Authors' results and conclusions:  Ten documents were included that focused on care specific to transgender and nonbinary individuals and six documents were included that focused mainly on care for cisgender women.  The American Society of Anesthesiologists (ASA) guideline regarding pregnancy screening prior to anesthesia and surgery (amended in 2021) recommended that pregnancy screening may be offered to female sex patients of childbearing age and for whom the result would alter the patient’s management, but testing should not be mandatory. Informed consent or assent of the risks, benefits, and alternatives related to preoperative pregnancy testing should be obtained.  In general, guidance surrounding pregnancy screening protocols is limited and lacks inclusivity (i.e., for non-cisgender patients); however, it was commonly recommended that providers should have sensitive discussions with patients about pregnancy testing based on a patient's anatomy, pregnancy potential, and sexual behavior. Discussions should be documented, and protocols should be audited. Published guides to exclude pregnancy, e.g., from the Centers for Disease Control and Prevention (CDC), may be helpful.  For transgender patients, the use of appropriate terminology and affirming language is essential. One commentary focused on how to take a transgender-inclusive sexual health history and recommended using open-ended questions.  Protocols should be in place for identifying transgender patients to ensure appropriate and considerate screening and avoid improperly flagging results or cancelling of tests based on sex specificity.  Fields can be used within the electronic health record (EHR) to document gender, sex, and organ information to provide an inclusive care environment and prevent medical mishaps.

Authors' recommendations:  Ten documents were included that focused on care specific to transgender and nonbinary individuals and six documents were included that focused mainly on care for cisgender women.  The American Society of Anesthesiologists (ASA) guideline regarding pregnancy screening prior to anesthesia and surgery (amended in 2021) recommended that pregnancy screening may be offered to female sex patients of childbearing age and for whom the result would alter the patient’s management, but testing should not be mandatory. Informed consent or assent of the risks, benefits, and alternatives related to preoperative pregnancy testing should be obtained.  In general, guidance surrounding pregnancy screening protocols is limited and lacks inclusivity (i.e., for non-cisgender patients); however, it was commonly recommended that providers should have sensitive discussions with patients about pregnancy testing based on a patient's anatomy, pregnancy potential, and sexual behavior. Discussions should be documented, and protocols should be audited. Published guides to exclude pregnancy, e.g., from the Centers for Disease Control and Prevention (CDC), may be helpful.  For transgender patients, the use of appropriate terminology and affirming language is essential. One commentary focused on how to take a transgender-inclusive sexual health history and recommended using open-ended questions.  Protocols should be in place for identifying transgender patients to ensure appropriate and considerate screening and avoid improperly flagging results or cancelling of tests based on sex specificity.  Fields can be used within the electronic health record (EHR) to document gender, sex, and organ information to provide an inclusive care environment and prevent medical mishaps.

Project Status: Completed

Year Published: 2023

URL for published report: https://www.med.upenn.edu/CEP/submit-a-request.html

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Penn Medicine Center for Evidence-based Practice

Contact Address: Penn Medicine Center for Evidence-based Practice, University of Pennsylvania Health System, 3600 Civic Center Blvd, 3rd Floor West, Philadelphia PA 19104

Contact Name: Nikhil Mull

Contact Email: cep@pennmedicine.upenn.edu

Copyright: Center for Evidence-based Practice (CEP)