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The physical examination is a core component of most medical encounters. For centuries, physicians have used the physical examination to determine the cause of a patient’s symptoms and develop a treatment plan. Despite its critical role in patient care, the physical examination may potentially cause patients harm. Consider a patient sitting on a table, naked under a thin gown, answering personal questions, being touched by a stranger, and wondering what bad news they may discover about their health. This routine scenario makes patients physically and emotionally vulnerable and may provoke feelings of embarrassment, shame, or fear. The risk of discomfort is amplified when patients have experienced previous psychological, physical, or sexual trauma, including prior traumatic encounters in the health care system itself.

Some medical procedures are inherently uncomfortable for most patients. For example, in one study, 73% of presumed cisgender patients undergoing digital rectal examination for prostate cancer screening reported experiencing moderate or higher discomfort during the exam.1 Such “sensitive” examinations can be more complicated for people with trauma histories: in another study, nearly one-half of presumed cisgender adult survivors of childhood sexual abuse reported experiencing triggered memories of abuse during pelvic examinations.2 For transgender and gender diverse (TGD) people, physical examination may be particularly fraught due to high rates of exposure to previous trauma and physical and emotional vulnerability related to being asked to reveal body parts that are not concordant with gender identity.3

Sexual and gender minority (SGM) individuals are disproportionately burdened by trauma, stress, and violence, and are at increased risk of exposure to adversity on intrapersonal, interpersonal, and institutional levels.4,5 In one survey, 98% of transgender participants (N = 97) experienced at least one potentially traumatic event, and 17.8% of those individuals reported clinically significant symptoms of posttraumatic stress disorder (PTSD).6 Higher rates of violence and intimate partner violence (IPV) represent important forms of trauma affecting SGM communities, though the narrative of adversity is more complex and embedded in social systems.7 Community-focused stigma and discrimination are increasingly identified as causes of health disparities in marginalized populations.8 They have been proposed as modifiable risk factors for the higher rates of poor physical health, disability, depressive symptoms, and perceived stress that are seen among transgender older adults.9 On an individual level, internalized homophobia and transphobia and identity concealment contribute to gender minority stress and negative health outcomes.10,11 Historically, the medical system has been a perpetrator of trauma among SGM people in many different ways, which include misgendering patients, labeling them as pathological, and outright refusing to provide them care. In a national survey on transgender discrimination, 24% of transgender respondents reported unequal treatment in health care settings, 33% did not seek preventive health services, and 19% reported being denied medical care altogether.12

SGM people comprise 4.5% of the general U.S. population; however, medical professionals to date have ...

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