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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(09): 884-890
DOI: 10.1055/s-0042-1751063
Review Article

Contraceptive Counseling for the Transgender Patient Assigned Female at Birth

Aconselhamento contraceptivo para a pessoa transgênera designada mulher ao nascimento
Sérgio Henrique Pires Okano 
1   Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brazil
2   Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
,
Giovanna Giulia Milan Pellicciotta 
1   Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brazil
,
Giordana Campos Braga 
1   Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brazil
2   Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Abstract

Although almost 0.7% of the Brazilian population identifies as transgender, there is currently no training for healthcare professionals to provide comprehensive care to these patients, including the discussion of reproductive planning. The use of testosterone promotes amenorrhea in the first months of use; however, this effect does not guarantee contraceptive efficacy, and, consequently, increases the risks of unplanned pregnancy. The present article is an integrative review with the objective of evaluating and organizing the approach of contraceptive counseling for the transgender population who were assigned female at birth. We used the PubMed and Embase databases for our search, as well as international guidelines on care for the transgender population. Of 88 articles, 7 were used to develop the contraceptive counseling model. The model follows the following steps: 1. Addressing the information related to the need for contraception; 2. Evaluation of contraindications to the use of contraceptive methods (hormonal and nonhormonal); and 3. Side effects and possible discomfort associated with the use of contraception. The contraceptive counseling model is composed of 18 questions that address the indications and contraindications to the use of these methods, and a flowchart to assist patients in choosing a method that suits their needs.

Resumo

Apesar de 0,7% da população brasileira se identificar como transgênera, não existe treinamento para que o profissional de saúde realize um acolhimento de maneira integral a estes pacientes, incluindo a discussão do planejamento reprodutivo. O uso de testosterona promove a amenorreia nos primeiros 6 meses de uso; entretanto, este efeito não garante eficácia contraceptiva, e, consequentemente, aumenta os riscos de uma gravidez não planejada. O presente artigo é uma revisão integrativa com o objetivo de avaliar e organizar uma abordagem do aconselhamento contraceptivo na população transgênera que foi designada mulher ao nascimento. Para a estratégia de busca, foram pesquisados os bancos de dados PubMed e Embase, incluindo diretrizes internacionais sobre cuidados à população transgênera. De 88 artigos, 7 foram utilizados para desenvolver o modelo de aconselhamento contraceptivo. O modelo segue as seguintes etapas: 1. Abordagem das informações relacionadas à necessidade de contracepção; 2. Avaliação das contraindicações ao uso dos métodos contraceptivos (hormonais e não hormonais); 3. Efeitos colaterais e possíveis desconfortos associados ao uso do contraceptivo. O modelo de aconselhamento contraceptivo é composto por 18 questões que abordam as indicações e contraindicações ao uso destes métodos e um fluxograma que auxilia na escolha dentre os métodos permitidos ao paciente de acordo com a sua necessidade.

Keywords

transgender - contraception - testosterone

Palavras-chave

transgênero - contracepção - testosterona

Contributions

Substantial contributions to the conception and design of the present article: Okano S. H.P., Pellicciotta G. G. M., and Braga G. C. Data collection or analysis, and interpretation of data; Okano S. H. P., Braga G. C. Writing of the article or critical review of the intellectual content: Okano S. H. P. and Pellicciotta G. G. M. Final approval of the version to be published: Okano S. H. P. and Braga G. C.


Supplementary Material



Publication History

Received: 14 December 2021

Accepted: 18 April 2022

Article published online:
06 July 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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