A transman (assigned female at birth, but identifies as male) was lying on the operating table after having his uterus removed. Months ago, he had undergone a mastectomy (removal of the breast tissue) and looked like a cis-male (identifying with the gender assigned at birth) for the most part. The anaesthesia had begun to wear off, and he could hear the hospital staff giggling. In hushed whispers, they were mocking how different his top and bottom halves were.
He shared this account with Coimbatore-based transmasculine activist Shyam Balasubramanian. According to Shyam, this is one of the many reasons why there is a need to sensitise the medical community — physicians, psychologists, nurses and pharmacists — towards the LGBTQ community.
Judgemental doctors
“When you talk to your doctor about your medical history, your sexual health can be an important part of it. You need doctors who will treat you in a clean, physiological way instead of giving you unsolicited advice about your body and gender,” says Shyam, sharing one of his worst experiences with a gynaecologist before his sex reassignment surgery.
“For half an hour, the gynaecologist tried to convince me that my gender dysphoria was unnatural, and chided me for the ‘trouble’ I was causing my parents. She rubbed my belly and said, ‘Wouldn’t you want to have a baby in here?’ I could have a perfectly well-functioning uterus and it would still be my right to have it removed.”
Felix, member of the Chennai-based LGBT support group Orinam, explains how a simple MRI scan can be a minefield of discrimination. “My friend had to get an MRI done, but as soon as the staff realised he was HIV positive, they started asking questions about his sex life, that had nothing to do with the treatment at hand.”
A doctor’s response may range from absolute apathy, says Felix, to complete ignorance. “Either they have no idea what a queer person’s anatomy is like, or they do, but are homo/transphobic and don’t want to treat you,” he says. “Sometimes it’s as simple as not making a face when you find out we are queer. Just treat us the same, like a professional.” The issue is not just with doctors monitoring sexual health. “Psychologists are generally the first people from the medical community we reach out to. But too many times we see that the psychologists start doing ‘conversion therapy’ instead,” says Shyam. Incorrect diagnoses about depression and anxiety are made, when all the person needs is clarity and acceptance about their gender. After the decriminalisation of homosexuality, says Shyam, members of the LGBTQ community are at least empowered to tell off such biased doctors.
Poor sex education
There is little research on what medicines can or can’t be given to a person who is on hormonal therapy, claims Shyam. “There are times when we ourselves have to research and provide that information to the doctor.”
Homophobia prevails across professions, says Dr Hema Tharoor, senior consultant psychiatrist at Apollo Spectra Hospital, underlining the need for education on gender and sex to begin at the school level. “We need biology chapters dedicated to gender identities, so that the section of students who go on to become doctors can think beyond what they have been taught by society,” says Dr Hema. Further, she adds, medical schools should teach students of endocrinology, gynaecology, surgery, psychology, and family physiology, how to deal with the needs of queer people.
The taboo regarding sex
India is not a country where people are comfortable talking about sex, let alone homosexual practices. A doctor’s cabin is one of the few places where you can do so. The fear of being judged by a doctor pushes away people who might really need medical help. “Self-medication is one of the biggest problems plaguing the queer community. Instead of going to a professional, they ask each other for advice,” says Shyam.
Conversations on queer sexual health revolve mostly around gay cis-men, claims activist K Brindaalakshmi. “We need more space for discussion about healthy sexual practices for queer women,” she says. “The first problem comes with the basic definition of virginity — someone who has not had penetrative sex. Moreover, when you have reached a certain age and have not married, the first assumption made is that you are sexually inactive.”
Inaccessibility of medical aid
Brindaalakshmi, who regularly holds safe-sex workshops, says there needs to be greater research into external contraceptives for women. Most people see contraceptives as a way to avoid pregnancies, not sexually-transmitted infections. “So when it comes to queer women, most doctors assume that there isn’t a need for contraceptives. Secondly, the STIs we talk about are generally related to penetrative sex, though you can just as easily get an infection from unclean fingernails or toys,” she says. There are products used by a section of the queer community, such as Stand-to-Pee devices, that aren’t easily available.
Medical and legal aid for the LGBTQ community is a click away with Varta Trust (Kolkata), Grindr for Equality (Los Angeles) and SAATHII (Chennai) having joined hands to develop an online locator for medics and lawyers who are trusted by the community. This list was collated by taking feedback from LGBT support groups.
Visit www.vartagensex.org/reachout.php
