Thread by @KiraNewmanMDPhD

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD 1/🏳️‍🌈🏳️‍⚧️#LGBTQ+ includes many diverse groups.

🔖Helpful reference from @FenwayHealth: lgbtqiahealtheducation.org/publication/lg…

🔑Caveats:
👥Definitions vary across communities
💬Terms change frequently
⭐️If unsure, ask what terms someone would like you to use.

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth 2/Ask all patients verbally or on registration form:
✅Pts expect to be asked
✅Pts think it's important for HCP to know
✅Gender identity & sexual orientation affect care

⚠️Don't assume pronouns from appearances

@theNASEM👉
nap.nationalacademies.org/catalog/26424/…

✅#Genderbread👇

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM 3/#LGBTQ+ health #disparities

Access
-13% LGB+ ppl uninsured
-25% trans ppl had insurance deny gender-affirming care in last yr

Discrimination
-33% trans ppl had neg experience/harassment/refusal in healthcare in last yr
-LGBTQ+ ppl delay/avoid care b/c fear of discrimination

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM 4/#LGBTQ+ health #disparities, cont.

#MentalHealth
-⬆️Depression, anxiety
-LGBTQ youth 2-5x ⬆️ likely to attempt suicide (@afspnational 👇)

#Cancer
-Lesbian women 4x ⬇️ likely to have pap than straight women
-Gay/bisexual men 17x ⬆️ likely to get anal cancer than straight men

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM @afspnational 5/#LGBTQ+ health #disparities, cont.

Comorbidities
-Obesity ⬆️lesbian/bisexual women vs straight women (data 👇)
-Eating disorders ⬆️ common in LGBTQ+ people

STIs
-Variable incidence by sexual orientation, gender identity. ⬆️ in gay/bi men, LGB nonbinary ppl, trans women

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM @afspnational 6/#LGBTQ+ health #disparities, cont.

Substance use🚬🍷🍺💉💊
-⬆️ rates of SUD (@samhsagov 👇), often comorb w/ anxiety or depression
-Only 7% of SUD trt programs have LGBTQ-specific services

Trauma
-⬆️ rates of #IntimatePartnerViolence (@CDCgov 👇)
-⬆️ rates of sexual violence

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM @afspnational @samhsagov @CDCgov 7/Bathrooms are a major #LGBTQ #IBD issue

❗️Many states have proposed anti-#trans “#bathroom bills” to prevent access
🚽Few gender-neutral public restrooms

@CrohnsColitisFn is adding gender-neutral bathrooms to the “We Can’t Wait” app
crohnscolitisfoundation.org/wecantwait

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM @afspnational @samhsagov @CDCgov @CrohnsColitisFn 8/Considerations with #Gender-affirming treatments and #IBD

-Do trans ppl feel safe asking #IBD doc/in clinic?
-Hormones and risk of IBD flare?
-Use of colon/ileum for neovagina in quiescent IBD?
-Safety/outcomes of scrotoplasty for ppl w hx fistulizing Crohns?

❗️Need data❗️

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM @afspnational @samhsagov @CDCgov @CrohnsColitisFn 9/Pearls for #Trans-Affirming Care 🏳️‍⚧️

⭐️How to say it/ document it / make it right

(h/t @COREIMpodcast)

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM @afspnational @samhsagov @CDCgov @CrohnsColitisFn @COREIMpodcast 10/Most studies on sexual function & fertility in #IBD don’t include #LGBTQ

Some❓s:
-How sex for LGBTQ+ ppl affected?
-Recs re: receptive anal sex in pt w IPAA? Proctitis?
-Fertility for LGBTQ+ with IBD?

⚠️Note: straight & LGBTQ+ people engage in anal sex, NOT only gay men

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM @afspnational @samhsagov @CDCgov @CrohnsColitisFn @COREIMpodcast 11/No #LGBTQ-specific #IBD data

📊Likely that disparities overall impact #IBD patients, too

⭐️Need for more awareness and research to develop best practices

One paper on qualitative aspects of #LGBTQ #IBD pts:
magonlinelibrary.com/doi/abs/10.129…

@MondayNightIBD @JosephHabibi_MD @VictorChedidMD @ManuelBragaMD @doctornikkid @agoldowskymd @DougSimonetto @dr_chhabrag @DrMalSimons @TolgaGidenerMD @HowardTLeeMD @FenwayHealth @theNASEM @afspnational @samhsagov @CDCgov @CrohnsColitisFn @COREIMpodcast 12/Time for discussion!🗣️

❓Do you feel that being #LGBTQ+ impacts #IBD?

❓If not confident with #LGBTQ-specific #IBD care, what would help you feel more confident?
📚Is it educational?
👥Cultural?
⚕️Clinical experience?
❓Something else?

#MondayNightIBD #GItwitter