“You mean ‘women,’ right?”
“Why can’t you say the word ‘woman?'”
“What do you have against women?”
“Why do you want to dehumanize women?”
“Why do you hate mothers?”
“Why are you trying to erase women?”
Let me be clear: No one is trying to erase women.
And yes, my job as a gynecologist is to provide the best care I can to all women. But, my job is also to provide the best care to all people with vulvas, vaginas, uteri, ovaries, breasts or any combination of the aforementioned. Because everyone deserves access to safe, non-judgmental healthcare. But we are far from reaching that goal.
My exam room is incredibly intimidating at baseline. Patients are expected to come in, drop trou, discuss all their most intimate concerns and then display every physical part of themselves that they have been taught to be embarrassed about. No one looks forward to going to the gynecologist!
As professionals, it is the duty of all OB-GYNs to strive to create an environment of support and comfort to decrease the incredible anxiety that our exam rooms provoke. And traditionally, we have taken that to mean: make it even more gendered, more woman-only, more pink, pretty and delicate. More exclusive.
But with exclusivity comes, well, exclusion. And with this hyper-gendered environment, we are often excluding already marginalized groups and creating a bigger healthcare divide.
There is a long history of healthcare discrimination against members of the LGBTQIA+ community. They are less likely to seek healthcare when needed due to inequities in access and fear of discrimination, which leads to poorer health outcomes.
The 2015 National Transgender Discrimination Survey of over 27,000 individuals found that 23% of transgender people did not see a doctor when they needed to due to fear of being mistreated because of their identity. And an updated study in 2019 demonstrated that 18% of all LGBTQIA+ people avoid getting health care due to fear of discrimination.
How can we improve the health of a community that fears bias and discrimination from our offices? A community that fears their identities won’t be respected by the very people who are supposed to keep them healthy?
From a systematic review by Hottes, et al in 2016, 20% of LGBTQIA+ people reported at least one suicide attempt, while various studies of transgender people report anywhere from 26 to 47% have attempted suicide at some point in their lives. Gender-diverse people also have higher rates of homelessness and are more likely to be victims of intimate partner violence.
While there are many societal interventions that can be enacted to improve the health of gender-diverse people, one of the easiest for everyone to adopt is simply using gender-inclusive terms and language that affirms a person’s identified gender. A study by Dr. Stephen Russell in 2018 shows that the use of chosen names and preferred pronouns decreases the risk of depression and suicide. In fact, studies have shown that transgender young adults who were able to use their chosen names and pronouns had a 71% reduction in depression, a 34% decrease in suicidal thoughts and a 65% decrease in suicide attempts.
Even being able to use their chosen name in only one context was associated with a 29% reduction in suicidal thoughts.
A simple adjustment in language can make a huge difference.
Inclusive and respectful language literally saves lives. Inclusive language and inclusive action support all patients.
And remember: Inclusion of all is exclusive of none.
Inclusivity is not threatening to you, but being non-inclusive may be life-threatening to someone else.
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