Prevalence of Sexual Assault in a Cohort of Transgender and Gender Diverse Individuals

INTRODUCTION

An American is sexually assaulted every 68 s.¹ Sexual assault affects people of all gender identities. In fact, almost half of transgender and gender diverse (TGD) individuals have been sexually assaulted in their lifetime.² The incidence of sexual violence is even higher among TGD people of color.² Relative to cisgender people, transgender individuals not only are at an elevated risk of experiencing at least one form of physical or sexual violence, but also at an increased risk of multiple types of violence over their life course.³ TGD individuals also often have complex needs after an assault, and there is limited or no access to services that meet these needs.⁴ For those that are able to access services, there is often a lack of awareness and competence among healthcare providers.⁵ The purpose of this study is to determine the prevalence of sexual assault in a cohort of TGD individuals in order to improve the healthcare experience for this population.

METHODS

TGD individuals participated in an online survey between 2017 and 2018 which assessed participant demographics, medical history, and history of sexual assault. The survey was piloted by a convenience sample of ten TGD individuals. People were eligible to participate if they were between 18 and 64 years of age and identified as TGD. Participants were recruited on social media, listservs, and by postcards distributed at conferences and social events. Informed consent was obtained. Descriptive statistics were used to analyze the data. The survey was approved by the Institutional Review Board (IRB) at Atrius Health and the University of Miami and was available online between May 1st 2017 and October 31st 2018 via SurveyMonkey.

RESULTS

Nine hundred ninety-six TGD individuals completed the survey. The mean age of participants was 28 (SD 10). The majority of respondents were white (810, 85%) and non-Hispanic (859, 89%). Seven hundred eighty-seven (79%) individuals identified as transmasculine or assigned female at birth, and 209 (21%) as transfeminine or assigned male at birth. Forty-seven percent of all respondents have experienced sexual assault. Of those that have been assaulted, 362 (46%) were transmasculine and 72 (34%) were transfeminine (Table 1).

Table 1.

Demographic Information

DISCUSSION

Healthcare providers need to be aware that half of their TGD patients have been a victim of sexual assault. Universal screening for trauma and trauma-informed care should be implemented to help establish a secure and affirming environment. Because medical examinations may be particularly stressful for TGD people even under ideal conditions, it is important to create a safe space that allows these patients to feel comfortable discussing their concerns. While taking a history, healthcare providers should be mindful of names and pronouns, avoid making assumptions about sexual orientation and practices, validate experiences and emotions, and collaborate with patients on the plan of care. Patient-centered communication and care can be accomplished by asking for patient input and can help to establish trust⁶. During the physical examination, steps can be taken to ensure patients feel comfortable including allowing a support person, using preferred terms for anatomy, and only performing a pelvic examination if necessary. A trauma-informed care perspective can enable TGD individuals to feel empowered during a difficult visit.

A limitation of this study is the lack of diversity among survey respondents as most were white and had insurance. However, this would likely mean that the actual percentage of TGD individuals experiencing sexual assault is increased, since TGD people of color have higher rates of sexual violence. More research is needed on the best ways to support TGD people after an assault has occurred.

Declarations

Conflict of Interest

The authors report no conflict of interest or financial disclosures