Accueil et suivi des personnes en demande de transition en soins de premiers recours : retour sur plus de dix ans d'expérience.

Ten years ago, trans-gender people were looking for respectful and safe accompaniment. It was in this context of difficulty in finding answers that the Maison Dispersée de Santé de Lille began to set up a support service. The approach was immediately anchored in the gender transition pathway within primary care medicine, i.e. in access to local care. Caregivers and users, we build together our practice of health and care by meeting, debating, listening and sharing individual and collective expertise. Thus, we have gradually built a rigorous and non-rigid framework of a global, bio-psycho-social accompaniment that takes into account experiential learning. This framework must take into account the health of each individual in order to propose, follow and adapt a hormone replacement treatment. It allows for the accompaniment of physical changes, possible pre-existing psychological suffering or that which appears during the transition, as well as the upheaval of one's place in society. People with gender variations need medical support because they are part of a social reality that leads to this demand. The prevalence of transidentity has long been underestimated and this need has also been underestimated. Our experience of more than ten years of accompanying transitions of women and men in this context shows the feasibility of transitions in primary care within the French system of care and medico social support.

Environnement réconfortant et respect de l'intimité. L'organisation du cabinet médical pour la consultation gynécologique.

INTRODUCTION: Social science concepts (intimate distance, personal space) suggest that the gynecological examination environment (GEE) might influence women’s feelings during the exam.Purpose of research: We explore this hypothesis by assessing women’s preferences for the GEE. RESULTS: An opinion poll was conducted, without randomization to explore women’s point of view. In 2017, questionnaires were referred to women by 14 general practitioners in the Lille region. Among 173 answers, 73% granted importance to the medical setting, especially to a comfortable ambiance and an isolated place during an exam (to respect women’s privacy). Women expected at least: a separation of consultation/examination (77%), disposal of sanitary towels (80%), a place to leave clothes and underwear (74%), a changing area (56%). Fifty-five percent judged it unnecessary to cover the lower body. Concerning the examination table: comfort was satisfactory (93%), “calm and peaceful colors” were appreciated, but clamps should be improved. CONCLUSIONS: The GEE is characterized by a balance of natural comfort and a sequentially delimited spatial configuration. The study revealed cultural and subjective dimensions of privacy. Physicians need to apply psychosocial competences to perform a person-centered gynecological exam.

Following ICD-11, Rebuilding Mental Health Care for Transgender Persons: Leads from Field Experimentations in Lille, France.

Psychiatrists have long been charged with access and coordination of care for transgender persons. This is now challenged by the World Health Organization's removal of diagnoses of mental illness related to gender identity in the 11th revision of the International Classification of Diseases. Using French field experimentations based on informal and primary care and free and informed consent, we discuss key challenges for a new organization of mental health care respectful of human rights. Developing informal and primary care as well as peer support has emerged as promising. Mental health expertise should be transferred from tertiary to secondary care.

How Doctors' Beliefs Influence Gynecological Health Care for Women Who Have Sex with Other Women.

Background: Women who occasionally or regularly have sex with other women (WSW) are rarely identified in primary care. Although we know about their specific health needs, health care professionals still find it difficult to ask questions about sexual orientation (SO) and behaviors, and sometimes, patients may find them difficult to answer. The presumption of heterosexuality still remains a widespread attitude in health care. This study took place in a primary care setting, and aimed to identify differences in gynecological health care and clinical practice for women, according to what their presumed SO and behaviors were. Methods: We conducted a cross-sectional observational, descriptive, and comparative study from October 2018 to February 2019. Three hundred thirty-eight general practitioners (GPs) from Rhône-Alpes area (France) received an anonymous questionnaire with clinical case vignettes. The main outcome was the percentage of GPs who perform a different gynecological follow-up for WSW and non-WSW. Results: In total, 165 questionnaires were analyzed. Ninety percent of respondents performed a different gynecological follow-up for WSW, compared with other women. They less often addressed topics such as contraception needs, use of barrier protections, and screening of sexually transmitted infections. Ninety-two percent of respondents were aware that they have WSW among their patients, but 2/3 of them never or rarely asked about SO. Conclusion: Most GPs know that they manage WSW but may misidentify these patients and their real care needs. Therefore, WSW receive a different and poorer follow-up than non-WSW. Clinical guidelines would be useful to improve and standardize quality and experience of health care for WSW.

Why and how to support depsychiatrisation of adult transidentity in ICD-11: A French study.

BACKGROUND: For the 11th version of the International Classification of Diseases, the WHO recommended to rename transgender transidentity as "gender incongruence", to remove it from the chapter of mental and behavioral disorders, and to put it in a new category titled "Conditions related to sexual health". This should contribute to reduce stigmatisation while maintaining access to medical care. One argument in favor of depsychiatrisation is to demonstrate that essential features of gender identity disorders, namely psychological distress and functional impairment, are not necessarily reported by every transgender person, and may result from social rejection and violence rather than dysphoria itself. Initially confirmed in Mexico, these hypotheses were tested in a specific French medical context, where access to care does not require any prior mental health evaluation or diagnosis. METHOD: In 2017, 72 transgender persons completed retrospective interviews which focused on the period when they became aware that they might be transgender and perhaps would need to do something about it. RESULTS: Results showed that psychological distress and functional impairment were not reported by every participant, that they may result from rejection and violence, and especially from rejection and violence coming from coworkers and schoolmates. Additional data showed that the use of health services for body transformation did not depend on distress and dysfunction. Finally, participants preferred ICD 11 to employ "transgender" or "transidentity" rather than "gender incongruence". CONCLUSION: Results support depsychiatrisation. They are discussed in terms of medical, ethical, legal, and social, added values and implications of depsychiatrisation.