INTRODUCTION: Neovaginoplasty, is a gender affirming surgery provides a way for transfeminine persons to remove masculine appearing genitalia and replace with a more gender congruent appearance. As of 2019 “bottom” surgery was reported in transgender and non-binary persons at a rate of 4-13% with prevalence increasing rapidly (Nolan et al., 2019). The benefits of combined general and epidural anesthesia for neovaginoplasty has been well described (Salgado et al., 2019). In this study we examined dosing strategies for epidural infusions at our institution for patients undergoing neovaginoplasty. METHODS: This study was approved by the Institutional Review Board at our institution. Non-experimental retrospective chart reviews were conducted and all trans-gender patients who underwent neovaginoplasty procedures between 2014-2019 and were over the age of 18 at the time of chart review were included. Patient demographics including age, ethnicity, BMI were collected as well as comorbidities, history of hormone use, DVT, and nausea. Lumbar Epidurals were placed preoperatively and dosed after incision. Epidural start and stop times were collected along with pain scores measured on a visual analogue scale, and blood loss was recorded. RESULTS: The final cohort consisted of 154 cases that matched the eligibility criteria of this study. About half of these patients, 49.3%, spent 2-4 hours in the PACU after their procedures. The most common ASA status was 2. As expected, an overwhelming number of patients, 141 of 154 (91.6%) reported using hormone therapy. Epidural infusion duration prior to first pain score assessment was 0 to 701 minutes. Median epidural infusion duration was 285 minutes. Patients whose epidural was begun early had an average pain score of 5.06/10 (+2.11). Epidurals which were started late had an average pain score of 5.16/10 (+3.04). Maximum EBL noted for all cases was 450 mls. CONCLUSION: Overall, pain score was not significantly impacted by epidural start time post incision. Average initial pain scores were high in both cohorts, despite good pain relief on postoperative day 1. Observed EBL for these procedures was low at our institution, with no patients requiring blood transfusion. Central sensitization may play a large role in the initial pain scores and PACU length of stays for neovaginoplasty patients. Our future protocols will move towards dosing epidurals prior to incision for these procedures.

Children’s literature plays a critical role in shaping how children view themselves and the world around them. This is especially true in regards to outgroups such as the transgender and gender nonconforming communities. Transgender individuals have been gaining increased visibility in the past few years. The misconceptions surrounding these topics are not exclusively found outside the classroom. Title IX was expanded to include gender identity as recently as 2014. Yet, much confusion and apprehension is present when discussing the topic of transgender and gender nonconformity, especially in the elementary school classroom. To address these misconceptions, inclusion of these outgroups into culturally inclusive curriculum is critical. With the power that children’s literature has on empathy, attitudes, and comprehension, classroom libraries should consider including transgender and gender nonconforming titles into teacher resources and classroom libraries. Many positives can come from the power of children’s literature, but there also lies the chance to fall into new and/or unique pitfalls that affect the elementary classroom, such as gender stereotyping. Therefore, this thesis analyzed transgender and gender nonconforming titles for elementary classrooms for trends and themes. 30 titles total were analyzed with 21 being selected to represent the ideals found in transgender and gender nonconforming children’s literature.

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Deep in the library stacks, two transgender men unearth a moldy copy of the United States and Mexican Boundary Survey of 1857. The survey, in its dispassionate cataloging of every plant and animal unfortunate enough to be caught in the crosshairs of Manifest Destiny, energizes the nameless narrator and his lover Emilio to pen an alternative field guide to the border. The Book of New Fish rewrites the history of the Rio Grande through the eyes of its fish who—like the two trans men—bear witness to the violent beauty of living in between countries, identities, and genders. Covering ground from the Spanish conquistadors to invasive species and unraveling their relationship in the process, the project demands increasingly steep sacrifices of the main characters as they try to figure out why we hurt those we love most in the search for identity and belonging.

Individuals who identify as lesbian, gay, bisexual, questioning, and other non-heterosexual orientations (LGBQ+) are significantly more likely to experience a sexual assault. To date, research on barriers to sexual assault disclosure (i.e., telling someone about a sexual assault) has been conducted almost exclusively on heterosexual women. Participants ages 18 to 30 participated in a cross-sectional, online study that assessed unwanted sexual experiences, disclosure of those experiences, perceptions of the police and perceptions of belonging to the LGBQ+ community. Findings demonstrated that survivors who identified as LGBQ+ took longer to initially disclose their sexual assault and had greater negative perceptions of police than survivors who identified as heterosexual. Also, among survivors who identified as LGBQ+, the degree of "outness" of sexual orientation was positively associated with sexual assault disclosure. However, perceptions of the police were not associated with disclosure of sexual assault to the police among people who identified as LGBQ+. Perceptions of belonging to the LGBQ+ community were also not associated with disclosure likelihood. The results of this study help to better understand how the sexual assault disclosure process differs by sexual orientation and suggest that providers who work with survivors who identify as LGBQ+ need to keep in mind the unique concerns faced by survivors who identify as LGBQ+ who may be considering disclosing their trauma. These findings also call attention to the negative perceptions of police that continue to be held by people who identify as LGBQ+. Due to limited research on the topic of sexual assault and the LGBQ+ community, this study may encourage future researchers to examine additional barriers to sexual assault disclosure that may be unique for survivors who identify as LGBQ+ and how disclosure is received by both formal and informal support.