Gender-affirming wellness care supports and affirms a person’s gender identity holistically across a range of physical, emotional, behavioral and social dimensions. That care could look like routine gynecological care and screening, or contraceptive management. It could also look like hormone therapy or surgical intervention. My goal as a provider is to listen, learn and gather the information I need to provide the best care I can within the framework of each person’s unique identity, expression, needs and goals.
When I provide medical care in this context, I think it is incredibly important to first recognize that seeking care as a gender-diverse person is often more difficult than seeking care as a cis person. I am part of a healthcare system that is not built for people outside the binary. With this in mind, I actively work to create a safer space within that system and hold myself accountable to my own values and external feedback. I recognize that medical environments are not inherently safe for everyone and can be scary for some. I see you, I am here for you and I will do everything in my power to create a safer space for you.
As a nurse-midwife, the people within my current scope of care are those who were assigned female at birth. If at any point a person needs or desires something outside of my scope, I will connect them to a provider who can best meet their needs. This could include referrals for care from a physician, surgeon or mental health professional–either within WHA or the larger healthcare community. But you don’t have to know what you need at the outset in order to schedule a visit with me. Come as you are, come with your questions and we’ll figure out a plan moving forward. While always tailored to the individual, my approach tends to follow these key steps.
Learning about you.
In an organization like WHA where the word “women” is in our name, we can sometimes assume we know who’s coming to see us. But I want to see you exactly how you want to be seen. Which is why I begin each conversation with a new patient by asking their name, gender identity and pronouns if that information isn’t already documented. I want the entire visit to feel in tune with who you are, which starts with using your correct name, pronouns and the terms you prefer for your physical anatomy.
Gender identity and expression and how each person experiences their own is a diverse spectrum, so what gender-affirming care means is different from person to person. From the start of our time together, I want to understand your identity and experience and how they impact your physical health, emotional well-being and goals for the future. If you’re comfortable sharing, I also want to learn about any past positive or negative experiences receiving health care. This could include learning about why you have not sought care before so I can understand where you’re coming from and what might make you most comfortable, even if that means adjusting how I normally do things to better meet your individual needs.
We’ll also discuss what brings you in now. Many people will come to a visit knowing exactly what direction they’d like to go. Others have no idea where to start–and that is perfectly fine. Whether you’re seeking routine gynecological care or just want to talk, your plan of care can be an ongoing conversation. No matter where you are, it is exactly the right place to start.
Discussing care options.
To help us make a plan together, there is some baseline information I like to gather in our first appointment. We can collect some things through discussion and some through physical assessment. I will explain all of the information I’d like to gather, why it’s important and how it’s normally collected. Whether through discussion or physical assessment, what we move forward with is based on your level of comfort. If you are not comfortable with it, no physical exam has to happen that day. I repeat, no physical exam has to happen that day. Beyond this baseline health information and history, I am happy to have you take charge and drive the visit the way you need. I am also happy to help guide the agenda if that is your preference.
This first appointment can go in a number of directions. It may be all about establishing our relationship and building trust. Or, we may discuss routine gynecological and preventative care. Or, we might discuss your physical body in the context of your identity and whether you are considering hormone therapy or surgery. We might also discuss my role in referring you to the care you need. Or we might talk about all of these things to set the roadmap for what we do at future visits. I would rather a person show up saying “I don’t know what I need” than not come at all.
Performing routine exams or preventative screenings.
For some patients, their first wellness visit may include a routine physical exam and preventative screenings, such as a Pap smear to screen for cervical cancer or testing for sexually transmitted infections. When doing any type of physical exam or procedure, I use the principles of trauma-informed care: safety, choice, collaboration, trustworthiness and empowerment. The values of consent are also incredibly important to me and I believe become even more important in the field of reproductive healthcare where the nature of our work involves interacting with people’s bodies in very vulnerable and intimate ways.
My practice is to explain each step before I do it so there are no surprises, obtain consent before moving forward with any type of touch and continue to explain as we proceed, giving people the option to decline anything that makes them uncomfortable. I will wait for your yeses just as I will listen for and respect your no’s, even if those no’s are non-verbal. Part of my explanation is why a certain thing might be recommended so if people are not ready to proceed, they can make an informed decision to refuse. My goal is to empower people with information, not pressure them into uncomfortable situations.
During any physical care, I move as slowly–or as quickly–as you want and I always stop the moment I’m asked. You are in control of this process. Some people like to touch the instruments beforehand to see how they work and then have me narrate what I’m seeing as I go. Some people prefer to use distraction or fidget techniques for themselves or use headphones with music if they don’t want to be as present in their bodies at that moment. Both are perfectly ok and valid. As part of my practice and values, I almost never use stirrups. I do this to increase comfort, reduce feelings of exposure and vulnerability and so people have more freedom and ability to move away if they need to.
Determining next steps.
- Like everything else with your care, next steps will be entirely personalized and depend on what we discuss/do at that first visit. Here are a few potential scenarios.
- If the first visit was us talking and getting to know each other better, then the next visit may be a routine exam and recommended health screenings.
- If the first visit is a routine exam and/or screenings, then there will be some sort of follow-up based on any results. This could be anything from a MyHealth message to another appointment.
- If we started hormone therapy, we’ll set a date to follow up and check in on your safety and wellness. This may be a couple of days or a couple of weeks or months based on your needs.
- If we talked about a longer-term plan, we’ll chart out what the next few months to a year look like and how often we’ll connect.
It’s important to remember that gender-affirming wellness treats individuals holistically, meaning care is on a continuum. Establishing an environment of trust and collaboration with patients is at the foundation of my practice and I recognize that this takes time. The first visit is only the beginning and what’s right for you today may not be right for you tomorrow, or in a year. Your needs and goals may change and that’s ok. I would love to start the conversation with you.