NRU Pride

June is Pride month, which is dedicated to celebrating LGBT+ communities worldwide. It also provides an opportunity to celebrate these communities in our own field and to consider how we can improve inclusion and health care for LGBT+ patients in urology.

Learning to rectify my personal and professional identities has not always been easy, but finally getting to a place where the two can work together has led me to the most fulfilling portion of my career in urology.

Health-care inequality exists in marginalized groups such as the LGBT+ community. Having been involved in setting up a urological service to connect with this community, I reflect on how health-care organizations must prioritize the unmet needs of this group in order to strive for equality.

The BJU International paper by van de Grift and colleagues includes important data outlining the long-term cosmetic and functional outcomes for masculinizing surgery in patients born with differences in sex development. This overview highlights some of the important findings and their context in what can be a controversial subject.

Reassurance provided by pre-exposure prophylaxis (PrEP) for HIV might lead to increased sexual risk-taking in men who have sex with men (MSM), potentially increasing the risk of transmitting other infections. A recent study has shown increased transmission of hepatitis C virus (HCV) in this population, suggesting a need for HCV screening.

In a recently published study, surveys of transgender individuals on hormone therapy provide insight into the self-reported effects of medication where previous thinking was only speculative. Still, controlled studies are required to avoid overinterpreting the clinical significance of specific findings in the context of what might be expected in the general population.

In this Review, Amarasekera and colleagues consider the effect of prostate cancer diagnosis and treatment on men in sexual minority groups, including men who have sex with men and transgender women as well as men with HIV, and discuss how and why efforts to study this population are complicated and evolving.

Transgender persons can be affected by sexual dysfunctions before, during, after, because of, and despite therapy. In this Review, experts in the field discuss trans sexuality across the gender dysphoric spectrum, and suggest ways in which trans persons can be supported in their sexuality and sexual function.

Devices designed to enhance and diversify sexual pleasure are useful in clinical practice; however, many taboos still seem to exist and the scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use is sparse. In this Review, Dewitte and Reisman discuss the clinical use of sex toys and sexual devices, as well as sexually explicit media, across a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties.

For transgender people who experience gender dysphoria as children, in whom impending puberty is unacceptable for their psychosocial health and wellness, pubertal blockade is a therapeutic option. In this Review, the authors discuss pubertal blockade and its implications for fertility preservation, surgical care and psychosocial health, all of which must be considered and discussed with the patient and their family and/or legal guardian before initiation.

Gender transition can substantially improve quality-of-life in individuals with gender dysphoria, and various surgical options are available for female-to-male (FtM) transition, including facial and chest masculinization, body contouring, and genital surgery. In this Review, the authors describe the management of these patients, with a particular emphasis on the surgical techniques used, and consider developments that might improve outcomes for FtM patients in the future.