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Victim IssuesSexualityTransgender people can be any sexual orientation: heterosexual, lesbian, gay, bisexual, pansexual, queer, and many others.5 Transgender people may be monogamous or polyamorous.6 They may be casually dating or in long-term relationships. Some may be celibate or asexual (i.e., have no sexual attraction to others)—by choice or by circumstance. Some avoid sexual relationships altogether because they are uncomfortable with their bodies, they feel physically vulnerable, or they fear not being seen as the gender they see themselves. Others have abstained for religious reasons or due to social reticence. Some transgender and non-transgender individuals engage in alternative sexual practices such as bondage and discipline or sadism and masochism (BDSM). When practiced with respect for a person's boundaries, BDSM is safe, sane, and consensual. It should never be used to excuse actions taken against a person's will. Lack of consent is always sexual assault. As the following quote shows, a few victims may need help to understand this fact:
People engage in many different forms and types of sexual behavior, some of which may be outside a provider's comfort zone or knowledge base. Most professionals learn not to judge those who engage in sexual practices different from their own, or at least to refrain from sharing their opinions. Sadly, however, transgender victims of sexual violence frequently report negative interactions with all types of professionals.  Sexuality and sexual practices can be profoundly affected following a sexual assault, regardless of the person's gender or identity. Individuals who engaged in a vibrant sexual life prior to the assault may have a radically different relationship to sex and sexuality—with self or others—after being assaulted. Individuals may avoid any contact, decide to abstain, become "stone," or severely curb their sexual behavior. Enjoyment of sex and sexual expression may decrease substantially, and specific sexual behaviors that were previously enjoyed may now be triggers or unwelcome. Transgender individuals, who may have had conflicting feelings about their bodies before being assaulted, may be even more uncomfortable with or dysphoric about their bodies afterward. Because the vast majority of sexual assaults involve violation of a person's genitals, the level of trauma and dissociation (i.e., detachment from reality) concerning a transgender person's genitals and body may be significantly elevated as a result. Implications and Actions for ...
Health Care ProvidersBe careful of making assumptions about patients' sexuality, and make sure to listen to (and believe) their accounts. One transgender victim of sexual assault said that medical services would have been improved if providers—
 Unfortunately, some urgent care health care providers make unwarranted and damaging assumptions about patients' sexual orientation or gender identity and which sexual acts they participate in. In some cases, for example, health care professionals have minimized the trauma of anal assaults of MTFs (male-to-female individuals) by assuming that they regularly engaged in (consensual) anal sex. Urgent care providers or specialists who may only see a transgender patient once will likely not need to know about the individual's consensual sexual behavior or sexual orientation. However, primary care physicians or providers with whom the transgender patient develops an ongoing relationship will want to have discussions about sexuality, sexual behavior, and sexual orientation. Some people may engage in higher risk behaviors because negotiating safer sex in addition to disclosing transgender status may feel overwhelming and defeating. If you are a routine health care provider, work with and educate your patients about the sexual risks involved with specific sexual behaviors (e.g., sexually transmitted infections, pregnancy) and help them develop effective strategies for reducing the risks of specific behaviors. Atypical prevention strategies may need to be implemented due to transgender bodies that may not lend themselves to traditional barrier methods of protection. Any testing or treatments should be accompanied by transgender-specific educational discussions and materials. Because many transgender people are of low income and because some are involved in the sex trade or engage in survival sex (i.e., the exchange of sex for food, shelter, safety, or other basic needs), consider offering free safer sex supplies. Trusted providers are hopefully already having these discussions with both their transgender and non-transgender patients as well as with their straight and lesbian/gay/bisexual patients.
1. FORGE, 2005, Sexual Violence in the Transgender Community Survey, quotation from narrative response, unpublished data.
Emergency Medical PersonnelA patient’s sexual orientation or consensual sexual practices are generally not relevant to your role as emergency medical personnel serving victims of sexual assault. If the assault appears to be motivated by bias, hate crime laws do not require the victim to actually be part of a protected class; it is the belief that a person is of a specific sexual orientation (or gender identity) that will result in the case being considered a hate crime. Concentrate on what the patient says, and do not inquire about sexual orientation. Recording what a patient says about an assault is important; having information in the record may be essential if the patient decides to press charges against the perpetrator. As with all assaults, it is critical to remember that sexual behaviors that were part of a sexual assault do not represent an individual's consensual sexual behavioral choices. Law EnforcementA victim's sexual orientation or consensual sexual practices are generally not relevant to a law enforcement officer's role in serving victims of sexual assault. If the assault appears to be motivated by bias, hate crime laws do not require the victim to actually be part of a protected class; it is the belief that a person is of a specific sexual orientation (or gender identity) that will result in the case being considered a hate crime. Concentrate on the victim's statement, and do not inquire about sexual orientation. As with all assaults, it is critical to remember that sexual behaviors that were part of a sexual assault do not represent an individual's consensual sexual behavioral choices. AdvocatesMost advocates also provide support for the victim's family and friends or connect victims to their support systems. In doing so, always use gender-neutral language when asking if there is someone they would like called. Be careful to avoid verbal and nonverbal reactions if a partner's gender differs from what was assumed. Generally speaking, a victim's sexual behavior will not be a topic of discussion between advocate and victim. If the victim brings up gender identity or orientation or sexual practices, however, having an open attitude and responding nonjudgmentally helps to encourage trust and maintain continued dialogue. TherapistsOver the long term, sexual assault survivors may find that their sexual attractions and sexual practices are deeply affected by the assault. According to some respondents to the 2005 FORGE survey1:
Survivors in intimate relationships may benefit from couples therapy, which can help both partners understand how the assault affects their sexual relationship and help them develop or strengthen the skills they need to cope with any changes to that relationship. Some people may engage in higher risk behaviors because negotiating safer sex may feel overwhelming and defeating. Explore negotiating skills with clients, specifically for navigating sexual interactions. Using role playing techniques can be especially empowering and can reinforce healthy behaviors.
1. FORGE, 2005, “Implications," quotation from narrative response to the Sexual Violence in the Transgender Community Survey, accessed Feb. 13, 2013. (Two of the four quotes are on FORGE’s Implications Web page.)
Support Group FacilitatorsSupport groups may address issues of sexuality and intimacy with existing partners or new and potential partners. Transgender group members may have many of the same concerns as non-transgender members. All may benefit if they share how sexual assault affected their sexuality and if they discuss strategies for regaining the type of sexual (or asexual) life they want to have. If the topic of sexuality emerges within a group discussion, you can ask questions without presuming people's sexual orientation or the types of relationships they desire. For example, ask "Do you have someone significant in your life?" or "Are you partnered?" rather than "Are you married?" Similarly, if a client is sharing details about a partner ("my spouse and I...."), allow them the opportunity and control to share their partner's gender if they wish. Some clients may not disclose the gender of their partners, and others prefer to disclose gender on their own terms and in their own language. Never make an assumption about a partner's gender because that assumption may be incorrect. |
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