On sex and gender in medicine

De-sexing the medical record? An Examination of Sex Versus Gender Identity in the General Medical Council’s Trans Healthcare Ethical Advice

Sara Dahlen

What do the terms sex and gender identity, or gender history, mean in a medical context? When does it matter to a healthcare professional whether a patient has male or female reproductive biology? How should a doctor approach a patient who does not wish for their biological sex to be openly acknowledged? The General Medical Council (GMC) advises doctors that transgender patients may have the marker for their sex amended to instead reflect their gender identity. This paper will attempt to critically examine two key points in the GMC trans healthcare ethical advice using Beauchamp and Childress’ Four Principles approach, exploring how doctors might consider an incongruence between sex and gender identity in clinical practice. Read more

Sex, gender and nursing

Robin Ion, Leanne Patrick, Mark Hayter, Debra Jackson

The aim of this editorial is to raise awareness and provoke discussion about the issues of sex and gender in nursing. Here, we provide a brief summary of a complex and challenging area. This topic has been the subject of significant heated debate on social media and has, more recently, come to the fore in more mainstream media and throughout sections of academia—prompting increasingly polarized discussion. It is now an issue where deeply held views are evident—some quite entrenched. We have begun to see some of this spilling over into the healthcare environment. It is an issue that nurses cannot ignore, and one that nurse clinicians, academics, researchers and policy makers urgently need to engage with. Read more

Do we need the word ‘woman’ in healthcare?

Sara Dahlen

Should clinicians be using the word ‘woman’ in medical language? Are phrases like ‘human milk’, ‘parental’ and ‘hand-held notes’ preferable to ‘breastmilk’, ‘maternal’ and ‘maternity notes’1? Whether to adopt a new terminology is a complex question, worthy of reflection and analysis, and open dialogue between patients, clinicians and academics. While new phrases might be argued as socially progressive, their ability to translate into medical practice or general health messaging seems currently uncertain. Clinicians might be put into a difficult position of balancing various concerns around language choice in healthcare communication, and it is, therefore, important they are aware of multiple viewpoints.

The omission of words such as ‘woman’ or ‘mother’ in favour of ‘gender inclusive’ or ‘gender neutral’ terminology tends to signal the clinician’s acknowledgement of a minority group. It is a form of communication aiming to be sensitive to the needs of transgender people, who have an identity or sense of self that is incongruent with their reproductive biology. Transgender patients require medical care appropriate to their bodies, but may not wish to be described by common words that reference their natal sex. Thus, an argument made for gender inclusive terminology might be that because some individuals with the capacity to gestate a child do not identify as women, pregnancy ought not be described solely as a ‘women’s issue’.1–3 Academic publications may adopt gender neutral language for topics in female reproductive health. Examples include: a study protocol on menstruation using ‘people who menstruate’,4 an update of cervical cancer screening guidelines writing ‘individuals with a cervix’5 or an ethics paper exploring elective caesareans during the COVID-19 pandemic writing ‘pregnant person’.3 Yet, gender neutral language may be met with resistance when applied to other contexts. Read more

Breastfeeding grief after chest masculinisation mastectomy and detransition: A case report with lessons about unanticipated harm

Karleen Gribble, Susan Bewley, Hannah Dahlen

An increasing number of young females are undergoing chest masculinsation mastectomy to affirm a gender identity and/or to relieve gender dysphoria. Some desist in their transgender identification and/or become reconciled with their sex, and then revert (or detransition). To the best of our knowledge, this report presents the first published case of a woman who had chest masculinisation surgery to affirm a gender identity as a trans man, but who later detransitioned, became pregnant and grieved her inability to breastfeed. She described a lack of understanding by maternity health providers of her experience and the importance she placed on breastfeeding. Subsequent poor maternity care contributed to her distress. The absence of breast function as a consideration in transgender surgical literature is highlighted. That breastfeeding is missing in counselling and consent guidelines for chest masculinisation mastectomy is also described as is the poor quality of existing research on detransition rates and benefit or otherwise of chest masculinising mastectomy. Recommendations are made for improving maternity care for detransitioned women1. Increasing numbers of chest masculinsation mastectomies will likely be followed by more new mothers without functioning breasts who will require honest, knowledgeable, and compassionate support.

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