Pre-exposure Prophylaxis Awareness and Use Among Transgender and Nonbinary Individuals in Canada.

BACKGROUND: Transgender and nonbinary populations are disproportionately affected by HIV and face barriers to accessing HIV-related services. Pre-exposure prophylaxis (PrEP) may benefit those at risk of HIV acquisition. However, PrEP awareness and uptake, along with potential barriers and facilitators, have not been investigated among transgender and nonbinary individuals living in Canada. SETTING: This study analyzed data from 1965 participants of the 2019 Trans PULSE Canada survey, a national convenience sampling survey of transgender and nonbinary individuals in Canada. METHODS: Data were analyzed to estimate levels of PrEP awareness and uptake and to identify predictors of PrEP awareness among the study population. Prevalence ratios estimated from block-wise modified Poisson regression models were used to assess predictors of PrEP awareness. RESULTS: PrEP awareness, lifetime PrEP use, and current PrEP use were estimated to be 71.0%, 2.2%, and 0.9%, respectively, among the full sample, and 82.3%, 7.3%, and 3.8% among those with indications for PrEP use. Respondents who were aged 45 years or older, transfeminine, Indigenous, living in Atlantic Canada or Quebec, and had high school education or less were significantly less likely to be aware of PrEP. Lifetime sex work, past-year HIV/STI testing, being single or in a nonmonogamous relationship, and higher levels of emotional social support were positively associated with PrEP awareness. CONCLUSIONS: There is a need to improve PrEP awareness and particularly uptake among transgender and nonbinary individuals in Canada. This study revealed inequities in PrEP awareness within this population, which may serve as targets for future public health initiatives.

Gynecological concerns and vaginal practices and exposures among transfeminine individuals who have undergone vaginoplasty.

BACKGROUND: Vaginoplasty is a gender-affirming surgery that is medically necessary for some transfeminine individuals. Little research exists describing vaginal health after the initial recovery from surgery, and evidence-based guidelines for vaginal care practices are unavailable. AIM: The study sought to describe self-reported gynecological concerns and vaginal care practices among transfeminine persons who have undergone vaginoplasty. METHODS: A total of 60 transfeminine participants 18+ years of age, living in Canada, and who had undergone vaginoplasty at least 1 year prior were recruited through social media, community groups, healthcare provider referrals, and study recontact. Participants completed a cross-sectional, online questionnaire detailing demographics, gynecological concerns, and genital practices and exposures. Hierarchical clustering was used to group participants based on behavioral practices and exposures. Associations between clusters and gynecological concerns were assessed. OUTCOMES: Outcomes included self-reported gynecological concerns within the past year, recent vulvar or vaginal symptoms (past 30 days), and behavioral practices/exposures, including douching with varied products and dilating. RESULTS: Participants reported a variety of concerns in the past year, including urinary tract infection (13%) and internal hair regrowth (23%). More than half (57%) had experienced at least 1 recent vaginal symptom, most commonly malodor (27%) and vaginal bleeding (21%). Of participants, 48% were dilating weekly and 52% reported douching in the past 30 days. Four distinct clusters of vaginal practices/exposures were identified: limited exposures; dilating, no douching; dilating and douching; and diverse exposures. No significant associations between cluster membership and gynecological concerns were identified, though cluster membership was significantly associated with surgical center (P = .03). Open-text write-ins provided descriptions of symptoms and symptom management strategies. CLINICAL IMPLICATIONS: The results provide insight for clinicians on common patient-reported gynecological concerns and current vaginal care practices and exposures, including symptom management strategies. STRENGTHS AND LIMITATIONS: This was the first study to investigate vaginal health and genital practices/exposures among a community sample of transfeminine individuals. As participants self-enrolled for a detailed survey and swab collection, individuals experiencing concerns were likely overrepresented. CONCLUSION: Transfeminine individuals reported a range of gynecological concerns outside of the surgical healing period. Genital practices/exposures varied across clusters, but no clear associations between clusters and symptoms were identified; instead, practice/exposure clusters were dependent on where the individual underwent vaginoplasty. There is a need for evidence to inform diagnostics, treatments, and vaginal care guidelines to support vaginal health.

The Effect of Gender-Affirming Medical Care on the Vaginal and Neovaginal Microbiomes of Transgender and Gender-Diverse People.

Transgender and gender diverse individuals may seek gender-affirming medical care, such as hormone therapy or surgery, to produce primary and/or secondary sex characteristics that are more congruent with their gender. Gender-affirming medical care for transmasculine individuals can include testosterone therapy, which suppresses circulating estrogen and can lead to changes in the vaginal epithelium that are reminiscent of the post-menopausal period in cisgender females. Among transfeminine individuals, gender-affirming medical care can include vaginoplasty, which is the surgical creation of a vulva and neovaginal canal, commonly using penile and scrotal skin. The effect of gender-affirming medical care on the vagina of transmasculine individuals and on the neovagina of transfeminine individuals is poorly characterized. This review summarizes what is known of the epithelium and local microbiota of the testosterone-exposed vagina and the neovagina. We focus on potential pathogens and determinants of gynecological health and identify key knowledge gaps for future research.