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Are We Preparing Patients for Gender-Affirming Surgery? A Thematic Social Media Analysis

2020; Lippincott Williams & Wilkins; Volume: 146; Issue: 4 Linguagem: Inglês

10.1097/prs.0000000000007192

1529-4242

Kyle R. Latack, Widya Adidharma, Dominic Moog, Thomas Satterwhite, Miriam Hadj-Moussa, Shane D. Morrison,

Names, Identity, and Discrimination Research

Sir: Gender-affirming surgery, procedures that align one's appearance with their gender identity, are becoming more common.1 However, there remain many barriers in transgender care.2,3 Among many reasons, distrust of the medical field and fear of discrimination are contributing factors to why the transgender community frequently turns to social media for medical information and advice.4 Our study aims to characterize the types of questions raised about gender-affirming surgery online. Providers can use this information to understand topics most important to patients, fill in knowledge gaps regarding gender-affirming surgery, and initiate discussion on sensitive topics patients may not know how to introduce. Two social media platforms were analyzed: Reddit and Quora. We analyzed the subreddits r/asktransgender, r/MtF (male-to-female), and r/FtM (female-to-male). Questions about gender-affirming surgery were identified through searches for gender-affirming surgery–related terms on platform built-in search engines and coded into categories developed a priori (Table 1). On Quora, all questions were analyzed, whereas on Reddit, the search was limited to 6 months because of content volume. A subset of data (10 percent) was used to confirm intercoder (K.R.L., W.A., and D.M.) reliability. Posts were coded postoperatively if the user explicitly mentioned already having completed surgery. Table 1. - Breakdown of Questions by Category* Category Keywords† Frequency (%) Paraphrased Examples Treatment options Types of operations, procedure options Preoperatively, 57 (9.2); postoperatively, 2 (1.5) Can someone explain the different types of vaginoplasties? Provider selection Locations, experiences Preoperatively, 64 (10.3); postoperatively, 0 (0) What surgeons are in X part of the country? Finance Costs, planning Preoperatively, 65 (10.5); postoperatively, 1 (0.8) Which companies offer coverage for top surgery? General information/resources Where to find more information Preoperatively, 49 (7.9); postoperatively, 0 (0) What are good websites for encouragement? Societal How surgery fits into society in general, managing government documents, bathing suits/bathrooms Preoperatively, 59 (9.5); postoperatively, 3 (2.3) Worried about being denied entry into X country Personal Emotions, mental health, individual experiences with surgery Preoperatively, 101 (16.3); postoperatively, 24 (18.3) Anyone else have continued dysphoria postoperatively? Risks/side effects Adverse outcomes from surgery, unexpected Preoperatively, 34 (5.5); postoperatively, 3 (2.3) Vaginal odor postoperatively Surgical preparation/preoperatively other Hormone use before, logistics of surgery travel, preparing for surgical consultations Preoperatively, 72 (11.6); postoperatively, 1 (0.8) What to ask surgeon at first consultation Sexual function Orgasm, sexual ability, return to sexual activities Preoperatively, 46 (7.4); postoperatively, 12 (9.2) How long after surgery before feeling pleasure? Urinary function Urination, urethra Preoperatively, 3 (0.5); postoperatively, 0 (0) Are there complications with urination after surgery? Appearance Color, scars, general appearance of outcomes Preoperatively, 21 (3.4); postoperatively, 22 (16.8) How to reduce top surgery scars General recovery Recovery path, daily activities Preoperatively, 48 (7.7); postoperatively, 29 (22.1) When can I start exercising? Surgical equipment Drains, catheters, sutures Preoperatively, 0 (0); postoperatively, 21 (16.0) My stitches are coming loose, is that a problem? Pain Pain experience and management, numbness Preoperatively, 1 (0.2 (1); postoperatively, 13 (9.9) How to tell if pain is abnormal *Search terms: Gender affirming surgery, top/bottom surgery, phalloplasty, and vaginoplasty.†Keywords used for coding. Examples paraphrased to keep original post as anonymous as possible. Six-hundred twenty preoperative and 131 postoperative questions were identified. Kappa agreement between coders was greater than 0.7. Personal questions, those regarding an individual's emotions and experiences with the surgical process, were the most popular category preoperatively and the second most popular postoperatively (16.3 percent and 18.3 percent, respectively) (Table 1). Challenges with mental health and continued dysphoria were common themes within the postoperative personal questions [n = 6 (25.0 percent)]. Other common postoperative categories were general recovery, appearance, and surgical equipment. Surgical preparation, finances, and provider selection were common preoperatively. In both the surgical preparation and recovery categories, questions about hormonal therapy (continued or cessation) were common [n = 16 (22.2 percent) and n = 7 (24.1 percent), respectively]. Our results contribute to the growing literature of social media use in the transgender community by analyzing the gender-affirming surgery–related content. Questions regarding surgical equipment (e.g., sutures and drains) and appearance were common in the postoperative period. Before surgery, surgeons can specifically emphasize expected postoperative outcomes and what symptoms require seeking care. Sensitive themes such as sexual function, mental health, and personal questions were also common. Patient navigators, peers, or medical professionals who help patients navigate a complex health system have been shown help improve distrust within the medical field.5 Increasing the presence of such navigators in gender clinics could help facilitate sensitive discussions and provide personal advice. Limitations to this study include the fact that data were gathered from only two platforms over a limited period. However, the platforms chosen are large, anonymous communities designed for discussion, and accounts are not required to access content. Understanding the questions raised on social media can help physicians ensure that patients are receiving accurate and complete information about their procedures, open up discussion on sensitive topics, and set postoperative expectations. Given the high frequency of personal questions, gender clinics may benefit from the use of patient navigators as a way to provide support and increase trust in health care providers. DISCLOSURE The authors have no financial interests to disclose in relation to the content of this article.