Considerations for the Treatment of Sexual and Gender Minority Individuals in Colon and Rectal Surgery

Abstract

Sexual and gender minorities (SGMs) experience critical barriers to health care access and have unique health care needs that are often overlooked. Given the rise in individuals identifying as lesbian, gay, bisexual, transgender, and queer, colorectal surgeons are likely to care for increasing numbers of such individuals. Here, we discuss key barriers to health care access and research among SGM populations and outline approaches to address these barriers in clinical practice. We also highlight two specific topics relevant to SGM populations that colorectal surgeons should be familiar with: current approaches to anal cancer screening among men who have sex with men, and transgender individuals, as well as the management of recto-neovaginal fistula in transfeminine individuals.

Keywords

LGBT - rectovaginal fistula - vaginoplasty - anal cancer - gender-affirming care

Publikationsverlauf

Artikel online veröffentlicht:
25. April 2024

• References

• 1 Inc GUS. LGBT Identification Steady at 7.2%. Gallup.com. Accessed November 24, 2023 at: https://news.gallup.com/poll/470708/lgbt-identification-steady.aspx
• 2 Vélez C, Casimiro I, Pitts R, Streed CJ, Paul S. Digestive health in sexual and gender minority populations. Off J Am Coll Gastroenterol 2022; 117 (06) 865
• 3 Leone AG, Trapani D, Schabath MB. et al. Cancer in transgender and gender-diverse persons: a review. JAMA Oncol 2023; 9 (04) 556-563
• 4 Kutner BA, Simoni JM, DeWitt W, Gaisa MM, Sandfort TGM. Gay and bisexual men who report anal sex stigma alongside discomfort discussing anal sex with health workers are less likely to have ever received an anal examination or anal swab. LGBT Health 2022; 9 (02) 103-113
• 5 Cathcart-Rake EJ. Cancer in sexual and gender minority patients: are we addressing their needs?. Curr Oncol Rep 2018; 20 (11) 85
• 6 Kamen CS, Dizon DS, Fung C. et al. State of cancer care in America: achieving cancer health equity among sexual and gender minority communities. JCO Oncol Pract 2023; 19 (11) 959-966
• 7 Lick DJ, Durso LE, Johnson KL. Minority stress and physical health among sexual minorities. Perspect Psychol Sci 2013; 8 (05) 521-548
• 8 Heer E, Peters C, Knight R, Yang L, Heitman SJ. Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: a review of the literature. Prev Med 2023; 170: 107478
• 9 Webster R, Drury-Smith H. How can we meet the support needs of LGBT cancer patients in oncology? A systematic review. Radiography 2021; 27 (02) 633-644
• 10 Wakefield D. Cancer care disparities in the LGBT community. Curr Opin Support Palliat Care 2021; 15 (03) 174-179
• 11 Scout N. Unique issues facing sexual and gender minorities in cancer. Cancer Discov 2023; 13 (06) 1297-1300
• 12 Durso LE, Meyer IH. Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sex Res Soc Policy 2013; 10 (01) 35-42
• 13 Suen LW, Lunn MR, Sevelius JM. et al. Do ask, tell, and show: contextual factors affecting sexual orientation and gender identity disclosure for sexual and gender minority people. LGBT Health 2022; 9 (02) 73-80
• 14 Acree ME, McNulty M, Blocker O, Schneider J, Williams HS. Shared decision-making around anal cancer screening among black bisexual and gay men in the USA. Cult Health Sex 2020; 22 (02) 201-216
• 15 Apaydin KZ, Fontenot HB, Shtasel DL, Mayer KH, Keuroghlian AS. Primary care provider practices and perceptions regarding HPV vaccination and anal cancer screening at a Boston Community Health Center. J Community Health 2018; 43 (04) 792-801
• 16 Milner GE, McNally RJ. Nonadherence to breast and cervical cancer screening among sexual minority women: do stigma-related psychological barriers play a role?. Health Psychol 2020; 39 (10) 891-899
• 17 Tracy JK, Lydecker AD, Ireland L. Barriers to cervical cancer screening among lesbians. J Womens Health (Larchmt) 2010; 19 (02) 229-237
• 18 Agénor M, Bailey Z, Krieger N, Austin SB, Gottlieb BR. Exploring the cervical cancer screening experiences of black lesbian, bisexual, and queer women: the role of patient-provider communication. Women Health 2015; 55 (06) 717-736
• 19 Kulik JA, Mahler HI. Social support and recovery from surgery. Health Psychol 1989; 8 (02) 221-238
• 20 Tseng MY, Liang J, Yang CT. et al. Trajectories of social support are associated with health outcomes and depressive symptoms among older Taiwanese adults with diabetes following hip-fracture surgery. Int J Geriatr Psychiatry 2022;37(12):10.1002/gps.5842
• 21 Smith TO, Aboelmagd T, Hing CB, MacGregor A. Does bariatric surgery prior to total hip or knee arthroplasty reduce post-operative complications and improve clinical outcomes for obese patients? Systematic review and meta-analysis. Bone Joint J 2016; 98-B [phone]
• 22 James S, Herman J, Rankin S, Keisling M, Mottet L, Anafi M. The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality; 2016. . Accessed July 11, 2023 At: https://www.ustranssurvey.org/reports
• 23 Borah L, Lane M, Nathan H. Missing, inconsistent, and other-a call to improve transgender representation in oncology research. JAMA Oncol 2023; 9 (07) 891-894
• 24 Cahill S, Singal R, Grasso C. et al. Do ask, do tell: high levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American community health centers. PLoS One 2014; 9 (09) e107104
• 25 Doucette C, Milano MT, Kamen C. Patient perceptions of sexual orientation and gender identity data collection in an outpatient radiation oncology setting. Int J Radiat Oncol Biol Phys 2023; 116 (01) 68-78
• 26 Mullins MA, Reber L, Washington A. et al. Barriers, facilitators, and recommendations for sexual orientation and gender identity data collection in community oncology practices. Cancer Med 2023; 12 (18) 19203-19214
• 27 Gioia SA, Russell MA, Zimet GD, Stupiansky NW, Rosenberger JG. The role of disclosure & perceptions about providers in health discussions among gay and bisexual young men. Patient Educ Couns 2021; 104 (07) 1712-1718
• 28 Alpert AB, Mehringer JE, Orta SJ. et al. Transgender people's experiences sharing information with clinicians: a focus group-based qualitative study. Ann Fam Med 2023; 21 (05) 408-415
• 29 Hsieh N, Shuster SM. Health and health care of sexual and gender minorities. J Health Soc Behav 2021; 62 (03) 318-333
• 30 Clifford GM, Georges D, Shiels MS. et al. A meta-analysis of anal cancer incidence by risk group: toward a unified anal cancer risk scale. Int J Cancer 2021; 148 (01) 38-47
• 31 Leeds IL, Fang SH. Anal cancer and intraepithelial neoplasia screening: a review. World J Gastrointest Surg 2016; 8 (01) 41-51
• 32 Barroso LF, Stier EA, Hillman R, Palefsky J. Anal cancer screening and prevention: summary of evidence reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infection Guidelines. Clin Infect Dis 2022; 74 (Suppl. 02) S179-S192
• 33 Palefsky JM, Lee JY, Jay N. et al; ANCHOR Investigators Group. Treatment of anal high-grade squamous intraepithelial lesions to prevent anal cancer. N Engl J Med 2022; 386 (24) 2273-2282
• 34 Poynten IM, Jin F, Roberts JM. et al. The natural history of anal high-grade squamous intraepithelial lesions in gay and bisexual men. Clin Infect Dis 2021; 72 (05) 853-861
• 35 Thompson MA, Horberg MA, Agwu AL. et al. Primary care guidance for persons with human immunodeficiency virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2021; 73 (11) e3572-e3605
• 36 Hirsch BE, McGowan JP, Fine SM. et al. Screening for Anal Dysplasia and Cancer in Adults With HIV. Johns Hopkins University; 2022. . Accessed November 27, 2023 at: http://www.ncbi.nlm.nih.gov/books/NBK556472/
• 37 Goldie SJ, Kuntz KM, Weinstein MC, Freedberg KA, Palefsky JM. Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus-negative homosexual and bisexual men. Am J Med 2000; 108 (08) 634-641
• 38 Seigel R, Miller K, Fuchs H, Jemal A. Cancer statistics. CA Cancer J Clin 2022; 72 (01) 7-33
• 39 Fuchs MA, Multani AG, Mayer KH, Keuroghlian AS. Anal cancer screening for HIV-negative men who have sex with men: making clinical decisions with limited data. LGBT Health 2021; 8 (05) 317-321
• 40 Griggs J, Maingi S, Blinder V. et al. American Society of Clinical Oncology Position Statement: strategies for reducing cancer health disparities among sexual and gender minority populations. J Clin Oncol 2017; 35 (19) 2203-2208
• 41 Sexual Orientation and Gender Identity (SOGI) Data Collection | Division of Cancer Control and Population Sciences (DCCPS). Accessed November 27, 2023 at: https://cancercontrol.cancer.gov/research-emphasis/supplement/sexual-orientation-gender-identity
• 42 The ASCO Post. LGBTQ Patients and Survivors of Cancer Expressed Concern Over Discrimination in Health Care Settings According to New Survey - The ASCO Post. Accessed November 27, 2023 at: https://ascopost.com/news/june-2023/lgbtq-patients-and-survivors-of-cancer-expressed-concern-over-discrimination-in-health-care-settings-according-to-new-survey/
• 43 Hulbert-Williams NJ, Plumpton CO, Flowers P. et al. The cancer care experiences of gay, lesbian and bisexual patients: a secondary analysis of data from the UK Cancer Patient Experience Survey. Eur J Cancer Care (Engl) 2017;26(04):
• 44 Jabson JM, Kamen CS. Sexual minority cancer survivors' satisfaction with care. J Psychosoc Oncol 2016; 34 (1–2): 28-38
• 45 Brown GR, Jones KT. Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat 2015; 149 (01) 191-198
• 46 Lehavot K, Rillamas-Sun E, Weitlauf J. et al. Mortality in postmenopausal women by sexual orientation and Veteran status. Gerontologist 2016; 56 (suppl 1, suppl 1): S150-S162
• 47 Baughman A, Clark MA, Boehmer U. Experiences and concerns of lesbian, gay, or bisexual survivors of colorectal cancer. Oncol Nurs Forum 2017; 44 (03) 350-357
• 48 Banerjee SC, Walters CB, Staley JM, Alexander K, Parker PA. Knowledge, beliefs, and communication behavior of oncology health-care providers (HCPs) regarding lesbian, gay, bisexual, and transgender (LGBT) patient health care. J Health Commun 2018; 23 (04) 329-339
• 49 Schabath MB, Blackburn CA, Sutter ME. et al. National Survey of Oncologists at National Cancer Institute-Designated Comprehensive Cancer Centers: attitudes, knowledge, and practice behaviors about LGBTQ patients with cancer. J Clin Oncol 2019; 37 (07) 547-558
• 50 Sutter ME, Simmons VN, Sutton SK. et al. Oncologists' experiences caring for LGBTQ patients with cancer: qualitative analysis of items on a national survey. Patient Educ Couns 2021; 104 (04) 871-876
• 51 Morrison SD, Claes K, Morris MP, Monstrey S, Hoebeke P, Buncamper M. Principles and outcomes of gender-affirming vaginoplasty. Nat Rev Urol 2023; 20 (05) 308-322
• 52 Cristofari S, Bertrand B, Leuzzi S. et al. Postoperative complications of male to female sex reassignment surgery: a 10-year French retrospective study. Ann Chir Plast Esthet 2019; 64 (01) 24-32
• 53 Rossi Neto R, Hintz F, Krege S, Rubben H, Vom Dorp F. Gender reassignment surgery–a 13 year review of surgical outcomes. Int Braz J Urol 2012; 38 (01) 97-107
• 54 Raigosa M, Avvedimento S, Yoon TS, Cruz-Gimeno J, Rodriguez G, Fontdevila J. Male-to-female genital reassignment surgery: a retrospective review of surgical technique and complications in 60 patients. J Sex Med 2015; 12 (08) 1837-1845
• 55 Amend B, Seibold J, Toomey P, Stenzl A, Sievert KD. Surgical reconstruction for male-to-female sex reassignment. Eur Urol 2013; 64 (01) 141-149
• 56 van der Sluis WB, Bouman MB, Buncamper ME, Pigot GLS, Mullender MG, Meijerink WJHJ. Clinical characteristics and management of neovaginal fistulas after vaginoplasty in transgender women. Obstet Gynecol 2016; 127 (06) 1118-1126
• 57 Morris MP, Wang CW, Holan C. et al. Rectal injury during penile inversion vaginoplasty: an algorithmic approach to prevention and management. Plast Reconstr Surg 2023; 152 (02) 326e-337e
• 58 Pansritum K, Thomrongdullaphak S, Suwajo P. A rectoprostatic fascia reinforcement flap for rectal injury and rectoneovaginal fistula in gender-affirmation surgery. Plast Reconstr Surg 2022; 150 (04) 909-913
• 59 Bollo J, Balla A, Rodriguez Luppi C, Martinez C, Quaresima S, Targarona EM. HPV-related squamous cell carcinoma in a neovagina after male-to-female gender confirmation surgery. Int J STD AIDS 2018; 29 (03) 306-308
• 60 Bandi B, Maspero M, Floruta C, Wood HM, Ferrando CA, Hull TL. Complex Rectoneovaginal Fistula Repair after Vaginoplasty. Urogynecology (Phila) 2024; 30 (02) 161-166
• 61 Altomare DF, Scalera I, Bettocchi C, Di Lena M. Graciloplasty for recurrent recto-neovaginal fistula in a male-to-female transsexual. Tech Coloproctol 2013; 17 (01) 107-109
• 62 Guevara-Martínez J, Barragán C, Bonastre J, Zarbakhsh S, Cantero R. Rectoneovaginal fistula after sex reassignment surgery. Description of our experience and literature review [in Spanish]. Actas Urol Esp (Engl Ed) 2021; 45 (03) 239-244
• 63 Omarov N, Tatar S. The repairing of the recto-neovaginal fistula in a male-to-female transgender through perineal graciloplasty. Cureus 2021; 13 (06) e15784
• 64 Champagne BJ, McGee MF. Rectovaginal fistula. Surg Clin North Am 2010; 90 (01) 69-82
• 65 Gaertner WB, Burgess PL, Davids JS. et al; Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum 2022; 65 (08) 964-985
• 66 Abu Gazala M, Wexner SD. Management of rectovaginal fistulas and patient outcome. Expert Rev Gastroenterol Hepatol 2017; 11 (05) 461-471
• 67 Sarrau M, Casoli V, Weigert R. Successful conservative management of traumatic post-coital recto-neovaginal fistula in male-to-female transsexual. J Obstet Gynaecol 2014; 34 (08) 747-748
• 68 Shoureshi P, Dy GW, Dugi III D. Neovaginal canal dissection in gender-affirming vaginoplasty. J Urol 2021; 205 (04) 1110-1118
• 69 Dy GW, Jun MS, Blasdel G, Bluebond-Langner R, Zhao LC. Outcomes of gender affirming peritoneal flap vaginoplasty using the Da Vinci Single Port Versus Xi robotic systems. Eur Urol 2021; 79 (05) 676-683
• 70 Chong W. Interposition of a unilateral Singapore posteriorly based fasciocutaneous axial flap for treating rectoneovaginal fistula in a male-to-female trans-sexual patient. Turkish J Plastic Surg 2020; 28 (02) 123-127
• 71 Elmer-DeWitt MA, Wood HM, Hull T, Unger CA. Rectoneovaginal fistula in a transgender woman successfully repaired using a buccal mucosa graft. Female Pelvic Med Reconstr Surg 2019; 25 (02) e43-e44
• 72 Men Who Have Sex with Men (MSM). CDC. Accessed December 4, 2023 at: https://www.cdc.gov/std/treatment-guidelines/msm.htm
• 73 Transfeminine. Merriam-Webster.com. Accessed November 29, 2023 at: https://www.merriam-webster.com/dictionary/transfeminine