Week 4: LGBTQIA+, adolescent, and sex worker health

What does LGBTQIA+ stand for?

Lesbian, gay, bisexual, transgender, gender diverse, intersex, queer/questioning, asexual.

The + identifies those not listed.

What is 'Gender'

Gender: Socially constructed categories assigned to individuals on the basis of their apparent sex at birth.

what is 'Sex'?

Sex: Construct built upon the biological characteristics related to sexual reproduction

what is 'Intersex'?

Intersex: Born with physical or biological sex characteristics that are more diverse than the stereotypical definitions of male and female.

What is gender identity?

An inner sense of oneself as man, woman, masculine, feminine, neither, both or moving between.

What are gender pronouns

How a person chooses to publicly express their identity through the use of a pronoun.

What is gender dysphoria

Medical term that describes the distress a transgender or gender diverse person experiences.

What is 'Sexuality' (3 componenets)

3 components

Orientation: Who we are attracted to.

Behaviour: The sexual experiences we have.

Identity: How we identify to ourselves and others.

What does TGDNB stand for?

Transgender, gender diverse, non-binary.

What is hormonal replacement therapy?

Some, but not all go on HRT.

Mental health outcomes can improve significantly when able to access gender-affirming hormones.

What is used for male to female transitioning in regards to hormonal replacement therapy? What should be considered?

Combination of oestrogen, and anti-androgen.

Causes calmer mood, reduced libido, body fat redistribution, slower growth of body hair, reduced acne, electrolyte disturbances.

What is used for female to male transitioning in regards to hormonal replacement therapy? What should be considered?

Testosterone therapy

Early: Acne, oily skin, increased libido.

Later: body fat redistribution, muscle growth, body/facial hair/ deeper voice.

What surgical options can be used for male to female transition?

Facial feminisation surgery.

Brest augmentation.

Genital reconstruction surgery.

What surgical options can be used for female to male transition?

Facial masculinisation surgery

Mastectomy

Genital reconstruction surgery.

What are the barriers to health for LGBTQIA+ individuals?

State sanctioned structural discrimination.

Discriminations in schools, healthcare facilities, workplaces.

Lower health outcomes

Mental health, wellbeing and physical health can be markedly worse.

How should correct LGBTQIA+ terminology be used in clinical practice?

It is vital to use the correct terminology and language regarding a patients identity.

What should be considered regarding adolescents and sexual health?

Discuss with the individual about them discussing it with parents.

Do not presume they are not having sex.

Understand there are choices with consequences.

What is Gillick Competence?

A legal principle allowing those under 16 to consent to their own medical treatment without parental knowledge or consent, provided they have the maturity and intelligence to fully understand the proposed treatment.

How do unplanned pregnancies occur and what should be considered within a healthcare point of view.

No contraception (knowledge, access, cant afford it)

Health related factors, lower education, aspects of sexual behaviour.

When should a report be made regarding adolescent consent to medical treatment?

They form a reasonable belief that a child has suffered harm or is likely to as a result of physical or sexual abuse, and the parents have not protected or are unlikely to protect the child.

Who is obligated to mandatory reporting?

Teachers and principles, doctors, nurses and midwives, police officers.

Out of home care workers

Early childhood workers

Youth justice workers

Registered psychologists

What are the 3 major subtypes of eating disorders?

Anorexia nervosa (feat of weight gain)

Bullimia nervosa (binging, followed by methods to avoid weight gain)

Eating disorders not otherwise specified.

How does mental health affect LGBTQIA+ adolescents?

Significant mental health comorbidity.

High majority of LGBTQIA+ individuals report being diagnosed with a mental health condition. Can affect livelihood or access to healthcare.

What is the RCH gender clinic?

Royal Children hospital gender clinic.

Initial assessment by psychologist or child psychiatrist.

Later seen by paediatrician.

Treatment: puberty blockers (which are reversible).

Or GHT.

How can stigma affect sex workers?

Disclosure or concealment of sex work.

Reduced access to healthcare.

Issues gaining employment.

Judgement.

General health issues.

What are the main regulatory models throughout the world for sex work?

Criminalisation/prohibtion most places globally.

Legalisation/regulation: determines the legal conditions under which the sex industry can operate.

Decriminalisation: Regulates sex workers / activities without using criminal law.

What is the Sex work decriminalisation Act 2022?

Used in Victoria to decriminalise sex work.

Ensures safety, health, human rights and reduces stigma.

How do STI's affect sex workers?

Sex workers have LOWER rates of most STIs

Extremely high rate of condom use.

Must be tested every 3 months.

What is Chlamydia? How does it present?

Transmitted via contact with genital fluids. Caused by bacteria.

Can actually often be asymptomatic.

Men: Urethritis, discharge, dysuria.

Women, discharge, cervicitis.

Managed with antibiotics.

What is Gonorrhea? How does it present?

Transmitted via contact with infected genital fluids.

Caused by bacteria.

Men: purulent urethral discharge, dysuria, infection.

Women: May be asymptomatic, or present with discharge.

Managed with antibiotics.

What is Herpes Simplex Virus? How does it present?

Around 1/3 adults have the virus.

Around 80% don't know they have it because of very mild symptoms or none.

Transmitted via skin to skin contact.

May present with severe outbreak. Painful ulcers, difficulty urinating, flu like symptoms.

Managed with saline bathin of lesions, topical lignocaine, urinating in a bath helps relieve dysuria.

What is Syphillis? How does it present?

Transmitted orally, vaginal or anal sex.

Presents very differently depending on infection stage. Large painful ulcers, rash, flue like symptoms.

Untreated syphilis can lead to serious complications.

Managed with antibiotics.

What is Hepatitis B and C? How does it present?

Viral infection.

Hep B: Blood, semen, other bodily fluids.

Hep C: Blood.

Presents may be asymptomatic, or infection like symptoms.

Vaccine available: Hep B.

What is HIV? How does it present?

Transmitted viral infection via blood, breast milk, semen, mucosa.

Present similar to Hep B.

Treatment: PrEP, PEP, ARTs.