Are women-who-have-sex-with-women an 'at-risk' group for cervical cancer? An exploratory study of women in Aotearoa New Zealand.

BACKGROUND: International research consistently indicates that women-who-have-sex-with-women (WSW) are less likely to engage in cervical screening than heterosexual women. In the main, studies have explored rates of engagement and highlighted some reasons for non-engagement. This study extends on this work by exploring perceptions among sexual minority women (WSW) for lower rates of engagement among WSW more generally and is the first study on this topic undertaken in Aotearoa New Zealand. METHODS: A sample of 177 self-identified WSW domiciled in New Zealand completed an online survey about their engagement in cervical screening, reasons for engaging (or not) in cervical screening, and perceptions of why SMW might be less likely to engage in cervical screening. RESULTS: Fewer than half of participants had engaged in cervical screening every 3years as recommended, with women who had only ever had sex with other women being significantly less likely to have engaged in screening. A lack of clear information about risk relative to sexual history, heteronormativity, and the invasive nature of screening were the dominant reasons for lower engagement among WSW. CONCLUSIONS: A legacy of misinformation, and endemic heteronormativity in public health messaging around cervical screening is a significant barrier to engagement in screening for WSW. To increase engagement in screening among WSW, public health information needs to specifically address the needs of WSW.

Communicating with LGBTQ+ persons at end of life: A case-based analysis of interdisciplinary palliative clinician perspectives.

OBJECTIVE: Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) persons with serious illness and their families often experience end-of-life (EOL) care disparities, such as homophobia and transphobia, disrespect and mistreatment, and exclusion of significant others or life partners. The aim of the study was to explore interdisciplinary clinicians' communication knowledge and priorities using a case of a gay man at EOL and his same-sex, cisgender spouse. METHODS: Interdisciplinary clinicians (n = 150) who participated in a national 3-day communication training program, rooted in Adult Learning Theory and supported by the National Cancer Institute, responded to open-ended questions about a composite case study emphasizing diversity challenges relevant to LGBTQ + communities in the EOL context. A thematic analysis of responses using an iterative, inductive approach was conducted until saturation was reached. RESULTS: Participants from nursing (48%), social work (35%) and chaplaincy (17%) responded to the survey. Five themes emerged: 1) provision of patient-centered care; 2) legal and ethical factors inform care and decision making; 3) considerations of same-sex spouse or couple context; 4) dynamics and role of family of origin; and 5) elements of inclusive clinical care. CONCLUSIONS: LGBTQ + inclusive communication training is essential for all palliative clinicians to deliver culturally safe care. Our findings have implications for identifying unconscious bias, addressing discriminatory care, filling clinician knowledge gaps, and informing educational interventions to support LGBTQ + inclusion. Future research must focus on micro- and macro-level communication issues that shape the quality of palliative and EOL care for patients and chosen family members.

Absolute and relative e-cigarette harm perceptions among young adult lesbian and bisexual women and nonbinary people assigned female at birth.

PURPOSE: Young adult lesbian and bisexual women report considerable e-cigarette disparities, which may be attributed to low harm perceptions. No studies have assessed differences in e-cigarette harm perceptions in this group, nor which factors might be intervention targets to influence harm perceptions. MATERIALS AND METHODS: We investigated differences in and modifiable correlates of e-cigarette harm perceptions among young adult lesbian and bisexual women and non-binary people assigned female at birth. Young adult women and non-binary people assigned female at birth, aged 18-30 years old, and who self-identified as lesbian or bisexual (N = 471) reported absolute and relative harm perceptions of e-cigarettes to health in an online survey. We modeled associations between harm perceptions and individual, interpersonal, and contextual factors. RESULTS: Bisexual (vs. lesbian) participants perceived higher absolute harm of e-cigarettes (Mean (M) = 7.61 vs M = 7.09, p = .03). Participants rated e-cigarettes as slightly less harmful than cigarettes, and there was no statistically significant difference by sexual orientation (Bisexual: M = 4.84 vs Lesbian: M = 4.36). In multivariable models, bisexual (vs. lesbian) participants and Hispanic/Latinx and Other race (vs. non-Hispanic White) participants reported higher absolute and relative e-cigarette harm perceptions. Greater sexual identify affirmation and greater perceived stress were associated with higher absolute and relative e-cigarette harm perceptions. CONCLUSIONS: E-cigarette harm perceptions vary vis-à-vis individual-level factors. Self-identification as bisexual or minoritized race/ethnicity, greater sexual identity affirmation, and greater perceived stress was associated with increased harm perceptions. Understanding variations may inform targeted health communications to reduce e-cigarette use disparities.

Almost invisible: A review of inclusion of LGBTQI people with cancer in online patient information resources.

OBJECTIVE: This review assessed the inclusion of lesbian, gay, bisexual, trans, queer and/or intersex (LGBTQI) people in online cancer information. METHODS: The websites of Australian cancer organizations were reviewed to identify if they included LGBTQI people and the extent and nature of this inclusion. Websites that did not include LGBTQI people were then reviewed to identify if information was implicitly LGBTQI inclusive. International LGBTQI cancer information resources were reviewed to identify key content. RESULTS: Of sixty-one Australian cancer organization websites reviewed, eight (13%) mentioned LGBTQI people, including 13 information resources targeted to LGBTQI people and 19 general cancer information resources that mentioned LGBTQI people. For Australian cancer websites that did not mention LGBTQI people, 88% used gender neutral language to refer to partners, 69% included a range of sexual behaviours, 13% used gender neutral language when referring to hormones or reproductive anatomy but none acknowledged diverse relationship types. Internationally, 38 LGBTQI-specific cancer information resources were identified. CONCLUSIONS: Cancer patient information resources need to be LGBTQI inclusive. LGBTQI-targeted resources are required to address this population's unique needs and improve cultural safety and cancer outcomes. PRACTICE IMPLICATIONS: Recommendations are provided for LGBTQI inclusive cancer patient information resources.

Past-Year Blunt Smoking among Youth: Differences by LGBT and Non-LGBT Identity.

Blunt use (co-use of tobacco and marijuana) is a growing phenomenon among youth and disproportionately affects minority populations. LGBT+ populations are significantly more likely to use marijuana and tobacco, but this relationship has yet to be examined among LGBT+ adolescents. This analysis aimed to investigate past-year blunt use among a national sample of youth and delineate the differences between non-LGBT and LGBT+ youth. We used Wave 2 of the Population and Tobacco Health (PATH) study. We analyzed data from 7518 youth, comparing past-year blunt use between LGBT+ and non-LGBT youth, controlling for biological sex, race, and age using weighted logistic regression models. Greater than 1 in 10 youth (10.6%) reported using blunts in the past year. More than one in five (21.6%) LGBT+ youth reported using blunts in the past year. There were no significant differences between boys and girls. Older youth (17 years old) were more likely to use blunts in the past year (aPR: 3.04, 95% CI 2.48, 3.79) than younger youth. Compared with non-LGBT youth, LGBT+ youth were 2.17 times (95% CI 1.86, 2.54) more likely to report using blunts in the past year. Blunt use and its respective impact on health outcomes among developing youth are of concern to public health. These findings demonstrate that certain subgroups of youth are more at risk for use and emphasize the need for tailored interventions to mitigate initiation and current use, given that one of the goals of the Healthy People 2030 initiative is to "Improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals".

Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: A review of the literature.

The LGBTQ+ community is at higher risk of certain cancers but is less likely to participate in screening programs or engage with preventive healthcare. Despite this, the barriers and facilitators to cancer screening are not well understood in this population. We conducted a literature review of research related to LGBTQ+ participation in cancer screening, as well as barriers and facilitators to participation. Following abstract and full-text screening, 50 studies were included in the final synthesis. Compared to their heterosexual counterparts, lesbian and bisexual women were less likely to participate in cervical cancer screening and mammography, but gay and bisexual men were more likely to participate in anal and colorectal cancer screening. Transgender individuals had lower rates of screening than cisgender individuals for all cancer types. Barriers to participation were found at the individual-, provider-, and administrator-level, and good communication with a healthcare provider was the strongest facilitator. These results provide reasonable first steps toward improving participation rates for LGBTQ+ populations in cancer screening. Patient-centered approaches should draw on core guiding principles to inform the provision of care, including anticipating LGBTQ+ patients, improving knowledge about care for these patients, and confronting individually-held biases that may affect care, in order to improve care experiences and participation rates in preventive services.

Sexual Identity Differences in Tobacco (Re)Uptake: Testing Mediation by Internalizing and Externalizing Symptoms.

INTRODUCTION: Tobacco use among gay, lesbian, and bisexual individuals is disproportionately higher than among heterosexual individuals. Identifying the mechanisms behind these differences can inform prevention and cessation efforts aimed at advancing health equity. Internalizing and externalizing symptoms as mediators of tobacco (re)uptake among sexual minority individuals was examined. METHODS: Waves 4 and 5 of the Population Assessment of Tobacco and Health (2016-2019) study were analyzed in 2022. Adolescents aged ≥14 and adults years not using tobacco at Wave 4 (n=21,676) were included. Wave 4 sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or something else. Associations of sexual identity with (re)uptake of cigarette use, E-cigarette use, and polytobacco use at Wave 5 were assessed, along with possible mediation of these associations by Wave 4‒internalizing and ‒externalizing symptoms. RESULTS: Internalizing and externalizing symptoms predicted tobacco (re)uptake regardless of sexual identity, particularly for female individuals. Gay/lesbian females (AOR=2.26; 95% CI=1.14, 4.48) and bisexual females (AOR=1.36; 95% CI=1.06, 1.74) had greater odds of E-cigarette (re)uptake than heterosexual females. High internalizing and externalizing symptoms accounted for over one third of the difference in E-cigarette (re)uptake among bisexual compared with that among heterosexual females. Males who reported sexual identity as something-else had lower odds of cigarette (re)uptake than heterosexual males (AOR=0.19; 95% CI=0.06, 0.66); this association was not mediated by internalizing and externalizing symptoms. CONCLUSIONS: Internalizing and externalizing symptoms uniquely contribute to E-cigarette (re)uptake among bisexual females. Strategies that reduce sexual minority stressors and resulting psychological distress may help to reduce tobacco use disparities.

Help me to come out gracefully! Working with lesbian, gay, and bisexual, people affected by cancer to develop a national practitioner guide supporting inclusive care.

INTRODUCTION: The healthcare support needs of the lesbian, gay, bisexual (LGB) and transgender community are becoming an emerging area of healthcare research. Providing person-centred care is World Health Organisation policy and as such it is important that Radiography services can demonstrate areas in which they are working with people to design, develop and feedback on the services that they receive. This research aimed to establish how cancer treatment impacted on the identities of LGB people, their experiences of care, and their engagement with developing a practitioner guide. METHODS: This cooperative inquiry is underpinned by person-centred philosophy and participatory research principles. Participants were nine lesbian, gay, and bisexual people affected by cancer. Each engaged in two facilitated, audio-recorded conversations to explore their experiences of cancer care. An analytical framework based on Mezirow's Transformational Theory was used to organise the data, followed by detailed content analysis to develop themes. RESULTS: Participants included men and women, aged 45-68, who had experienced different cancers. They explored how cancer treatment had impacted on them, and worked with the researcher and stakeholders to establish a seven-recommendation practitioner guide aimed at improving LGB people's care experiences. Their accounts revealed a broad range of issues that both corroborate and build on existing evidence. Themes highlighted expectations and experiences of both assumptions and prejudice in healthcare interactions. These experiences, along with misinterpretation of relationships with significant others, led to feelings of discomfort and reserve about self-expression. Findings of the research are presented in the following key areas: Dilemmas of attending oncology appointments; Inclusive experiences of care; and Formulation of the practitioner guide. CONCLUSION: The research findings enabled development of a national practitioner guide with the participants and key stakeholders to raise awareness of the needs of LGB persons affected by cancer and support better care. IMPLICATIONS FOR PRACTICE: By providing real-life accounts this research adds to understanding of how LGB persons interact with services, developing evidence to support cultural competence within the profession of Radiography and oncology services more broadly.

Adolescent substance use at the intersections of foster care, sexual orientation and gender identity, racial/ethnic identity, and sex assigned at birth.

BACKGROUND: Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth are overrepresented in foster care and report greater substance use during adolescence. OBJECTIVE: Using an intersectional lens, the current study investigates differences in foster care placement and variation in substance use at the intersections of foster care and sexual orientation, gender identity, racial/ethnic identities, and sex assigned at birth. PARTICIPANTS AND SETTINGS: A sample of 121,910 LGBTQ youth (grades 6-12) completed either the Minnesota Student Survey in 2019, the California Healthy Kids Survey from 2017 to 2019, or the 2017 LGBTQ National Teen Study. METHODS: Youth reported their substance use in the past 30 days (alcohol, binge drinking, cigarette, marijuana), social positions (sexual orientation, gender identity, racial/ethnic identities, sex assigned at birth), living arrangement (foster care or not), and grade in school. Logistic regression was used to examine the main and interaction effects of foster care and social positions on youth substance use. RESULTS: Results indicated significant differences in substance use at the intersection of foster care placement and youth social positions. Significant two-way interactions for foster care placement and social positions emerged predicting alcohol, binge drinking, and marijuana use. CONCLUSIONS: Findings show that LGBTQ youth in foster care are at higher risk for substance use than those not in foster care. Particular support is needed for lesbian, gay, and questioning youth, transgender youth, LGBTQ youth assigned male at birth, and Asian or Pacific Islander LGBTQ youth in foster care.

Hidradenitis suppurativa in sexual and gender minorities: A review and considerations for providers.

The literature on hidradenitis suppurativa in sexual and gender minorities remains sparse. This review article aims to discuss critical factors for providers to consider in lesbian, gay, bisexual, transgender, queer, intersex, and asexual patients with hidradenitis suppurativa, including associated comorbidities, gender-affirming hormonal therapy, squamous cell carcinoma, infections in HIV-positive patients, and creating a welcoming clinic for sexual and gender minority patients.

Relationship Between Sexual Orientation and Human Papillomavirus-Related Oral Cancer Knowledge and Awareness.

Purpose: Human papillomavirus (HPV)-related oral cancers are increasing, and lesbian, gay, bisexual, and other people with a minority sexual orientation may be disproportionately impacted. This study examined the relationship between sexual orientation and HPV-related oral cancer knowledge. Methods: Data from 10,859 adult participants in the 2017-2019 Health Information National Trends Survey 5, cycles 1-3, were obtained. The three data sets were merged, and weighted multiple imputation (n = 15) was applied to address missingness. Weighted logistic regression analyses examined differences in HPV-related oral cancer knowledge between sexual minority versus heterosexual participants by sex, after adjustment for race, ethnicity, age, education, income, insurance, regular medical provider, and smoking status. Results: In this weighted sample, age ranged from 18 to 101 years (mean = 56.3 years); 42% were males, 5.2% were sexual minority men/women, and 94.8% were heterosexual/straight. Overall, only 19% of respondents were aware that HPV can cause oral cancer. After controlling for sociodemographic factors, there were no significant differences in HPV-related oral cancer knowledge for sexual minority men (adjusted odds ratio [AOR]: 1.10; 95% confidence interval [95% CI]: 0.86-1.42) or women (AOR: 0.98; 95% CI: 0.76-1.26) compared with those who were heterosexual/straight. Conclusion: Overall, knowledge of HPV-related oral cancer was low, regardless of sexual orientation. There were no differences in HPV-related oral cancer knowledge between sexual minority men and women compared with their heterosexual counterparts. Educational programs are needed to increase awareness of the HPV/oral cancer link. Further research on differences in HPV-related oral cancer knowledge and attitudes by sexual orientation and the intersection of other demographic factors is warranted.

Dermatologic care of the lesbian, gay, bisexual and transgender community of India.

Background In the Indian subcontinent, the lesbian, gay, bisexual, transgender, and queer community, commonly referred to as the third gender or transgender, is expected to exceed one million by 2030. Data on dermatologic conditions of the transgender population is deficient. Aims This study aimed to identify the common dermatological concerns and dermatologic procedures of the lesbian, gay, bisexual, transgender, and queer community of India. Methods This cross-sectional survey analysed the transgender participants of a non-institutionalised population in India via health camps that included 51 adult participants who self-identified as trans men and trans women. Results This study included 51 participants aged 20-49 years, of which the majority (94%) were trans women. The common dermatological problems were terminal hairs over the face, beard distribution, androgenetic alopecia, scars of gender-affirming surgeries, facial melanosis with topical steroid damaged skin and the need for facial feminisation procedures among trans women, while trans men had testosterone-related acne, androgenetic alopecia. Overall, 40.6% of participants reported dissatisfaction with one or more of their body parts. Laser hair removal was the most common gender-affirming dermatologic procedure. Conclusion This study provides an essential overview of the common dermatological conditions and procedures in the Indian lesbian, gay, bisexual, transgender, and queer community. Lesbian, gay, bisexual, transgender, and queer persons have insufficient access to dermatological services due to inadequate exposure and fear of discrimination. Even though transgender patients also present with similar dermatologic conditions as the general population, they have distinct cosmetic and treatment concerns during the period of transition owing to hormone-related or surgery-related changes. Addressing these challenges through enhancing dermatology residency training programs should be the focus of tomorrow. Limitations Considering convenience sampling and representative bias, further studies need to be conducted involving multiple study locations and larger sample sizes.

A double disparity: Rural sexual minorities and tobacco use among U.S. adults.

BACKGROUND: Marginalized groups continue to face an uneven distribution of the risks and consequences of smoking cigarettes, with rural/urban geography and sexual orientation status examined independently. However, little is known about the intersection of rural/urban geography and sexual orientation regarding tobacco use disparities. This study examined rural-urban sexual minority differences in tobacco use in the United States. METHODS: Data came from the 2018-2020 Behavioral Risk Factor Survey System (N = 675,221). We estimated cigarette smoking prevalence for each year of survey data by rural/urban status and sexual orientation. Multivariable logistic regressions were used to assess associations of rural/urban location and sexual orientation status with cigarette use. Additional Multivariable logistic regressions were conducted, including stratified analyses by sex on multiple sexual orientation categories. FINDINGS: Cigarette smoking was higher among participants who lived in rural areas and identified as lesbian or gay and bisexual. Furthermore, the disparities in smoking rates were significantly different, with 38 % higher odds of smoking among rural sexual minorities than urban sexual minorities (aOR = 1.38, 95 % CI = 1.19, 1.60). Stronger odds of cigarette smoking were found among rural gays or lesbians (aOR = 1.83, 95 % CI = 1.47, 2.28) and rural bisexuals (aOR = 2.40, 95 % CI = 2.03, 2.84) compared to urban straight counterparts. CONCLUSION: Findings highlight rural populations, particularly sexual minorities, might have an elevated risk of cigarette use. Prevention and cessation efforts that help these especially disadvantaged groups will be beneficial in addressing tobacco use disparities.

Cultural Competence in the Care of LGBTQ+ Patients: A Primer for Breast/Chest Centers.

The number of individuals identifying as lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) has doubled over the past 10 years, and this figure continues to rise. The LGBTQ+ community is diverse, encompassing a vast array of differences in gender identity and sexual orientation. Additionally, it is inclusive of people from all races, ethnicities, religions, and socioeconomic backgrounds. This intersectionality of identities and experiences impacts both access to health care and its delivery. Barriers to care for this population are multifactorial and include stigma, discrimination, bias, limited role models, issues with insurance coverage, lack of education and training for health care providers, and lack of research on LGBTQ+ health-related issues. Specific to breast cancer, the screening recommendations for this group are influenced not only by risk but also by gender-affirming hormonal and surgical therapies. This article will provide an overview of the LGBTQ+ population, review breast cancer screening compliance and recommendations, summarize the multitude of health disparities, and offer potential interventions to improve care delivery at the individual, facility, organizational, and health policy levels.

Histórias de lésbicas irmanadas em uma confraria em Belo Horizonte (MG) / Stories of lesbians joined in a "queer confraternity" in the city of Belo Horizonte, Brazil / Historias de lesbianas unidas en una cofradía de entendidas en la ciudad de Belo Horizonte, Brasil

Resumo Este artigo apresenta histórias de uma Confraria de lésbicas hoje idosas que viveram a juventude na cidade de Belo Horizonte. O objetivo é descrever como um grupo de lésbicas se constituiu em uma Confraria a partir do final dos anos 1970 e início dos 80 e, partindo dessas experiências, refletir sobre a invisibilidade lésbica à luz da heteronormatividade. Utilizando o conceito de estigma, busca-se captar os elementos que mantiveram essa geração de mulheres homossexuais entre o gueto, o armário e a invisibilidade, bem como conhecer as alternativas adotadas para estabelecer suas relações homoafetivas. Os dados coletados nas entrevistas em profundidade trazem à tona as estratégias adotadas para a construção de suas identidades e dos territórios seguros que lhes permitiram vivenciar seus desejos homoeróticos e se sociabilizarem entre iguais. Os guetos encontrados ou por elas construídos proporcionaram a vivência de seus proibidos afetos e a criação de longevos e persistentes laços de amizade que se consolidaram em uma potente rede de apoio entre elas na velhice.

Abstract This article presents stories of a fraternity of lesbians now elderly who lived their youth in the city of Belo Horizonte, Brazil. The objective here is to describe how a group of lesbians formed a fraternity from the late 70's and early 80's, and departing from their experiences, reflect on lesbian invisibility in the light of heteronormativity. We use the concept of stigma to capture the elements that kept the generation of homosexual women between the ghetto, the closet and invisibility, as well as to learn about the alternatives adopted by them to establish amorous relationships with other women. The data collected in the in-depth interviews bring to light the strategies adopted by to construct their identities and safe territories that allowed them to experience their homoerotic desires and socialize among equals. The ghettos found or built by them provided the experience of their forbidden affections and the creation of long-lived and persistent bonds of friendship that ended up consolidated in a powerful support network among them in old age.

Resumen Este artículo presenta historias de una Cofradía de lesbianas hoy ancianas que vivieron su juventud en la ciudad de Belo Horizonte. El objetivo es describir cómo un grupo de lesbianas constituyó una Cofradía desde finales de los años 70 y principios de los años 80 y, a partir de sus experiencias, reflexionar sobre la invisibilidad lésbica a la luz de la norma y del concepto de estigma, captando los elementos que mantuvieron a la generación de mujeres homosexuales entre el gueto, el armario y la invisibilidad, así como conociendo las alternativas adoptadas para la constitución de sus relaciones homoafectivas. Los datos recogidos en las entrevistas ponen profundamente de manifiesto las estrategias adoptadas para la construcción de sus identidades y de los territorios seguros que les permitieron experimentar sus deseos homoeróticos y socializar entre iguales. Los guetos proporcionaron la vivencia de sus afectos prohibidos y la creación de lazos de amistad duraderos y persistentes que se consolidaron en una poderosa red de apoyo entre ellas en la vejez.

Um capítulo esquecido na história da psicologia? sexualidades desviantes, psicopatologia e normalidade / A forgotten chapter in the history of psychology? deviant sexualities, psychopathology, and normality / ¿Un capítulo olvidado en la historia de la psicología? sexualidades desviadas, psicopatología y normalidad

Este artigo tem como objetivo produzir uma análise histórica sobre as intersecções entre Psicologia e sexualidade desviantes da norma no Brasil, de fins do século XIX a meados da década de 1980. Esta temporalidade foi escolhida por abarcar o surgimento das pesquisas científicas sobre sexualidade e desvios sexuais, a consolidação dos estudos psicológicos sobre a temática e o processo mais recente de despatologização da homossexualidade. Em termos teóricos e metodológicos, foram adotados os pressupostos da História Social da Psicologia e da historiografia das homossexualidades no Brasil. Desse modo, buscou-se compreender como as ideias, concepções e práticas psicológicas foram mudando ao longo do tempo, em conexão com as transformações socioculturais e políticas que ocorreram durante o século XX. Para isto, foram utilizadas fontes primárias e secundárias de pesquisa com vistas à produção de interpretações sobre as conexões entre as ideias, os atores e os eventos narrados. Argumenta-se, ao longo do artigo, que as ideias e práticas psicológicas estão intrinsecamente conectadas aos contextos socioculturais e políticos de seu tempo, sendo os movimentos dinâmicos e os conflitos presentes nesses contextos fatores determinantes para a sua constituição.(AU)

This article aims to produce a historical analysis of the intersections between Psychology and sexualities that deviate from the norm in Brazil, from the late 19th century to the mid-1980s. This period was chosen because it encompasses the emergence of scientific research on sexuality and sexual deviations, the consolidation of psychological studies on the subject and the most recent process of de-pathologization of homosexuality. Theoretically and methodologically, the assumptions of the Social History of Psychology and the historiography of homosexualities in Brazil were adopted. Therefore, we sought to understand how psychological ideas, conceptions and practices have changed over time, in connection with the sociocultural and political transformations that occurred throughout the 20th century. For this, primary and secondary sources of research were used to produce interpretations about the connections between the ideas, the actors and the narrated events. It is argued, throughout the article, that the psychological ideas and practices are intrinsically connected to the sociocultural and political contexts of their time, being the dynamic movements and conflicts present in these contexts determining factors for their constitution.(AU)

Este artículo tiene como objetivo realizar un análisis histórico de las intersecciones entre la Psicología y las sexualidades desviadas de la norma en Brasil desde finales del siglo XIX hasta mediados de la década de 1980. Esta temporalidad fue elegida por abarcar el surgimiento de las investigaciones científicas sobre sexualidad y desvíos sexuales, la consolidación de los estudios psicológicos sobre el tema y el más reciente proceso de despatologización de la homosexualidad. En el marco teórico y metodológico, se adoptaron los presupuestos de la Historia Social de la Psicología y de la historiografía de las homosexualidades en Brasil. De esta manera, se pretende comprender cómo las ideas, concepciones y prácticas psicológicas han cambiado a lo largo del tiempo, en conexión con las transformaciones socioculturales y políticas ocurridas durante el siglo XX. Para ello, se utilizaron las fuentes de investigación primarias y secundarias con miras a generar interpretaciones sobre las conexiones entre las ideas, los actores y los eventos narrados. Se argumenta, a lo largo de este artículo, que las ideas y las prácticas psicológicas están intrínsecamente conectadas a los contextos socioculturales y políticos de su tiempo, y los movimientos dinámicos y los conflictos presentes en estos contextos fueron los factores determinantes para su constitución.(AU)

Expressões de homofobia e conflito intergrupal entre fãs de league of legends / Expressions of homophobia and intergroup conflict between league of legends fans / Expresiones de homofobia y conflicto intergrupal entre aficionados de league of legends

Os jogos digitais são considerados um ambiente de privilégio masculino que exalta o padrão heteronormativo de masculinidade. A partir da Teoria das Representações Sociais, buscamos identificar as diferentes formas de expressão e ancoragens da homofobia a partir de princípios organizadores, nos discursos dos fãs do jogo League of Legends (LoL) na rede social Facebook. Foram selecionados 470 comentários publicados em 2017, os quais foram analisados com apoio do Iramuteq (software de análise lexicométrica) por meio de uma classificação hierárquica descendente, resultando em quatro classes: "Debate sobre a sexualidade dos campeões" (14,9%), "Representatividade no LoL" (29,8%), "Confronto entre as histórias de Varus" (39%), e "Estratégia empresarial" (16,2%). Os resultados evidenciam a existência de um conflito intergrupal, mediado pelo processo de ameaça simbólica: enquanto alguns comentários, realizados majoritariamente por homens heterossexuais, se utilizam do preconceito sutil para perpetuar a manutenção da heteronormatividade, outros comentários reforçam a importância da representação da diversidade nos jogos digitais.(AU)

Digital games are considered an environment of male privilege that promotes heteronormative standard of masculinity. Based on the Theory of Social Representations, we seek to identify, based on organizing principles, the forms of expression and anchorages processes related to homophobia within the speeches of the fans of the game League of Legends (LoL), on Facebook. A total of 470 comments published in 2017 were selected to be then analyzed with support from IRAMUTEQ software (lexicometric analysis software), which resulted in four classes: "Debate on the sexuality of champions" (14.9%), "Representativeness in LoL" (29.8%), "Confrontation between the stories of Varus" (39%), and "Business strategy" (16.2%). The results show intergroup conflict that is mediated by the process of symbolic threat: some comments, which are mostly from heterosexual men, carry aspects of covert prejudice to perpetuate the maintenance of heteronormative standards, whereas other comments reinforce the importance of representing diversity in digital games.(AU)

Los juegos digitales son un entorno de privilegio masculino que enaltece el estándar heteronormativo de la masculinidad. Con base en la Teoría de las Representaciones Sociales, buscamos identificar las formas de expresión y anclaje de la homofobia a partir de principios organizativos en los discursos de aficionados del juego League of Legends (LoL) en la red social Facebook. Se seleccionaron 470 comentarios publicados en 2017, que pasaron por el análisis en IRAMUTEQ (software de análisis lexicométrico) mediante una clasificación jerárquica descendiente la cual dio como resultado cuatro clases: "Debate sobre la sexualidad de campeones" (14,9%), "Representatividad en LoL" (29,8%), "Confrontación entre las historias de Varus" (39%) y "Estrategia comercial" (16,2%). Los resultados muestran un conflicto intergrupal, mediado por la amenaza simbólica; mientras que algunos comentarios, hechos en su mayoría por hombres heterosexuales, utilizan prejuicios sutiles para perpetuar el mantenimiento de la heteronormatividad, otros comentarios refuerzan la importancia de representar la diversidad en los juegos digitales.(AU)

Butler e a psicanálise: do fracasso das normas à estranheza do gozo / Butler and psychoanalysis: from the failure of norms to the uncanniness of jouissance / Butler y el psicoanálisis: del fracaso de las normas a la rareza del goce

O objetivo deste artigo é fazer avançar o debate entre a psicanálise e os estudos queer, em especial a partir da interlocução traçada por Judith Butler com os trabalhos de Freud e Lacan. Retomando o modo como Butler articula Foucault, Derrida e a psicanálise para pensar os problemas de gênero, evidenciamos que a teoria psicanalítica permite à filósofa situar, a partir de sua concepção da melancolia de gênero, os pontos de fracasso da norma em função da vida psíquica do poder. Ainda que a cisheterossexualidade normativa imponha um roteiro de identificações e escolhas de objeto a seus sujeitos, há uma imprevisibilidade na maneira pela qual cada um responderá às injunções normativas da cultura, o que aponta para uma falha das normas em determinar completamente a subjetividade. A melancolia de gênero se torna, assim, uma marca da importância da psicanálise no percurso de Butler. Em seguida, discutimos as interpelações da filósofa ao simbólico lacaniano, bem como as nuances progressivamente introduzidas em sua leitura da diferença sexual. Ao longo do percurso de Butler, a diferença sexual deixa de ser considerada uma teoria da heterossexualidade e passa a ser apresentada como um conceito-borda, uma fronteira vacilante, que tomamos aqui como um convite para produzirmos uma releitura não normativa da diferença sexual na psicanálise a partir da teoria lacaniana da sexuação. Finalmente, localizamos a estranheza do gozo e o caráter irredutível da sexualidade às normas sociais como um importante eixo partilhado entre Butler e a psicanálise.(AU)

The aim of this article is to branch out the debate between psychoanalysis and queer studies, focusing on the interlocution drawn by Judith Butler with the works of Freud and Lacan. Returning to the way Butler articulates Foucault, Derrida and psychoanalysis to think about gender trouble, we show that psychoanalytic theory allows the philosopher to situate, from her conception of gender melancholy, the points of failure of the norm in function of the psychic life of power. After all, even though normative cis-heterosexuality imposes a script of identifications and object-choices on its subjects, there is an unpredictability to the way in which each one will respond to the normative injunctions of culture, so that norms fail to fully determine subjectivity. Gender melancholy thus becomes a mark of the importance of psychoanalysis in Butler's path. Then, we discuss the philosopher's interpellations to the Lacanian symbolic order, as well as the nuances progressively introduced in her reading of sexual difference. Along Butler's path, sexual difference is no longer considered a theory of heterosexuality and is presented as a border-concept, a vacillating frontier, which we take here as an invitation to produce a non-normative rereading of sexual difference in psychoanalysis, resorting to the Lacanian theory of sexuation. Finally, we locate the uncanniness of jouissance and the irreducible character of sexuality to social norms as an important shared axis between Butler and psychoanalysis.(AU)

El objetivo de este artículo es hacer avanzar el debate entre el psicoanálisis y los estudios queer, enfatizando la interlocución trazada por Judith Butler con los trabajos de Freud y Lacan. Volviendo a la forma en que Butler articula a Foucault, Derrida y el psicoanálisis para pensar los problemas de género, mostramos que la teoría psicoanalítica permite a la filósofa ubicar, desde su concepción de la melancolía de género, los puntos de falla de la norma en función de la vida psíquica del poder. Aunque la cis-heterosexualidad normativa imponga identificaciones y elecciones de objeto a sus sujetos, hay una imprevisibilidad en la forma en que cada uno responderá a los mandatos normativos de la cultura, lo que apunta a un fracaso de las normas para determinar completamente la subjetividad. La melancolía de género se convierte, entonces, en una marca de la importancia del psicoanálisis en la trayectoria de Butler. En seguida, discutimos las interpelaciones de la filósofa a lo simbólico lacaniano, así como los matices progresivamente introducidos en su lectura de la diferencia sexual. A lo largo de la trayectoria de Butler, la diferencia sexual deja de ser considerada una teoría de la heterosexualidad y pasa a ser presentada como un concepto-borde, um límite vacilante, que tomamos aquí como una invitación para producirmos una relectura no normativa de la diferencia sexual en psicoanálisis a partir de la teoría lacaniana de la sexuación. Finalmente, ubicamos la rareza del goce y el carácter irreductible de la sexualidad a las normas sociales como un importante eje compartido entre Butler y el psicoanálisis.(AU)

Análise da assistência sexual e reprodutiva de mulheres lésbicas, sob o olhar da Perspectiva dos Funcionamentos / Analysis of sexual and reproductive assistance for lesbian women, from the Perspective of Functioning

Trata-se de um estudo que possuiu como objeto a assistência sexual e reprodutiva da mulher lésbica, por profissionais médicos e enfermeiras, sob a perspectiva dos funcionamentos. Possuiu como objetivo geral: Analisar os funcionamentos básicos da mulher lésbica que são facilitados ou negados a partir das ações morais profissionais, de enfermeiras e médicos, durante a assistência sexual e reprodutiva. E como objetivos específicos: Discutir a influência das ações morais do profissional sobre suas práticas na assistência sexual e reprodutiva de mulheres lésbicas; Identificar quais as especificidades na assistência sexual e reprodutiva de mulheres lésbicas; Descrever os funcionamentos que são facilitados e negados durante a assistência sexual e reprodutiva de mulheres lésbicas. A presente pesquisa teve caráter exploratório-descritivo e natureza qualitativa. Os participantes da pesquisa foram 17 profissionais de saúde, 13 enfermeiras e 4 médicos, que realizam o atendimento de saúde sexual e reprodutiva, na cidade de Petrópolis. Para ter acesso aos participantes foram escolhidas, pelo menos, 1 ESF de cada distrito para conseguir abranger todo território municipal. A escolha foi feita através de sorteio aleatório e a partir da aceitação dos profissionais que atuavam naquela unidade. A escolha das unidades foi realizada de forma randomizada, respeitando os critérios de inclusão e exclusão. Após submissão e aprovação dos Comitês de Ética em Pesquisa do IMS-UERJ e FMP/UNIFASE foi iniciada a coleta dos dados. O instrumento de coleta de dados foi a entrevista semiestruturada e os depoimentos foram analisados através da análise de conteúdo proposta por Bardin. Após análise de dados, estabeleceu-se 4 categorias que são desenvolvidas de acordo com os capítulos: O acompanhamento de mulheres lésbicas durante a assistência sexual e reprodutivo e seus funcionamentos básicos; O acolhimento da mulher lésbica na assistência sexual e reprodutiva; As singularidades da mulher lésbica reconhecidas ou não pelos profissionais durante a assistência sexual e reprodutiva; A (in)capacitação profissional e violências contra as mulheres lésbicas. Com este estudo constatou-se que para a realização dos funcionamentos básicos está associado ao relacionamento estabelecido entre profissional de saúde e mulher lésbica, da abertura que este profissional dá para a mulher se sentir segura e confortável para expor a sua sexualidade e dúvidas, que se acabam por ficar atrelados a moralidade dos mesmos. Outro aspecto relevante é o interesse do profissional em buscar sua atualização, capacitação e qualificação nas singularidades da assistência à mulher lésbica. Neste sentido, os entrevistados, em sua maioria, descumprem com os funcionamentos básicos para uma assistência sexual e reprodutiva de mulheres lésbicas qualificadas. (AU)

This is a study that had as its object the sexual and reproductive care for lesbian women, by medical professionals and nurses, from the perspective of functioning. Its general objective was: To analyze the basic functions of lesbian women that are facilitated or denied based on professional moral actions, of nurses and doctors, during sexual and reproductive assistance. And as specific objectives: Discuss the influence of the professional's moral actions on their practices in sexual and reproductive assistance to lesbian women; Identify the specificities in sexual and reproductive assistance for lesbian women; To describe the functioning that are facilitated and denied during sexual and reproductive assistance to lesbian women. This research was exploratory-descriptive and qualitative in nature. The research participants were 17 health professionals, 13 nurses and 4 doctors, who provide sexual and reproductive health care in the city of Petropolis. To gain access to the participants, at least 1 ESF from each district was chosen to be able to cover the entire municipal territory. The choice was made through a random raffle and based on the acceptance of the professionals who worked in that unit. The choice of units was carried out at random, respecting the inclusion and exclusion criteria. After submission and approval by the Research Ethics Committees of IMS-UERJ and FMP/UNIFASE, data collection began. The data collection instrument was the semi-structured interview and the testimonies were analyzed through the content analysis proposed by Bardin. After data analysis, 4 categories were established, which are developed according to the chapters: Accompanying lesbian women during sexual and reproductive assistance and its basic functions; The reception of lesbian women in sexual and reproductive assistance; The singularities of lesbian women recognized or not by professionals during sexual and reproductive assistance; Professional disability and violence against lesbian women. With this study, it was found that for carrying out the basic functions, it is associated with the relationship established between the health professional and the lesbian woman, the openness that this professional gives to the woman to feel safe and comfortable to expose her sexuality and doubts, which are end up being linked to their morality. Another relevant aspect is the professional's interest in seeking updating, training and qualification in the singularities of assistance to lesbian women. In this sense, most of the interviewees fail to comply with the basic functions for qualified sexual and reproductive assistance to lesbian women. (AU)

Percepções e expectativas de homens trans acerca dos relacionamentos afetivo-sexuais pós-transição / Trans men's perceptions and expectations of post-transition affective-sexual relationships / Percepciones y expectativas de los hombres trans sobre las relaciones afectivo-sexuales después de la transición

As identidades transmasculinas ganharam visibilidade social e acadêmica no Brasil a partir de 2010, contudo, as questões subjetivas dos homens trans ainda são pouco debatidas, em particular temas associados aos relacionamentos afetivos na experiência desses sujeitos. Este estudo qualitativo tem por objetivo identificar as percepções e expectativas dos homens trans acerca dos relacionamentos afetivo-sexuais no cenário pós-transição de gênero. Participaram da pesquisa 15 homens transexuais hormonizados, com idades entre 20 e 41 anos. A coleta de dados foi realizada por meio de entrevista semiestruturada nas modalidades presencial e on-line. Empregou-se análise temática reflexiva, que resultou em dois temas analíticos. Os resultados apontam que os homens trans, ao contrário de suas expectativas iniciais, percebem que tiveram menos oportunidades de relacionamentos afetivo-sexuais depois de sua transição de gênero. Os participantes atribuem essa dificuldade especialmente ao fato de não terem se submetido à cirurgia de redesignação sexual. O desconforto é acentuado por sua materialidade corpórea divergente da cisnormatividade, sistema regulador que associa pessoas pertencentes ao gênero masculino à presença de um pênis. Outra fonte de desconforto é o repúdio social, que alimenta a abjeção, exotização e fetichização dos corpos transmasculinos. Também são descritas as especificidades do relacionamento dos homens trans com mulheres cisgênero, heterossexuais e lésbicas. Os resultados evidenciam que a fixação persistente no genital, como referente e signo determinante do gênero e da sexualidade, modula e regula a busca e o encontro de parceira(o) íntima(o).(AU)

Transmasculine identities have gained social and academic visibility in Brazil since 2010, but subjective issues, especially those associated with affective relationships, are still little discussed. This qualitative study sought to identify trans men's perceptions and expectations regarding post-transition affective-sexual relationships. A total of 15 transsexual men undergoing hormone therapy, aged between 20 and 41 years, participated in the research. Data were collected by means of in-person and online semi-structured interviews and analysed using reflexive thematic analysis, which resulted in two analytical themes. Results show that trans men, differently from their initial expectations, perceive fewer opportunities for affective-sexual relationships after their gender transition. The participants attribute this difficulty, especially, to the fact that they have not undergone sexual reassignment surgery. Discomfort isaccentuated by their bodily materiality diverging from cisnormativity, the regulatory system that associates people belonging to the male gender with the presence of a penis. Another source of discomfort is the social repudiation, which reinforces the abjection, exoticization, and fetishization of transmasculine bodies. The specifics of trans men's relationships with cisgender, heterosexual, and lesbian women are also described. The results show that the persistent fixation on the genital, as a referent and determinant sign of gender and sexuality, modulates and regulates the search for and encounter of intimate partners.(AU)

Las identidades transmasculinas han ganado visibilidad social y académica en Brasil desde 2010, sin embargo, las cuestiones subjetivas de los hombres trans son aún poco discutidas, en particular las cuestiones asociadas a las relaciones afectivas en la experiencia de estos sujetos. Este estudio cualitativo tiene como objetivo identificar las percepciones y expectativas de los hombres trans sobre las relaciones afectivo-sexuales después de la transición de género. Participaron en la investigación 15 hombres transexuales hormonados, de edades comprendidas entre los 20 y los 41 años. La recopilación de datos se realizó mediante una entrevista semiestructurada en las modalidades presencial y en línea. Se realizó un análisis temático reflexivo, que dio como resultado dos temas analíticos. Los resultados muestran que los hombres trans, al contrario de sus expectativas iniciales, perciben que han tenido menos oportunidades de relaciones afectivo-sexuales después de su transición de género. Los participantes atribuyen esta dificultad especialmente al hecho de no haberse sometido a cirugía de reasignación sexual. La incomodidad se acentúa por su materialidad corpórea divergente de la cisnormatividad, un sistema normativo según el cual las personas pertenecientes al género masculino deben tener pene. Otra fuente de malestar es el repudio social, que alimenta la abyección, la exotización y la fetichización de los cuerpos transmasculinos. También se describen las especificidades de las relaciones de los hombres trans con las mujeres heterosexuales, cisgénero y lesbianas. Los resultados muestran que la persistente fijación en los genitales, como referente y signo determinante del género y la sexualidad, modula y regula la búsqueda y el encuentro de parejas íntimas.(AU)