Urogynecologists’ Engagement and Experience with Transgender/Gender Diverse Care

Objectives: Urogynecologists provide care to transgender and gender diverse (TGD) patients, yet education and training has yet to be formalized within our field. To date, there are also no urogynecology-specific guidelines on TGD care. We aimed to investigate U.S. urogynecologists’ knowledge, skills, behaviors, attitudes, and training experience regarding the care of TGD patients.

Methods: This original 30+ item survey was sponsored by the American Urogynecologic Society (AUGS) and distributed to its roughly 1200 members via two email campaigns in October 2023.

Results: 125/1200 respondents completed the survey (10% response rate). The majority of respondents (81/110, 74%) had not received any training in TGD patient care as part of their urogynecology fellowship. Education on TGD care outside of formalized training predominately occurred through conference presentations (88/112, 79%) and self-directed learning (69/112, 62%). Despite a lack of formalized training, TGD patients do seek care from urogynecologists. Respondents who see TGD patients reported patients predominately present for pelvic floor disorders (79/87, 91%), with a smaller percentage of patients seeking gender affirming surgical care consultations (27/87, 31%), or revisions of gender affirming surgeries (16/87, 18%). Respondents were asked what clinical guidelines and recommendations they would like regarding TGD care and indicated the following areas most frequently: hormone management in the perioperative period (78/100, 78%), gender affirming surgeries under the scope of urogynecology (66/100, 66%), management of ovaries during gender affirming hysterectomy (65/100, 65%), and management of pelvic organ prolapse in patients following gender affirming surgery (65/100, 65%). Importantly, 44% (44/100) of urogynecologists stated they would like more training in the medical and surgical care of TGD patients.

Conclusions: Despite TGD patients presenting to the urogynecologists’ office for care, the majority of urogynecologists have not received any formalized training in TGD care, underscoring a major educational gap. Given this discrepancy, nearly half of respondents believe that urogynecologists should receive training in TGD care. Fellowships should incorporate at minimum basic training in TGD care to equip providers with the skills and knowledge needed to provide sensitive and equitable healthcare. Lastly, no current urogynecology clinical guidelines exist regarding the care of TGD patients within our specialty and future efforts should be directed at clarifying recommendations to enable urogynecologists to care for TGD patients.