LGBT+ Related Pain & The Impact of Stigma
It is no surprise that members of lesbian, gay, bisexual, and transgender communities face discrimination and barriers to health care. Less discussed is how members of the LGBT+ communities combat both physical and psychological pain. Although many members of the LGBT community experience disproportionate rates of chronic pain and mental health, certain barriers to healthcare unfortunately perpetuate the relationship between stigma and poor health. The following article will discuss a variety of LGBT+ pain conditions, ultimately explaining the complicated relationship between physical and mental pain.
Before discussing the implications of physical pain, it is imperative to acknowledge the psychological role of stigma in pain. Experiencing discrimination plays a huge part in the relationship between physical and mental health. In general, studies have shown that lesbian, gay, and bisexual individuals often report more physical health complaints than heterosexual individuals (3). It is estimated that these reports are associated with experiencing discrimination. The minority stress theory is one hypothesis which may explain pain disparities among LGBT individuals. According to this model, stressors associated with stigma (i.e. homophobic jokes, hate crimes, etc.) cause a great level of anxiety, ultimately resulting in negative health outcomes (2). Examples of such health outcomes range anywhere from pelvic pain to chronic migraines. Severity and type of pain often depends on social status and health conditions associated with certain identities.
For example, gay and bisexual men experience HIV-related pain at disproportionate rates. Although antiretroviral therapy (ART) is a beneficial method of HIV treatment, it is not uncommon for HIV-positive patients to experience comorbid symptoms of chronic pain (7). The etiology of such pain may be mediated by psychological implications of HIV. For example, depression, chronic pain, and pain severity are highly correlated (8). In one study, HIV-positive patients with moderate-severe chronic pain had significantly higher levels of depression symptoms than those without chronic pain (8). Psychological pain associated with HIV involves both substance abuse (i.e. using illegal drugs) and risky sexual behaviors (i.e. unprotected sex) (4). It is important to note that substance abuse may be both a cause and and effect of HIV-related pain.
Both psychological and physical pain directly impact the transgender community at high rates as well. For example, transgender men report high rates of pelvic pain associated with menstruation as well as the emotional pains of chronic stress and PTSD (6). Furthermore, transgender men taking testosterone report pain associated with cyclical testosterone dosing, pelvic, vaginal, or orgasmic pain (6). Transgender individuals also report significant rates of chest pain which is often a result of anxiety and depression (5). Perioperative pain management, or interdependency between doctor and patient, is a critical and supportive method of helping transgender individuals manage pain.
Pain symptoms are often exacerbated by psychological health. For example, transgender patients often experience gender dysphoria, which involves the stress of feeling incongruence between gender identity and biological phenotype. Coupled with the stress of pain management, social and psychological factors which negatively impact transgender individuals must be taken into consideration when assessing overall health.
Coping mechanisms for dealing with LGBT-related pain often involve substance abuse. According to a 2008 study which analyzed health outcomes among lesbian, gay, and bisexual individuals, participants who abused substances were significantly more likely to experience homophobia and internalize negative beliefs about homosexuality (1). As previously mentioned, transgender men experience elevated rates of chronic pain associated with menstruation. It is estimated that 35% of transgender people with chronic pelvic pain additionally experience depression and/or PTSD (6). It is therefore no surprise that the linkage between substance abuse may correlate with mental health conditions as well as chronic pain. To combat the negative effects of psychological and physical pain, it is recommended that members of the LGBT community seek effective coping strategies such as therapy, community outreach, and consultations with medical professionals.
Treatment for LGBT-related pain various across dimensions based on the experience of the individual. For example, transgender individuals may use nonsteroidal anti-inflammatory drugs (NSAIDS) to cope with health conditions such as vaginitis, STIs, or cervicitis to name a few (8). Oftentimes, treatment for gender-related issues may perpetuate pain itself. Cyclical testosterone dosing, for instance, is often associated with pelvic pain as well as orgasmic and penetration pain (8). Patients experiencing pain associated with gender and sexual orientation should always consider speaking to medical professionals for both mental and physical health. HIV-related spondyloarthropathy, a type of chronic joint pain, may be treated with NSAIDs such as indomethacin zidovudine as well (9).
As with any cluster of medical conditions, LGBT+ related pain is complicated, yet not unmanageable. According to Dr. Nadav Antebi-Gruzka, who researches resilience among LGBT+ individuals, “context really matters.” Patients experiencing pelvic pain associated with gender dysphoria, for example, may require more access to mental and physical health resources. Alternatively, providing LGBT+ patients with a welcoming, accepting environment when seeking medical attention may allow said patients to experience better health outcomes. According to Dr. Antebi-Gruszka, society-level resilience which promotes overall health includes programs and campaigns that eliminate stigma and create supportive communities. As always, pain should be recognized as a physical and psychological condition. By promoting this sort of awareness, as well as compassion and empathy within the medical community, members and allies of the LGBT+ community can fight the negative health outcomes of social stigma.
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Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016.
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