, just caz she presents as a man doesn't stop her being a woman. Where do you draw the line, I don't want a butch woman doing my smear, I don't want a woman with short hair. I can understand the issue if they were very masculine but they are very uncommon.

If you asked for a woman and were given a man with make up and a wig, that's a violation of your rights, because biology makes a woman, not outward appearances.

I would object to a TIM doing my smear because I don't want someone who covets or envies my genitals having anything to do with them. Creepy as fuck.

Yy

Ok how about this.

There are some situations where the needs of women must be paramount, for example when she is reviving medical care and has requested a female HCP, or when she is a client at a rape crisis centre. Faced with a transwoman in these situations, the woman may feel under pressure to accept the care of the transwoman despite being uncomfortable or distressed, due to a fear of offending or a fear of being perceived as bigoted. This has nothing to do with the transwoman’s professionalism.

In order not to compromise the care of a woman in these situations, and in order to recognise that this is not about any individual tramswoman, it is about the patient, a blanket single sex exemption policy should be used.

That’s not very well written but hopefully explains the concept roughly.

Hotdog I agree with you about transmen/non bianary, provided you can see they are actually female. But I would imagine they wouldn't want to do it as they would then not get their affirmation. Unless you objected in which case they shouldn't be doing it.... if they are good nurses they won't make a big thing about presenting as male - I wouldn't want anyone swaggering round as a stereotypical male as I want very small careful movements down there!

Babel I believe the reference to transmen was as they were born female.

Lazy I know you didn't ask me but as far as I'm concerned men have the right to ask for a male to do an exam and should absolutely get one. I would imagine they would be more likely to object to a trans woman doing it than women would to a trans man though.

Perfect Fortune.

To take pressure off the woman, this should be something that’s asked of her well in advance, or perhaps even added to her file? When booking a smear for example, the person should ask ‘do you require a woman to perform this?’ Or when you register as a patient someone asks you - when we call your for smears, do you require a female HCP? It should also be made clear that even if a woman ticks no, she still has the right to refuse at any point

I have been asked this previously at a practice which had a male nurse, and I think it’s a good option - it also allows the surgery to plan and allocate time.

That sounds like very good practice Bowlofbabelfish.

Thanks MipMipMip.

I wonder if anyone is going to argue against this now and how they might do that?

I know this post was quite a few pages ago, but I kind of liked it:

MrsTerryPratchett - And on the issue of gay HCPs. Mine is a lesbian. I know because she very very unsubtly dropped it into the conversation before she booked my smear. I assume she does this so homophobes can opt out. Because patient comfort is more important to her than affirmation.

I don't think it is unreasonable for a woman to specifically request a HCP that is not a transwoman for something as intimate as a smear test.

In the same way that if I was having a breast exam, I would very much prefer a woman (or trans woman) to perform the breast exam on me. It is not about validation (for me) to be seen by a woman, it is about not having a man touching my breasts. I would prefer that someone who understands having breasts does the exam (if that makes sense?). Before anyone picks apart my usage of the word 'man', I am distinguishing between man and male.

In the case of the OPs post though, the patients comfort should come before the ego of a trans HCP. I would hope that any trans woman or trans man working in a healthcare setting would have the humility to accept this. It is called professionalism. There is no harm in being trained to perform the test, but accept that not everyone will want you to perform it and equally, IMO, in this instance and others relating to it, trans status should be disclosed.

Side note... Is this possibly my most concise post ever??

I am sure someone will argue against it Fortunate, the very idea that women can ask and receive anything is anathema to some.

The analogies we have been treated to from the TWAW side to support their cause have become more and more ridiculous and, frankly, desperate. I thought we'd hit the bottom of the barrel with the 'styles of canine urination' but then along came the absurd 'obese woman at Pilates' and I heard a distinct scraping sound.

The analogies referencing black women are just downright offensive.

I’m still on page 3 so sorry if things have moved on.
I’m a doctor. I always ask all of my patients if they are comfortable for me to examine them before doing any intimate examination and always offer a chaperone, whether the patient is male or female. As far as I am concerned if a patient does not want me to examine them then I don’t. That’s it. It is their right to choose. It makes no difference whether it’s because I’m a woman, wear glasses, have long hair or whatever. It is their right to choose who does what to intimate parts of their body. Yes, in an emergency situation it may not be posssible, but for routine care it is. As a student I remember one of the hardest things to get over was asking patients to take their clothes off. It’s such an intimate thing to do and puts the examiner in such a position of power. We are at out most vulnerable in these situations. Another element of examination drummed into us was about maintaining a patient’s dignity at all times. Whether that’s using a sheet to cover their lower half while you examine their abdomen right down to the basics of not laughing at something you hear or see. If you can’t put your own feelings aside when doing the job, and always put the needs of your patient first then you need to a new job.

I would hope that any trans woman or trans man working in a healthcare setting would have the humility to accept this. It is called professionalism.

Natluc, what do you think about my post at 13.33 which rejects the idea that this has anything to do with individual trans people and their professionalsm or otherwise?

And also, however much you might hope that what you have said is the case, it has already been proven not to be so.

www.google.co.uk/amp/s/inews.co.uk/news/health/nhs-woman-transgender-nurse-smear-test/amp/

In the case of the OPs post though, the patients comfort should come before the ego of a trans HCP.

Should or must? Because the way some TRA are talking, they want to remove women's ability to refuse treatment from a TIM. We instead have to rely on TIM doing the right thing.

Must. Absolutely must. And it must be enshrined in good clinical practice.

Great to get your view Poppyred85.

It has sort of moved on to the idea that there is a fundamental conflict of interest between the reality of being a transwoman (where validation of your womanhood is essential for good mental health) and some situations which tacitly ask the patient or client for this validation.

Whether that’s using a sheet to cover their lower half while you examine their abdomen right down to the basics of not laughing at something you hear or see. If you can’t put your own feelings aside when doing the job, and always put the needs of your patient first then you need to a new job.

I had an EMCS with ds1 and I still vividly remember 2 young female theatre nurses/assistants pointing and giggling at something the other side of the sheet across my abdomen. I have zero idea what was so funny, whether it was my badly dry shaved pubes (thanks midwife!), my stretch marks or whether I’d crapped myself, as I had been given an epidural block and was numb, naked and prone, but DS1 is 12 and that scene regularly pops into my head when I think about the night he was born. I rarely think about the lovely obstetrician or anaesthetist, but I do think about how vulnerable I felt and how humiliating that experience was. I have zero respect for any HCP that doesn’t show the utmost respect for their patient’s needs and wellbeing.

Whilst slightly at tangent, in that the transwomen was a patient, the idea that someone in a healthcare setting is labelled transphobic for objecting to effectively mixed wards is horrifying but seems to be the approach now when it comes to healthcare policy metro.co.uk/2018/01/14/woman-who-feared-men-accused-of-transphobia-after-objecting-to-hospital-room-with-trans-woman-7227597/