Jordan previously experienced recurrent urinary tract infections (UTIs) and has recently been living with chronic pelvic pain. In their 20s, Jordan repeatedly contracted UTIs that they think were connected to sexual trauma. The infections brought on urinary urgency and pain, which were sometimes “unbearable”. Jordan went to see their GP for treatment and found the diagnosis to be “quite clear cut”. Based on a positive dipstick test result, the GP prescribed antibiotics. Jordan received several courses of antibiotics from their GP and once made use of an out of hours GP service. Jordan found their GPs to be helpful and felt that they had been listened to. As of now, Jordan’s recurrent UTIs haven’t flared up in several years.
More recently, Jordan began to experience chronic pelvic pain. They felt less certain about seeking care for this than with UTIs, as it felt “easier for me to kind of live with”. After several months, Jordan went to see their GP, who referred them on to gynaecology. Jordan is still awaiting a formal diagnosis but has been told that it is likely endometriosis (a condition where tissue similar to the lining of the uterus grows in other places, such as the ovaries and fallopian tubes). They are currently waiting on a laparoscopy referral, which initially got rejected because of Jordan’s gender identity. Jordan found this upsetting, as they are living with pain and their gender “ought not to make any difference whatsoever”. They were also recently treated for pelvic inflammatory disease, which has made it difficult to identify where symptoms stem from.
Currently, Jordan tries to manage their chronic pain and its impacts on their mental health. They question the potential relationship between their chronic pain and trauma-related mental illness. When seeking care, Jordan brings this up to doctors as “contextual information”. Jordan tries to ensure that their health issues are not “all my life is”, and finds positivity in their close relationships, hobbies, and art. Generally, Jordan feels comfortable talking to people they’re close to about their pelvic issues. They think that it may me more difficult to talk about urogynaecological issues than gynaecological ones, as they carry a “sense of shame”.
Jordan thinks that their care is sometimes affected by healthcare professionals making assumptions about their gender identity. Although Jordan medically transitioned in their teens, they now tend not to define their gender identity and sees themselves in a “plural way” in being masculine and feminine. At times, their care has felt “limited” or “awkward” based on the clinician assuming Jordan identifies as male. Jordan appreciates when healthcare professionals ask about how they identify and whether they want to be put on a male or female ward. This has allowed Jordan’s treatment to “follow the path that was best for me”. Jordan notes that since they are perceived as a well-educated, white male doctors may be more inclined to listen to them. In some cases, they feel that assumptions are also made based on their mental health diagnoses.
Based on their medical interactions, Jordan senses that doctors sometimes feel that treating gender non-conforming people is beyond their training. Jordan thinks that the physiological changes that may be associated with gender transition “ought not to be a barrier” to physicians treating patients. They encourage medical professionals to “see each person as an individual”. Jordan also thinks that improvements could be made to women’s health resources to ensure they are “inclusive for everyone”. While they think cisgender women’s needs are of “equal importance”, they think it could be less alienating to address that not everyone accessing women’s health services identifies as female.
Jordan thinks that medical care for chronic conditions could be improved by practitioners offering more in-depth examination and advice. They recommend measures like book prescription schemes to give longer-term support on coping with pain. Jordan also thinks that early intervention is important, as diagnosis can be a “supportive framework”. From their experience, good healthcare is when practitioners are empathetic, curious, and kind. As a patient, they sometimes feel they are “doing a dance” to try to seem appreciative and ask for just enough out of their doctor. To others with similar health issues, Jordan recommends to “keep pursuing help until something pays off”. Jordan would also like to see the public talk about gynaecological and urogynaecological issues without shame.
Jordan has chronic pelvic pain associated with pelvic inflammatory disease. Some symptoms are similar to that of UTIs, which sometimes made it difficult “trying to tease apart the symptoms”.
Jordan has chronic pelvic pain associated with pelvic inflammatory disease. Some symptoms are similar to that of UTIs, which sometimes made it difficult “trying to tease apart the symptoms”.
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So that’s, that’s sort of certainly been sort of an aspect of it and I think, you know, in terms of when I had the infection the kind of trying to tease apart the symptoms that were more associated with that and the rationale for treating it as an infection versus the fact that I experience pain kind of as an ongoing thing anyway.
[I had] a different clinician at one point who was saying that although I was treated for the infection, that pelvic inflammatory disease as a kind of diagnostic label itself is associated with a, you know, just a bit of vagueness and I think, I dunno, the impression I got is that’s it’s not necessarily a clinically helpful label when people are trying to offer treatment and assess and I think the impression I got is that that is particularly the case when there’s kind of ongoing chronic pain and that I think his preference was, you know, we use the term in a kind of descriptive way in terms of how it was treated but not to place too much importance on the label itself and focus rather on, you know, kind of managing the ongoing kind of side of things and investigating for things like endometriosis so, you know, I’m kind of, kind of aware that all these things interact with one another and in some context they can complicate things.
Jordan has recently had a good healthcare experience around pronouns and not making assumptions about gender identity.
Jordan has recently had a good healthcare experience around pronouns and not making assumptions about gender identity.
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The thing that sort of strikes me is that I don’t feel like I’m necessarily straightforwardly trans as maybe the general narrative among healthcare professionals would suggest in so far as I have, oh I transitioned at the age of 15, pursued living as male for some years after that with hormone treatment and chest surgery and then had a sort of a, I guess reinterpretation of my gender identity and how I sort of identity and that kind of involved reappraising some of the trauma that I’d been through before and kind of coming to see it more as a sort of a dissociative thing, not necessary in a pathological sense but just in a kind of identifying as a plu-, in a sort of plural way, and, you know, and then feeling as though there are kind of both female parts and male parts to me.
So I feel like where some clinicians have sort of interacted with me I think sometimes there’s an assumption that I’ve straight forwardly, you know, transitioned to an opposite gender and that’s it which then can make interaction kind of, either somewhat limited in terms of like I feel like there’s only so much they can understand what kind of needs I have in a, you know, in a healthcare setting or, you know, it, it maybe doesn’t necessarily impact on the care per se but I just feel very awkward in the interaction you know, or feel as though I’m being placed in a certain role.
And assumptions are put on me that, you know, may not actually be true. And I think like my recent experience when I actually was admitted with the infection to the hospital was really positive because I, I was kind of able to have the chance to explain exactly how I identify and, you know, in in as much detail as I wanted to. The people that I spoke to were completely fine with that and, you know, didn’t kind of make any assumptions whatsoever so you know, in terms of when it came to what ward I would be put on I was kind of given the choice of either a male ward or a female ward. Whereas, you know, previously I’ve kind of had interactions where it’s assumed I would want a male ward when in fact I would prefer a female ward. So just kind, just kind of having interaction where people have listened and asked the question have been really good.
Jordan feels that good health care is a “combination of kindness” and caring enough to “get to the bottom of what’s going on”.
Jordan feels that good health care is a “combination of kindness” and caring enough to “get to the bottom of what’s going on”.
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I think a combination of kindness and also wanting to be curious and get to the bottom of what’s going on for someone, you know, I think empathy has a massive part, you know, I I’m fully aware that there are plenty of doctors who, you know, could stare at their screen, not look at you in the interaction and still give you the right prescription at the end of it and treat your problem. But the actual sort of social side of that kind of interaction can feel, you know, kind of unnecessarily challenging I think, I think there’s a role for kindness just in being human and connecting with people who are clearly in some kind of physical or mental pain, you know, and even I think when there’s time pressure and stuff I don’t think, it takes a lot to make eye contact and, you know, smile and reflectively listen. You know, I think that should be a basic component of healthcare, you know, regardless of setting. But I think also, yeah like a drive to not take things for granted and to look a bit deeper into what might be going on for someone, you know, and not to necessarily take things at face value and to be able to pick up on, I don’t know, anomalies or just things that seem curious and to be willing to investigate.
Jordan’s gender identity has been a barrier to efficient care. They think that “speaking to the person and understanding their situation” is often all that is need to better accommodate gender non-conforming patients.
Jordan’s gender identity has been a barrier to efficient care. They think that “speaking to the person and understanding their situation” is often all that is need to better accommodate gender non-conforming patients.
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A recent referral to the hospital where I now live where the referral was rejected and sent back to the GP and supposedly, I don’t know, the overall message that both my GP and I were completely baffled was that they’re not equipped to handle my gender identity and we were just, we were just kind of thinking there, you know, there must be so many assumptions being made here, either that I have had some kind of surgery that affects, you know, my biology that then they don’t feel like they have an understanding of, you know, or maybe I’m seeking some kind of surgery that they don’t offer or, you know, there’s obviously some thought going on that is making them think there’s a valid medical reason as to why they can’t offer me something but there’s, you know, we haven’t either of us, my GP or I, had an opportunity to explain what the situation really is in any detail. So, I think, yeah that kind of assumption that, you know, transgender people or gender non-conforming people come with some kind of complexity that’s beyond, you know, the scope of any, you know, you know, scare quotes normal doctor, normal training doctor is just kind of a bit odd, I think.
I think I dunno what, I think it would be helpful for clinicians to know just know, that anyone, you know, anyone who’s medically trained ought to be able to provide care to someone who identifies, you know, as transgender or gender non-conforming just purely on the basis of, you know, yeah sometimes biology may be different, you know, in terms of hormone treatment or surgeries and stuff but a) that’s not necessarily the case and b) even if it is the case, I mean it ought not to be a barrier. Speaking to the person and understanding their situation will usually clarify that.
Jordan wants healthcare professionals to “assume the widest and broadest possible way of understanding gender nonconformity” and not to make assumptions.
Jordan wants healthcare professionals to “assume the widest and broadest possible way of understanding gender nonconformity” and not to make assumptions.
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I think the only thing I would want to emphasise again on the sort of trans specific side of things would be I think for clinicians to just assume the widest and broadest possible way of understanding gender nonconformity whatsoever. I think that, you know, there’s, you know, in previous years there’s been more of a drive of understanding, you know, transitioning and you know, trans men wanting to be seen as men, trans women wanting to be seen as woman and I think in more recent years there’s been a bit more narrative around like, you know, non-binary identities or, you know, if not using those exact terms, just, you know, different kind of ways of being trans and I kind of fear that maybe the previous narratives around, you know, straightforward transitions and stuff maybe are still instilled in some clinicians minds so I would yeah just kind of say try and just rid your mind of all of that, see each person as an individual and just find out where they’re at and treat them with respect and that’s kind of it.
