Transgender patients and healthcare:
How body image care is evolving under a changing cultural and legal framework

On 4 March 2020 the Association of Catalan Nurses in Body Image Management (ACICDDI) held its second annual conference at the Official College of Nursing of Barcelona (COIB), this year titled “Nurses and transgender people.” The seventeen speakers who offered presentations and interacted with the public included cisgender and transgender professionals from nursing, surgery, psychology, sociology, and anthropology.

INTRODUCTION

Barcelona, 4 March 2020. While transgender activism goes back over a century and legislation and de-legislation over decades, the medical world has been slow to depathologise trans identities. It was not until 2018 that the World Health Organization removed transsexuality from its list of psychiatric disorders.

Núria Sàez Gómez, founder and president of ACICDDI, wants nurses to take care of what, such as the renowned nurse, professor and academic Isabel Pera: “We have in mind that today’s conference is organized and that we are here to take the lead in nursing care for transgender people. ”

HISTORICAL DEVELOPMENT

Spain since democracy

Spain is known to be at the forefront of public acceptance of LGBTQI+ rights, alongside countries such as Sweden and Argentina. The first transgender demonstration took place in Barcelona in 1977, two years after Franco’s death, when 5,000 protestors marched on the Rambla to reclaim the right to do with one’s body as one pleases. Homosexual and transgender persons prosecuted or detained under the 1970 Law on Dangerous Persons and Rehabilitation had been specifically excluded from the pardon of 1975 and the amnesty of 1976, alongside vagrants, drug dealers, beggars, illegal immigrants, and others groups considered “dangerous” by the fascist regime and to require “rehabilitation”. It took two more years after the demonstration for the law to be modified and for transgender and homosexual persons to receive amnesty. The community then lobbied against the Law on Public Scandal, another tool of repression during Franco’s reign, obtaining its modification in 1983. Other important milestones were 1981, when sex change surgery ceased to be illegal and 1987, when Transexualia, the first Spanish transsexual association, was created. Another major milestone for Spain was its adoption of Gender Identity Law in 2007, allowing transsexuals to change their name and sex in their national ID document without requirement for a sex change operation.

By this time legislation addressing discrimination against the transgender community was also being approved worldwide. In 1989 the European Parliament adopted a first resolution condemning discrimination against transgender people. Exactly 20 years later it adopted a resolution on the rights of intersex people, this time condemning sex-normalizing treatments and surgery often performed on infants and children, and urging states to adopt legislation against these practices.

In a hyperactive meme culture with a penchant for controversy we constantly witness retrograde attitudes making us doubt whether progressive causes are actually advancing, but transgender issues are increasingly visible. Sometimes the balance appears positive: more professionals are openly declaring themselves transsexual and allowing their careers to become high-profile examples of non-discrimination. Trans models Valentina Sampaio and Teddy Quinlivan did so last year in the world of fashion when they were selected to model collections by Victoria’s Secret, and Chanel, respectively. Political associations are also giving visibility to the trans community by forming special committees and drafting new trans-specific legislation. Controversy sometimes ensues: last week the United Left (IU) coalition banned the Feminist Party of Spain (PFE) on grounds of indiscipline and discrimination against transsexuals. The PFE had repeatedly condemned IU’s efforts to facilitate sex change operations and surrogate pregnancies, arguing that the agenda of the LGBTQI+ lobby threatened feminism, the feminine identity, and the rights of children.

Today’s conference aimed to establish whether the medical community in Catalunya and Spain is sufficiently empathetic and prepared to meet the therapeutic and surgical needs of transgender people, as well as how the patients feel about its performance.


SPEAKER Dra. Alba Barbé

La taxonomia segueix sent estigmatitzant

The inaugural presentation was by Dr Alba Barbé, an anthropologist and film-maker, author of the documentary “EnFemme” about the eponymous association, which opened in Barcelona in 2007 as a shared flat where one could change into a woman’s clothes with some privacy. As an association, it began officially providing a support and social meeting place for transgender people including crossdressers, transsexuals, and people considering a sex change.

For Dr Barbé, the transgender community has suffered from a gender conception system that is unsustainable in that it is inherently discriminatory. The medical-psychiatric and sociocultural narrative has handled a temporarily unintelligible phenomenon by resorting to “maniacal taxonomy”. The mental health world should desist from this constant classification. The term “gender identity disorder” was famously replaced by “gender dysphoria” in the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders in 2013. This was to remove the stigma of the term disorder but the condition is still listed in what is essentially a psychiatric manual.

This classification creates an exceptionality mindset that results in systemic and structural violence that exists even before explicit attacks and disqualifiers are made. Transphobia, which victimizes the transgender and gender-neutral alike, is linked to the prejudice of the exceptionality mindset. Dr Barbé concluded by emphasizing that the social environment must be transformed so that gender comes to be seen as a right.

Dr Barbé concluded by emphasizing that the social environment must be transformed so that gender comes to be seen as a right.

Dra. Alba Barbé: “The medical-psychiatric and socio-cultural narrative has managed what was temporarily unintelligible with maniacal taxonomy.”


SPEAKER Dra. Judith Juanhuix

Dr Judith Juanhuix, a Catalan doctor in physics and transsexual activist, echoed some of Dr Barbé’s concerns. Her presentation focused on the paradigms and theoretical input that medical science has offered in the area of healthcare for transsexual people.

Dr Juanhuix explained that there were multiple, and therefore not scientific, interpretative frameworks used today in the medical and legal world to deal with trans reality: “Medicine and Psychiatry cannot explain phenomena that are inherently social or political.”

As an improvement over existing labels including the more polite ones like gender dysphoria and gender incongruence, she proposes an interpretative framework whereby the rights of transgender patients prevail and their gender variant is considered a part of human diversity. Because such a conceptualization of gender is no longer binary, to create men and women identifiable as such is no longer the objective. In practice, with respect to the trans aesthetic image, instead of imitating or rejecting a traditional masculine or feminine image, another option might be to create one’s own.

Conversely, what does remain an objective is to imbue society of the transgender reality, to render the community visible, and to fully vindicate its right to exist so as to avoid the psychological problems linked with discrimination and clandestine lifestyles. In terms of medical service, what primary care ought to focus on is to derive trans patients seeking assistance to services that will provide guidance rather than necessarily a treatment or diagnosis.

Where there is treatment, she advocates the inclusion of specific transgender indications in processes. For example, it is not ideal that trans women take oestrogen tablets designed for menopausal women.


Dra. Judith Juanhuix: “Medicine and Psychiatry cannot explain phenomena that are inherently social or political.”


SPEAKER MIGUEL MISSÉ

Bodily self-esteem

Miguel Missé, sociologist and trans activist, emphasized that there isn’t a single trans perspective, and that events like today’s conference helped disseminate the variety of these views. He supports spaces where transgender people from different backgrounds and age groups can meet and share experiences, for example so that people contemplating surgery might talk to people who have experienced it.

Mr Missé believes that with regard to image it is important that a diverse set of body images come to be associated with the trans aesthetic. He favors an all-inclusive idea of the trans image and doesn’t condone the clear division made between transvestite and transgender images. “For me to see a man put on makeup to go out on the street serves as a positive reference for trans people because he is breaking with a norm. […] From my perspective to see extremely masculine women who don’t live like men makes me freer, also because it widens my imagination. This has to do with the established parameters within which we operate but I think a good policy for the transgender world would be to broaden the limits of what is possible for men and women. To suddenly see men and women adopt a broad spectrum of body images, from the most masculine to the most feminine, that not only exists but has found a space in the collective imagination and elicit desire. This is key to bodily self-esteem.”

Mr Miguel Missé: “see men and women adopt a broad spectrum of body images, from the most masculine to the most feminine, that not only exist but have found a space in the collective imagination and elicit desire. This is key to bodily self-esteem.”


SPEAKER JULIETA VARTABEDIAN

In pursuit of a more traditional image

Julieta Vartabedian, an anthropologist known for her 2018 book Brazilian ‘Travesti’ Migrations, focused her presentation on the experience and world view of transgender women who defined their image as transvestite sex workers in Brazil.

Ms Vartabedian explained that given the transgender activity and libertine attitudes evidenced during the Rio Carnival, it’s a paradox that Brazil retains a record of sharp discrimination against the LGBTQI+ community. The 21-year dictatorship during which many were arrested ended in 1985, but verbal and physical violence targeting transsexuals in particular continues to this day.

Over the years many Brazilian transgender women chose prostitution to escape poverty but also the confines of their assigned sex identity. Many migrated or planned to migrate to Europe’s capitals where they could live in a more accepting society and in some cases receive treatment and surgery.

Success in prostitution offered validation for cross-dressing and being desirable to men. In some cases, it also funded a ticket to Europe. It was one of the world’s most famous transsexuals, the North American Christine Jorgensen, who provided the model for the aesthetic hegemony adopted by many trans women prostitutes. In the dichotomy of the wished-for body, the old masculine body had to die.

This amounted to a difficult and sometimes traumatic experience for many, for example those who underwent black market surgical procedures and ended up with silicone in their blood streams. Many distrusted the medical services because their chosen sex wasn’t recognized, or opted not to get AIDS-tested just to avoid the prejudice and stigma. The sex workers were highly vulnerable and health problems often mitigated their goals to achieve feminine beauty.

Still, Ms Vertabedian emphasized that avoiding victimization is important, some are “happy hookers” and others do not like their work, as with any profession. For many, emigration to Europe formed part of the life experience and while idealized views of Europe faded as the sex market changed tremendously over the last four decades, most stayed.

For many, migration had delivered upward mobility and a degree of the freedom pursued.


Ms. Julieta Vartabedian recounted the experience of Brazilian travesty sex workers who emigrated to Europe


SPEAKER MARÍA DEL CARMEN GARCÍA RETORTA

Report from a surgical unit: care and surgery at a Madrid hospital

Ms María del Carmen García Retorta, trans surgery unit nurse, and Dr Carmen María Iglesias Urraca, plastic surgery unit chief, had both come from the La Paz University Hospital in Madrid to speak at the conference.

Ms García Retorta began with an ethical code of nursing that she applied in her work. She continued her presentation with a description, from a surgery patient’s perspective, of their admission into the unit. A well-received patient would be asked how they were doing, receive all wished-for information and answers, and generally be made to feel relaxed and accompanied before and after the operation, with their privacy respected at all times. To test the extent to which this was taking place at various hospitals carrying out trans surgery, she conducted a survey of surgery patients who had received their operations in both public and private surgery units. The conclusions of her survey showed a very high level of satisfaction in terms of various aspects of nursing care received before and after the operation. She concluded by describing some of the methods she used in her service, including being available for the patient and ensuring their privacy at all times.

Ms García Retorta finished her presentation recalling a motto from her code of nursing ethics: “If you can cure, cure. If you can’t cure, alleviate. If you can’t alleviate, console. And if you can’t console, accompany.”


Ms. García Retorta believes in the patient-centric approach and that the nurse must permanently accompany and safeguard the privacy of the patient before and after surgery.


SPEAKER CARMEN MARÍA IGLESIAS URRACA

Dr Carmen María Iglesias Urraca then presented a brief description of trans surgery. She explained that to convert a man into a woman or vice versa was no easy task and limited by the distinct male and female osseous structures. Consequently, transvestite women who inject silicone and various other substances may achieve conversion into a “woman-lite”, but the morphologies of the back and gluteus remain very different. Among the operations available are phalloplasty and vaginoplasty. For the vaginoplasty the penis tissue is used to create the vagina walls and lips, and the urethra is reconducted. Changing a woman into a man can be more complicated, starting with the complete mastectomy, which produces mixed results depending on the size of the breasts removed, larger breasts leaving a correspondingly larger and more visible horizontal scar. Phalloplasty is probably the most complicated process and it also risky: it is assumed that up to 30% of surgery processes have complications at some point between the pre-operation stages and the end of the patient’s life. The penis is constructed from skin drafted from other parts of the body such as the forearm or thighs. Reconducting and extending the urethra is a very difficult process. Sensitivity and erections are achieved through the insertion of a variety of prosthetic devices specifically designed for neophalluses and different from the type used to treat impotence.

Dra. Carmen Iglesias Urraca: “In phalloplasty, sensitivity and erections are achieved through the insertion of a variety of prosthetic devices specifically designed for neophalluses and different from the type used to treat impotence.”


SPEAKER TINA RECIO

Transgender activists providing assistance and vision

Ms Tina Recio is a well-known trans activist in Catalonia and Spain. She began public actions in 2008 and has been involved on the legal and community sides of activism. In 2014 she won a pioneering condemnatory sentence in a widely covered gender identity-based discrimination case.

Ms Tina Recio has worked with transsexual women from Pakistan, Indonesia, Morocco, and Algeria. She was a presenter at national LGBTQI+ gatherings in 2015, and also during Woman’s Day that year in a gathering against gender violence. She regularly speaks publicly on transgender rights and works with the LGBTQI+ committee of the Catalonian Workers’ Commissions Union (CCOO Catalunya) to promote the rights of trans women in the workplace.

In 2016 she founded the Barcelona support organization I-Vaginarium to provide limited guidance with respect to surgical solutions. The idea is to provide a forum for information gathering and conversation for trans women who may need, or be able to share, information on vaginoplasty. And to keep the conversation realistic. When receiving trans women considering the operation, the advice given is not to reject one’s existing body and not have overly great expectations about surgery or prostheses. Emphasis is placed on the fact that the operation is not a matter of life and death. For those who will go through with it, pelvic floor physiotherapy is essential.

At the events and talks organised at I-Vaginarium, the women get to speak out about their concerns and experiences are shared but Ms Tina Recio, in agreement with other speakers heard at the conference, believes that improving public access to professional psychological help for the trans community is a pending task.

Ms Tina Recio: “At I-Vaginarium, emphasis is placed on the fact that the operation is not a matter of life or death”


SPEAKER ENRIQUE OLTRA RODRÍGUEZ

The labyrinth of sexuation from the eyes of the beholder

Dr Enrique Oltra Rodríguez, a nurse and sexologist, titled his presentation “the labyrinth of sexuation as an observer”. Perceptions are changing as transgender people become more visible in society. What is important is to retreat from the dichotomy or traditional masculine and feminine role. “We are not degenerates simply because we do not reproduce” Dr Oltra Rodríguez believes we must be open to new paradigms and amplify the contextual framework of sexology.

Science leaves many questions open; cerebral sexuation in particular is not well understood except in that it sometimes differs from genital sexuation. We could come to understand disparate sexuation of the brain and genitals as simply variations of human sexuality, and there are multiple scenarios. Transgender identities generally emerge at a young age. One may have a transgender identity that contradicts their assigned binary sex. The question of assigned gender may not be so clear when one is born with intersex or hermaphroditic organs.

Dr Oltra Rodríguez, also in attendance last year at ACICDDI’s inaugural conference, reiterated his findings that health care studies comparing and contemplating programs should not be restricted to pure financial data analysis. Indirect and intangible costs and benefits must be included for these evaluations to be meaningful.

Dr Oltra Rodríguez’ research reinforces his view that, while economies of scale are important, “ethics should provide the rationale in developing healthcare legislation”. The provision of enhanced healthcare service to the transgender community is the perfect example: it may not be easy to quantify discrimination, stigmatisation, and depression or any impact improved services may have.

Dr Oltra Rodríguez: “Ethics should provide the rationale in developing healthcare legislation.”


SPEAKER KAREN CARVALHO DE CASTRO

Providing trans-specific psychological assistance

Dr Karen Carvalho de Castro, a psychologist specialising in public health, provides counselling to transgender people. She began by emphasizing that transgender people don’t suffer a predisposition to psychological problems. Rather, their disproportionate need for psychological services arises from direct or indirect societal pressure.

Many years can pass between comprehension of one’s transgenderism and their beginning to express it. Carvalho de Castro says that seventeen is a common age for youths to begin a decision process. At this point, she describes the role of the psychologist working with transgender people as pretty much the same as with the rest of the population. However, she acknowledges specific work dealing with internalised transphobia. Naturally family issues are often at the forefront of the conversation, one must deal with rejection from society at large but sometimes from their own parents.

The other psychologist to take the podium was Ms Silvia Morell, who heads the Psychological Assistance Service at Casal Lambda, an association working for LGBTQI+ rights since 1976. The association serves community members as well as professionals and researchers, and its mission includes the sensitisation of public institutions, political parties, and the general public. As part of her work Ms Morell offers individual as well as group sessions for adolescents. The adolescents have already been constructing their new identity for years, so getting the totality of the relevant information from them is key before meaningful therapy can begin. One question is what kind of man or woman they want to become. Since we are dealing with adolescents, encouraging patience with the process is key. Ms Silvia Morell also echoed Ms Tina Recio’s point about helping young trans men and women have realistic expectations from their new life. This may include realistic expectations regarding the results of the operation but also a preparation regarding potential new conflicts after the sex change, for example rejection from some feminist groups as alluded to earlier in this article.

Sometimes the family comes along and one must assess to what extent they are prepared for their child’s sex change. Beyond the basic issue of acceptance, there are many points to evaluate about the family itself, for instance if they feel guilty and what impact this may have on the adolescent.

Dra. Karen Carvalho de Castro: the psychologist must also deal with internalised transphobia


SPEAKER SRA. SILVIA MORELL

The other psychologist to take the podium was Ms Silvia Morell, who heads the Psychological Assistance Service at Casal Lambda, an association working for LGBTQI+ rights since 1976. The association serves community members as well as professionals and researchers, and its mission includes the sensitization of public institutions, political parties, and the general public. As part of her work Ms Morell offers individual as well as group sessions for adolescents. The adolescents have already been constructing their new identity for years, so getting the totality of the relevant information from them is key before meaningful therapy can begin. One question is what kind of man or woman they want to become. Since we are dealing with adolescents, encouraging patience with the process is key. Ms Silvia Morell also echoed Ms Tina Recio’s point about helping young trans men and women have realistic expectations from their new life. This may include realistic expectations regarding the results of the operation but also a preparation regarding potential new conflicts after the sex change, for example rejection from some feminist groups as alluded to earlier in this article. Sometimes the family comes along and one must assess to what extent they are prepared for their child’s sex change. Beyond the basic issue of acceptance, there are many points to evaluate about the family itself, for instance if they feel guilty and what impact this may have on the adolescent.

Ms Silvia Morell: helping trans people have realistic expectations from their new life.


SPEAKER MARIA JESUS LUCIO PEREZ

Gender identity specialisation

Ms María Jesús Lucio Pérez, a sociologist, has worked as a personal case manager at the Gender Identity Unit (UIG) of the Ramon y Cajal University Hospital in Madrid since it was created in 2007, she has had ample opportunity to reflect on the state of healthcare provision to the trans community.

Patients admitted at La Paz or any other public sex change surgery unit are expected to have received the necessary advice, psychological care, exams, hormonal treatment, and other care and referrals necessary prior to surgery. The UIG was created to fulfill this stage of the process, to bring together expertise in a single location and provide a one-stop location for patients for all procedures other than the operation itself.

As such it earned a high level of patient satisfaction. At some point however, calls were made to decentralize the care, so that transgender people can receive similar care and referrals closer to where they lived. On 17 March 2016, the Madrid Community Assembly approved the law on Gender Identity and Expression. Among many other measures, it removed the need to be referred from the Ramón y Cajal UIG prior to a sex change operation at La Paz. Also, patients are now free not to receive psychological counseling before their operations. Although these changes may not guarantee the level of service obtained at the Ramón y Cajal UIG, and this may be partly why the latter is still growing to fulfill increasing demand, so it remains the logical option to many.

Ms Lucio Pérez credits the associative network for a lot of the progress made in the Community of Madrid with respect to the Health Department (Consejería de Sanidad). More people are seeking the services, and the services are improving. Surgery waiting lists that used to be up to seven years are now down to a few months.

Minors aged 12 can consult people at the UIG without parental consent, although an effort is made to bring families on the same page with respect to transsexuality and procedures. Minors can also freely receive hormonal treatment from age 16 and can be operated from 18. Lucio Pérez concluded by echoing what many of the public nurses heard today also emphasized: the importance empowering the patient and not being paternalistic.

Ms Maria Jesús Lucío Perez credits the associative network for a lot of the progress made in the Community of Madrid with respect to the Health Department (Consejería de Sanidad). More people are seeking the services, and the services are improving.


SPEAKER RAÚL PALOMERA TAMAYO

To feel that you are who you are not

Mr Raúl Palomera Tamayo, a nurse, who came to share his experience from both sides of the question. At least on the surface, his personal story as a transsexual appears to have been highly positive, or comparatively easy, but also because he manages to tell it in a cheerful tone that demystifies the experience for the cisgender listener.

Mr Palomera Tamayo explained he didn’t feel like a lesbian, and took time accepting his transsexuality, he was afraid at first. He said the experience included “looking in the mirror and not liking what you were seeing, but not due to being fat or ugly. Rather the sex you don’t want to be. It’s a terrible sensation of unhappiness. You avoid looking in the mirror.”

He went to see a psychiatrist and a psychologist. His grandmother had told him: “Why do you want to be a man if today women are just as much in charge as men”. Most of all he encountered a good amount of help and acceptance as a nurse in training and subsequently practicing. He recounts that in one hospital his name tag bore his given name and in the other his chosen name.

Mr Raúl Palomera Tamayo vspoke of his personal trans experience


SPEAKER GINA SERRA INSUA

Care for the elderly

Ms Gina Serra Insua, from the Association of Transexuals, Intersexuals, and Transgender people of Catalonia (ATC Llibertat), came to speak about geriatric transgender care. In particular, residential homes for the elderly are not prepared, with their nurses generally untrained in this area and sometimes completely unaware of their patient’s previous life experiences. They might change a diaper for a non-operated transgender person and find a penis where they expect vagina.

As a result, even if there is no direct discrimination, transgender residents may end up serving as guinea pigs while still facing the problems experienced by younger generations, such as being prescribed the wrong medication. Regulatory insufficiencies affecting the trans community in general also mean that care for the transgender elderly is a hit or miss experience.

Ms Gina Serra Insua: Regulatory insufficiencies affecting the trans community in general also mean that care for the transgender elderly is a hit or miss experience.


SPEAKER CARMEN CAMPOY

Colonial and patriarchal legacy

Doctor Carmen Campoy, professor in Anthropology and Sexology at Universidad de Lleida, took to the podium next for her presentation: “Transgender in Africa: history of an acculturation; a comparative study on culture and transgender identity.”
She explained that before colonization the identification of sexual roles wasn’t so dichotomous. A single person could be in a different space in terms of sexual relationships and roles. Colonialism demonized these variants, eventually African institutions and schools often adopted European models.

According to Dr Campoy, the theory is that all that is described by inherited patriarchal/colonial society is about control. Colonial gender identities can be seen as strategic. Gender is fully constructed, as a system. Accidents in this system such as homosexuality, bisexuality, and transsexuality can exist only as exceptions and perversions reaffirming the perceived regularity of nature.

Dr Campoy explained that we think of sex as biological, but it is in fact genital, so gender is not necessary linked to sex. Examples abound in different cultures and throughout history of different gender roles being perfectly accepted. Her study discusses five categories of variations from the colonial binary system that have found normal expression in different cultures and times: (1) hermaphroditic gender, (2) two-spirited tradition, (3) cross-gender roles, (4) marriage between women and between men, and (5) cross-gender rituals.v

In the Navajo culture, as an example of the first category, the hermaphrodite is called nadle and highly valued. An example of the two-spirited tradition is seen in the Polynesia Mahu, a highly respected figure who traditionally had a leading role impersonating a female deity in sacred dances, handing down religious tradition, and were asked by parents to name their children. Today the Mahus are also visible as LGBTQI+ activists while still performing ancestral ritualistic roles. Polynesia also provides an example of traditional cross-gender roles in the Marquesan vehine mako, or shark woman. The shark woman differs in that she is sexually aggressive and makes the initial sexual approach. She is audacious, bold, and dominant, and may also be wealthy and married. There is not stigma.

Marriage between women is seen among the Nilotic Nandi, where infertile women who do not necessarily show lesbian behaviour are married to younger women and adopt the role of husband. In the Azande tribe of Sudan, young men are considered women with respect to domestic tasks and temporarily married together. Upon reaching adulthood, one may become a warrior and marry another young man in turn who fulfils the traditional woman’s role. Regarding cross-gender rituals, the Iatmul people of Papua New Guinea observe the schismogenetic naven rite in which men imitate witches and women imitate warriors.

Dr Campoy believes that while legislation is going in the right direction, stigmatisation persists. By understanding the genesis of discrimination and observing other cultures, we can discover how many genders actually exist, and stop stigmatising.

Dra. Carmen Campoy: By understanding the genesis of discrimination and observing other cultures, we can discover how many genders actually exist, and stop stigmatizing.


SPEAKER EVA GONZÁLEZ LÓPEZ

On the role of case management nurses and community nurses

Ms Eva González López, plastic surgery nurse at Hospital Cruz Roja in Gijón, had also been in attendance last year at ACICDDI’s inaugural conference. This year, she contributed the final presentation for the day, titled “Transsexuality, nurses, and the journey through the healthcare system”. Her main focus was that specialised care for transgender patients is transversal and complex and as such requires good coordination between primary and specialised attention. She explained that, at the primary stage, the key is to accompany patients empathically. When working with children and their families it is important to differentiate those who are really trans from children merely playing with gender. For older minors, there is no rush in making decisions but they still must be encouraged to express themselves.

Patients often come in with complaints that they do not receive enough support, and with many questions. This is where the role of the community nurse must come into play, providing information directly and in schools, as well as mediation when necessary. The patient must be informed of their rights as well as existing resources. Community and case nurses alike can take responsibility for smooth gender transitions.

Ms González López explained that multidisciplinary attention carries a risk of lack of coordination, so the figure of the case management, or “coordination” nurse becomes indispensable. Like most speakers in the conference, she calls for access to specific training. Only 25% of nurses have had a sexology course, which helps to improve care for people at risk of suffering unequal/unjust treatment.

Ms Eva González López explained that we need dedicated case nurses for coordination across primary and specialised services as well as community nurses to disseminate information.


CONCLUSION

Another successful conference

Despite improving attitudes and services, the medical infrastructure is still lacking. For the cisgender and transgender public alike, psychological counselling can be hard to obtain or unavailable in the public health service. Hormone therapy solutions are still not specifically designed for trans users. “Maniacal taxonomy” continues to stigmatise.

The transgender patient may be seeking care in connection with the trans question or not. A sentiment evoked by several speakers was that whatever the nature of the request, cisgender nurses may do well to endeavour to treat transgender patients without patronizing them and with a sensitivity to their general and specific needs. The care provider, nurse, doctor, or administrator, should not make assumptions about spouses, sexual relations, protection, or the applicability of a given treatment or cure unless the patient is actively seeking it. This is consistent with a general patient-centric approach balancing the professional’s priorities and expertise with the individual needs of the patient, whether or not these needs are directly related to the condition for which the care is sought.

An audience of over 180 people attended the talks, coming from different professions and places and proved to be a highly interested and interactive public in the question sessions moderated by ACICDDI’s Noemi Arasa, Imma Amenós, and Núria Sàez Gómez. Many were nursing students with an interest in body image nursing and different social situations. The various viewpoints and perspectives expressed by the speakers also indicated a fairly complex panorama. Ms Sàez Gómez, founder of ACICDDI and organizer of the conference, concluded that in order to take on the care and help one needs to be more open. “As a nurse, I see many areas requiring improvements to adequately treat situations that have in the past been managed with too little knowledge about sexuality and identity. As for trans people… they need normality, a legal framework, research, training, and to be treated with respect and empathy,” she said.

A few attendees and participants, including Dr Enrique Oltra Rodríguez, Ms Eva González, Ms Nuria Sàez Gómez, Ms Noemi Arasa, Ms Silvia Morell, and others.

During coffee break with Ms Gina Serra, Ms Tina Recio, Ms Núria Sàez Gómez, and Ms Judith Juanhuix, and other participants.

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