Care for the transgender patient is a formally recognized area of focus within the field of urology. Care and surgery of the transgender patient has become a part of this field because of a variety of factors: greater awareness and acceptance of transgender people who live among us, and greater acceptance within medicine of both sexual diversity and gender diversity.
Today we recognize that gender is a spectrum, and not a binary construct. It is highly likely that the urologist of today will see transgender patients in her/his practice. Although genital gender-affirming surgery is emerging as a subspecialty within urology, the general urologist, who may be called on to provide routine urologic care to a transgender patient, or to refer the transgender patient to an appropriately trained urologic reconstructive surgeon, should also be familiar with the care, needs, and surgical anatomy of the transgender patient.
TERMINOLOGY AND CULTURAL SENSITIVITY/INSENSITIVITY
A person’s sex is assigned at birth and refers to biological factors such as male or female genital/reproductive anatomy, hormone levels, and genes. Sexual identity refers to an individual’s enduring physical, romantic, and/or emotional attractions to others to define them as heterosexual, homosexual, bisexual, or asexual (Anton, 2009). Gender refers to intangible social constructs (behaviors, social roles, attributes, and activities) that a given society considers appropriate to each sex. Gender is defined by society, culture, and social class. Gender identity refers to the individual’s own, complex, and entirely internal sense of self as “male,” “female,” or ‘‘other’’ on the male–female gender spectrum (APA, 2011). Gender identity is not equivalent to one’s sexual orientation. It is useful to consider the difference between gender identity and sexual identity as follows: “Sexual identity is whom one goes to bed with, whereas gender identity is who one goes to bed as.”
A cis-gender person is someone whose gender identity conforms to the sex to which that person was assigned at birth within that person’s society.
Gender nonconformity refers to the extent to which a person’s gender identity, roles, and expressions differ from the norms that a specific society and culture prescribe for the male or female sexes (Coleman et al, 2012). Gender conformity (and nonconformity) are rooted in the dominant societal and cultural norms and are influenced by subculture domains, including socioeconomic status, geography, and history.
Gender nonconformity is not the same as gender dysphoria. Gender nonconformity refers to the extent to which a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex (Coleman et al, 2012). Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and the sex that that person was assigned at birth (Fisk, 1974; Bockting et al, 2011). Not all gender-nonconforming people experience gender dysphoria.