Health Care for Transgender Men: What Is Missing in OB/GYN Care?

OBJECTIVE: Transgender men (TGM) are those who identify their sex as male but were assigned female at birth who face marginalization in obstetrics and gynecology (OB/GYN) practices. The following commentary highlights recommendations for creating inclusive OB/GYN spaces and improving outcomes for TGM patients. METHODS: The commentary is written in a call to action style using previously published literature about treatment and guidelines for care of transgender patients to highlight recommendations for creating inclusive OB/GYN spaces for TGM. The GLMA Handbook on LGBT Health and The UCSF Transgender Care Web site were among the resources used to gather information on transgender patient inclusivity in health care settings. RESULTS: Supporting literature was collected that reinstates the need to include framing questions specific to the TGM population during history-taking, creating inclusive clinic settings, and enhancing health care provider training in TGM care. CONCLUSIONS: It is important for TGM who have a vagina, cervix, and/or uterus to have routine gynecological screenings. However, the lack of gender inclusive care in OB/GYN clinics presents a barrier for many TGM and the recommendations emphasized in this commentary will increase sensitivity for the TGM patient population and decrease their marginalization in health care settings.

Transvaginal sonographic fetal axis determination in early second trimester.

OBJECTIVE: Correct prenatal determination of the fetal right/left axis is essential for the diagnosis of fetal malformations, in particular congenital heart anomalies. A reliable method of transabdominal echocardiographic assessment of the fetal situs in the late second trimester was established. We aimed to determine the validity of the transvaginal approach to assess fetal axis. METHOD: The study group consisted of 108 consecutive women in the second trimester of a singleton pregnancy, undergoing elective transvaginal anatomy scans. All had undergone previous transabdominal echocardiography to establish fetal axis. The same technique was used to assess the fetal axis during the transvaginal study, and the findings were compared. RESULTS: There was total agreement in fetal axis determination between transabdominal and transvaginal scans in all cases. The accuracy of the transvaginal study was not affected by maternal obesity, fetal position or the presence of cardiac malformation (in one case). CONCLUSION: Transvaginal ultrasonography is the reliable and accurate means of determining the fetal axis.