Saúde sexual e reprodutiva na população transgénero: uma revisão sistemática

Autores/as

  • Sílvia Martins Fernández Médica Interna de Medicina Geral e Familiar. USF São Neutel. Chaves, Portugal.
  • Alexandra Médica Interna de Medicina Geral e Familiar. USF Garcia de Orta. Porto, Portugal.
  • Raquel Araújo Almeida Médica Interna de Medicina Geral e Familiar. USF Alves Martins. Viseu, Portugal.

DOI:

https://doi.org/10.32385/rpmgf.v40i4.13937

Palabras clave:

Planeamento familiar, Saúde reprodutiva, Cuidados de saúde primários, População transgénero

Resumen

Introdução: O acesso a cuidados de saúde sexuais e reprodutivos seguros e de alta qualidade faz parte dos direitos e bem-estar de todas as pessoas. Há uma escassez de diretrizes clínicas específicas para a população transgénero (TG).

Objetivo: Esta revisão sistemática pretende descrever a abordagem da saúde sexual da população TG.

Métodos: Foi realizada uma revisão sistematizada em duas bases de dados, MEDLINE e Scopus, seguindo os Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. A qualidade dos estudos foi avaliada utilizando o Critical Appraisal Skills Programme Qualitative Checklist para estudos qualitativos e uma versão adaptada do Quality Assessment Tool for Cross-Sectional Studies. O protocolo foi registado na plataforma PROSPERO (CRD42022371962).

Resultados: Dos 671 artigos recuperados através da pesquisa, 13 cumpriram os critérios de inclusão e exclusão e foram selecionados para análise. Os fenómenos de interesse foram subdivididos em problemas relativos ao paciente e ao prestador de cuidados, contraceção, preservação da fertilidade e rastreio de cancro cervical. Os métodos contracetivos podem ser usados com vista à prevenção da gravidez, tendo também impacto na disforia de género. Uma percentagem significativa dos utentes TG acredita que a testosterona pode ser usada como método contracetivo, o que os impede de reconhecer o seu risco de engravidar. A escassez de educação formal dos profissionais de saúde neste tema, aliada à discriminação da população TG, contribui para o aumento dos mitos em saúde. A maioria dos TG deseja a parentalidade, não definindo preferência relativamente a filhos biológicos ou não. A realização de exame pélvico e rastreio do cancro cervical não é rotineira na população TG.

Conclusão: A presente revisão reforça a relevância e necessidade de desenvolver guidelines no âmbito da saúde sexual e reprodutiva da população TG. Os cuidados de saúde primários são de vital importância na gestão dos problemas de saúde desta população.

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Referencias

World Health Organization. Sexual health, human rights and the law. Geneva: WHO; 2015.

Bonnington A, Dianat S, Kerns J, Hastings J, Hawkins M, De Haan G, et al. Society of Family Planning clinical recommendations: Contraceptive counseling for transgender and gender diverse people who were female sex assigned at birth. Contraception. 2020;102(2):70-82.

Davidson M. Seeking refuge under the umbrella: inclusion, exclusion, and organizing within the category Transgender. Sex Res Social Policy. 2007;4:60.

Van Caenegem E, Wierckx K, Elaut E, Buysse A, Dewaele A, Van Nieuwerburgh F, et al. Prevalence of gender nonconformity in Flanders, Belgium. Arch Sex Behav. 2015;44(5):1281-7.

Calderon-Cifuentes PA. Trans discrimination in Europe: a TGEU analysis of the FRA LGBTI survey 2019 [homepage]. TGEU; 2021. Available from: https://tgeu.org/tgeu-report-on-trans-discrimination-in-europe/

Herman JL, Flores AR, O’Neill KK, et al. How many adults and youth identify as transgender in the United States? [homepage]. UCLA School of Law; 2022. Available from: https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/

European Parliament. Sexual and reproductive health and rights in the EU, in the frame of women’s health – P9_TA(2021)0314 [homepage]. European Parliament; 2021 Jun 24. Available from: https://www.europarl.europa.eu/doceo/document/TA-9-2021-0314_EN.html

Direção-Geral da Saúde. Estratégia de saúde para as pessoas lésbicas, gays, bissexuais, trans e intersexo – LGBTI. Vol. 1: promoção da saúde das pessoas trans e intersexo [Internet]. Lisboa: DGS; 2019. Available from: https://apmgf.pt/wp-content/uploads/2023/06/i025699.pdf

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Critical Appraisal Skills Programme. CASP qualitative checklist [Internet]. Oxford: CASP; 2018. Available from: https://casp-uk.net/images/checklist/documents/CASP-Qualitative-Studies-Checklist/CASP-Qualitative-Checklist-2018_fillable_form.pdf

National Institutes of Health. Quality assessment tool for observational cohort and cross-sectional studies [homepage]. London: NIH; 2021 Jul. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools

Haley SG, Tordoff DM, Kantor AZ, Crouch JM, Ahrens KR. Sex education for transgender and non-binary youth: previous experiences and recommended content. J Sex Med. 2019;16(11):1834-48.

Beswick A, Corkum M, D’Souza D. Locally advanced cervical cancer in a transgender man. CMAJ. 2019;191(3):E76-8.

Bentsianov S, Gordon L, Goldman A, Jacobs A, Steever J. Use of Copper intrauterine device in transgender male adolescents. Contraception. 2018;98(1):74-5.

Shires DA, Stroumsa D, Jaffee KD, Woodford MR. Primary care clinicians’ willingness to care for transgender patients. Ann Fam Med. 2018;16(6):555-8.

Agénor M, Cottrill AA, Kay E, Janiak E, Gordon AR, Potter J. Contraceptive beliefs, decision making and care experiences among transmasculine young adults: a qualitative analysis. Perspect Sex Reprod Health. 2020;52(1):7-14.

Forsberg H, Eliason MJ. Healthcare providers’ pregnancy prevention counseling of trans and non-binary assigned female at birth (TNB/AFAB) patients. J Homosex. 2022;69(2):356-83.

Nahata L, Chen D, Quinn GP, Travis M, Grannis C, Nelson E, et al. Reproductive attitudes and behaviors among transgender/nonbinary adolescents. J Adolesc Health. 2020;66(3):372-4.

Cipres D, Seidman D, Cloniger C 3rd, Nova C, O'Shea A, Obedin-Maliver J. Contraceptive use and pregnancy intentions among transgender men presenting to a clinic for sex workers and their families in San Francisco. Contraception. 2017;95(2):186-9.

Stark B, Hughto JM, Charlton BM, Deutsch MB, Potter J, Reisner SL. The contraceptive and reproductive history and planning goals of trans-masculine adults: a mixed-methods study. Contraception. 2019;100(6):468-73.

Reynolds CA, Charlton BM. Sexual behavior and contraceptive use among cisgender and gender minority college students who were assigned female at birth. J Pediatr Adolesc Gynecol. 2021;34(4):477-83.

Gomez AM, Đỗ L, Ratliff GA, Crego PI, Hastings J. Contraceptive beliefs, needs, and care experiences among transgender and nonbinary young adults. J Adolesc Health. 2020;67(4):597-602.

Light A, Wang LF, Zeymo A, Gomez-Lobo V. Family planning and contraception use in transgender men. Contraception. 2018;98(4):266-9.

Vyas N, Douglas CR, Mann C, Weimer AK, Quinn MM. Access, barriers, and decisional regret in pursuit of fertility preservation among transgender and gender-diverse individuals. Fertil Steril. 2021;115(4):1029-34.

Tishelman AC, Sutter ME, Chen D, Sampson A, Nahata L, Kolbuck VD, et al. Health care provider perceptions of fertility preservation barriers and challenges with transgender patients and families: qualitative responses to an international survey. J Assist Reprod Genet. 2019;36(3):579-88.

Rahman M, Li DH, Moskowitz DA. Comparing the healthcare utilization and engagement in a sample of transgender and cisgender bisexual+ persons. Arch Sex Behav. 2019;48(1):255-60.

Chen D, Kolbuck VD, Sutter ME, Tishelman AC, Quinn GP, Nahata L. Knowledge, practice behaviors, and perceived barriers to fertility care among providers of transgender healthcare. J Adolesc Health. 2019;64(2):226-34.

Fix L, Durden M, Obedin-Maliver J, Moseson H, Hastings J, Stoeffler A, et al. Stakeholder perceptions and experiences regarding access to contraception and abortion for transgender, non-binary, and gender-expansive individuals assigned female at birth in the U.S. Arch Sex Behav. 2020;49(7):2683-702.

Deutsch MB. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people [homepage]. 2nd ed. San Francisco: University of California-UCSF Transgender Care; 2016 Jun 17. Available from: https://transcare.ucsf.edu/guidelines

Weiselberg E. Menstrual considerations for transgender male and gender diverse adolescents who were assigned female at birth. Curr Probl Pediatr Adolesc Health Care. 2022;52(8):101239.

Becerra Pérez MM, Menear M, Brehaut JC, Légaré F. Extent and predictors of decision regret about health care decisions: a systematic review. Med Decis Making. 2016;36(6):777-90.

Wierckx K, Van Caenegem E, Pennings G, Elaut E, Dedecker D, Van de Peer F, et al. Reproductive wish in transsexual men. Hum Reprod. 2012;27(2):483-7.

Semlyen J, Kunasegaran K. Understanding barriers to cervical screening uptake in trans men: an exploratory qualitative analysis. Lancet. 2016;388 Suppl:104.

Direção-Geral da Saúde. Diagnóstico e estadiamento do cancro invasivo do colo do útero: norma n.º 018/2012, de 21/12/2012. Lisboa: DGS; 2012.

Santé Publique France. Baromètre santé 2010 [homepage]. Santé Publique France; 2016 Sep 27. Available from: https://www.santepubliquefrance.fr/etudes-et-enquetes/barometres-de-sante-publique-france/barometre-sante-2010

Subramaniam A, Fauci JM, Schneider KE, Whitworth JM, Erickson BK, Kim K, et al. Invasive cervical cancer and screening: what are the rates of unscreened and underscreened women in the modern era? J Low Genit Tract Dis. 2011;15(2):110-3.

Van Doorslaer E, Masseria C, Koolman X. Inequalities in access to medical care by income in developed countries. CMAJ. 2006;174(2):177-83.

Giffort DM, Underman K. The relationship between medical education and trans health disparities: a call to research. Sociol Compass. 2016;10(11):999-1013.

Van Gerwen OT, Jani A, Long DM, Austin EL, Musgrove K, Muzny CA. Prevalence of sexually transmitted infections and human immunodeficiency virus in transgender persons: a systematic review. Transgend Health. 2020;5(2):90-103.

Marshall Z, Welch V, Minichiello A, Swab M, Brunger F, Kaposy C. Documenting research with transgender, nonbinary, and other gender diverse (trans) individuals and communities: introducing the Global Trans Research Evidence Map. Transgend Health. 2019;4(1):68-80.

Publicado

2024-09-16

Cómo citar

Saúde sexual e reprodutiva na população transgénero: uma revisão sistemática. (2024). Revista Portuguesa De Medicina Geral E Familiar, 40(4), 363-73. https://doi.org/10.32385/rpmgf.v40i4.13937

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