Victim Issues

Some transgender people have a negative body image; they may be so uncomfortable with their chests, for example, that they do not allow health care providers to listen to their heart or lungs during routine exams. Being sexually assaulted may cause transgender patients to shut down and make them unable or unwilling to discuss their bodies during an exam or even be unable to accurately describe bodily sensations/symptoms. In these cases, maintain eye contact, engage the patient verbally, be patient, acknowledge that the topic may be uncomfortable, but ultimately be respectful of a patient's boundaries. As one survivor put it, "The [procedures] are more intrusive if you are uncomfortable with your body in the first place. [Health care professionals] need to understand that."¹

Other techniques for reassuring patients with poor body image include the following:

• Work with the patient to develop examination strategies that will work for them (e.g., listening to the heart and lungs through clothing).
• Before beginning the exam and then throughout, tell patients what will be done and why. This explanation is particularly critical for transgender people because their bodies may have been the object of curiosity (at best) and revulsion or violence (at worst). Telling patients why a procedure is medically necessary will give them greater confidence that it is appropriate to their medical care and not being done to satisfy your curiosity. (This practice also allows the patient to say no to any part of their medical care, letting them set and maintain boundaries.)
• If possible, allow patients to have a loved one or advocate present during the exam. Knowing that there is someone in the room who knows their transgender identity and will advocate on their behalf can be very reassuring. Of course, it is vital to screen the companion/loved one to make sure that this person is not the perpetrator (see Companions as Abusers in this e-pub).
• Many urgent care or forensic care facilities have dolls with detailed anatomy. Some transgender patients may find it easier to identify injuries, pain, or assault experiences through these assistive devices. (Offer multiple-gendered dolls, if available.)
• If needed, offer patients paper and pencils so that they can draw or write if they are unable to articulate or use other means to communicate.

Some transgender people have a negative body image, so being sexually assaulted may cause them to shut down and make them unable or unwilling to discuss their bodies or the assault. Be respectful of a patient's boundaries.

Some transgender people have a negative body image. Due to this discomfort with their bodies, they may be reluctant to discuss what happened during the sexual assault. Although many survivors have difficulty reporting details of their assault, transgender victims may have the added layer of not wanting to talk about specific parts of their bodies that they feel disconnected to or about which they feel embarrassed or ashamed. This may be especially true, for example, if law enforcement does not know that the victim is transgender and the assault violated a part of the body that is not typically associated with the gender the officer perceives the individual to be.

Some transgender people are unable or unwilling to discuss their bodies because of poor body image. Being sexually assaulted may cause transgender victims to shut down even more. If this is the case, consider using dolls with detailed anatomy. Some transgender patients may find it easier to identify injuries, pain, or assault experiences through these assistive devices. (Offer multiple-gendered dolls, if available.) If needed, offer patients paper and pencils so that they can draw or write if they are unable to articulate or use other means to communicate.

Mental health providers who are helping survivors work through the aftermath of sexual assault need to take extra steps to be sensitive to transgender clients' needs. Be aware that transgender survivors may need your “permission” and extra support before they can talk about how the assault affects how they feel about their bodies and/or gender. Sexual assault may play a pivotal role in how people perceive their bodies and which course they pursue related to gender. It also is critical to determine and reflect the terms clients use to refer to their body and identity. See Preferred Language: Implications and Actions for Therapists in this e-pub for more information.

Support group facilitators who are helping survivors work through the aftermath of sexual assault need to take extra steps to be sensitive to transgender clients' needs. Be aware that transgender survivors may need your "permission" and extra support before they can talk about how the assault affects how they feel about their bodies and/or gender, especially in a group setting. Sexual assault may play a pivotal role in how people perceive their bodies and which course they pursue related to gender.

Some support group participants may find the complicated stories of some transgender survivors challenging and confusing. Though it is important not to silence a transgender survivor's narrative about body image, you must not let the unique challenges of one survivor take the focus away from other group members or from discussion that benefits most or all in the group. One way to help this process is to draw comparisons between the experiences of transgender and non-transgender group members. Note, for example, how all people have different perceptions about their bodies. Drawing out similarities will help the transgender person feel less isolated and different and will help other group members see how human experiences are just that—human, not transgender or non-transgender.