From the Editor Medical Abuse

From the Editor

Medical Abuse
"Domestic" Violence: Not Just a "Family" Matter

Queers and straights. We have different kinds of families, and different kinds of "domestic" relationships. While many straight people have nuclear families - a spouse, possibly children, and extended family based on their family of origin; many queer folks have created their own family, that extends far beyond a spouse, or biological family. As we create our extended family(ies), we incorporate a broader pool of people than "just" friends, or just acquaintances. Our family may also include our therapist, or physician, or clergy, or other professional allies that we grow to trust in ways that our straight counterparts will rarely understand. We have needs that are unique, to which few non-queer people can relate.

[Perhaps we, as a greater queer community, need to be able to more clearly differentiate between "family" and our professional allies and intimates. When our physicians and therapists become part of our circle of family, we make expectations of them to behave as if they were part of our loving family, when in reality, we are just another patient to them. This certainly doesn't absolve them for behaving unprofessionally, but offers a view that needs to be evaluated.]

As trans people, we enter into a uniquely intimate relationship with our physicians and therapists. Unfortunately, we still may fear that our helping professionals will out us or otherwise treat us differently than their non-trans patients/clients.

Trans people who are on (or desire) hormones, often fall victim to the mindset that physicians wield a great amount of power, control, and authority in our lives. We sometimes get brainwashed into believing that we don't have any rights in our medical care. We feel we must go along with our doctors, because they have something that we need, and we must silence our voices, always agree, and be passive patients.
The Harry Benjamin Standards of Care once intended as beneficent guidelines for the care of the transgendered by their creator have become a dictatorial manifesto for the systemized victimization of transgendered individuals by "caring" therapists and physicians. This widespread adherence to the HB Standards of Care often makes transgendered people feel like second class citizens, continually realizing just how fragile and vulnerable we are to the immense power that our therapists and physicians have over us.

Many physicians in the Midwest (as well as all over the country, since this is not an isolated issue), are abusively treating their trans clients. Of course, every physician, regardless of who they are treating, have both good and bad qualities.
What I'm about to describe intersects with many circles of thought and a wide range of categories of injustice: anti-trans discrimination; issues surrounding the application of the Harry Benjamin Standards of Care - be it appropriately or not; lack of professionalism; borderline malpractice; and just plain poor manners.

One of the most dramatic incidences of abuse is by a practitioner who has decided to get his vicarious thrills out of asking all of his trans patients about the intimate details of their sex lives. At each visit, he repeatedly asks trans people about what kind of sex they have, with whom, how frequently, which orifice, how enjoyable is it for them, and specifically how they are using various body parts in the enjoyment of their sexuality. "Do you enjoy using your vagina for sex? You are receptive, right?… you aren't? How can you possibly satisfy a partner if you aren't being penetrated?" This practitioner asks these questions not because he is concerned about a potential sexually transmitted infection, not in hopes of educating his patients on safer sex techniques, nor to inquire about his patients' happiness, but rather out of a perverted sense of curiosity.
When a patient sees him for a cold, or for an infection, some of the first questions he asks are about sex, not about the presenting symptoms. Many have come to believe that they are both being inappropriately treated and cared for, but also receiving inferior care because the practitioner is more focused on his desire for sex information, than the reason the patient came to his office.

This clinician also seems overly preoccupied with the gynecological health of his FTM patients. "When was your last Pap smear? Do you engage in vaginal penetration? It's important to have routine pelvic exams, you know?" Of course these questions are very important in caring for FTM patients, as well as biological women. However, again, when the patient is being seen for a cold, and has had routine medical maintenance exams (clearly documented in his chart), what relevance do Pap smears have to do with the quality treatment of this patient? Does he just want to be able to physically touch his clients inappropriately, as well as verbally interrogate them about their sex lives?
Another extreme is another physician in that practice, who is also one of the few transgender care providers in the Midwest. He rarely asks his patients about gyn issues, or their sexuality. He avoids performing routine Pap smears on his patients because he bases his care on assumptions he's made about the health and wellness and sexual practices of his FTM patients. He believes that no FTMs engage in penile-vaginal penetration, and are thus, less likely to have cervical cancer, so believes that routine Pap smears are not important. When brave FTM patients have requested pelvic exams, he suggests the patient make another

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