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Detox the Box: Q & A with LGBTQ Health Expert

 

Caitlin_cropped

Caitlin Copple

Communications Consultant

Before you can change the world, let alone the world’s largest tampon manufacturer, you have to figure out your message. As you read in one of our last blogs, Women’s Voices for the Earth’s clever members came up with our latest catchy campaign title, and we love it. However, how we talk about Aunt Flo and our private parts can vary based on our racial heritage or ethnic and cultural backgrounds. And if you identify as a queer, lesbian, trans* or bisexual person, some of the terms associated with “down there” become even more complicated.

When talking about toxic chemicals in “feminine products” (email us if you have a better idea on what to call them), people who don’t necessarily fit into the male/female gender dichotomy can feel excluded. Women’s Voices for the Earth, an advocacy group that aims to engage all people through a social justice lens, needs some help with how to promote this conversation among all groups of people, including those whose gender identity or sexual orientation might be different from the majority of our members.

Since I have an advocacy background in the lesbian, gay, bisexual, transgender, and queer (LGBTQ) movement, I thought it would be fun to interview one of the Northwest’s leading health experts, Dr. Jessica Rongitsch of Seattle’s Capitol Hill Medical Clinic, for her advice.

Jessica Rongitcsh
Dr. Jessica Rongitsch

Dr. Rongitsch is a board-certified primary care physician practicing internal medicine. She grew up in St. Paul, Minnesota and graduated from University of Minnesota Medical School. Then she left the Midwest for Seattle, completing her residency at Virginia Mason Medical Center, where she now teaches residents and medical students. Her interest in public health blossomed while caring for patients in the International District Medical Clinic, which led her to Pike Market Medical Clinic for the next eight years, where she served low-income and uninsured patients, seniors, immigrants, the homeless and LGBTQ communities.

Dr. Rongitsch strives to provide thoughtful, evidence-based primary care that is respectful of all gender identities and sexual orientations. She prescribes hormones and provides primary care for trans* and gender-variant patients.

A quick note about the asterisk: Trans* is an umbrella term that includes the full gender identity spectrum. Trans (without the asterisk) is best applied to trans men and trans women, while the asterisk makes special note in an effort to include all non-cisgender (i.e. women-born-women and men-born-men) gender identities, including transgender, transsexual, transvestite, genderqueer, genderfluid, non-binary, genderfuck, genderless, agender, non-gendered, third gender, two-spirit, bigender, and trans man and trans woman.

WVE: What are the health disparities facing trans* people and lesbian, bi, and queer women? Are you aware of any that are specifically tied to environmental health? 

JR: While LBTQ people are frequently grouped under this umbrella term, the issues facing lesbian, trans, bi, and queer individuals are variable and unique. Lesbians, bi, and queer women are likely earning less than their male counterparts. Earning a lower income often means lack of health insurance or underinsurance. Lesbians, bi, and queer women also may have difficulty finding a culturally-competent provider—a provider who will treat them respectfully and who is well-versed on their health needs.  Even though I practice in downtown Seattle, I have been repeatedly shocked when my patients tell me about previous doctors who said they didn’t need pap smears—they do!

Trans* patients have even greater disparities.  Many Trans* patients face significant discrimination in the workplace and earn lower wages.  It can be difficult to find providers willing to provide hormone management or surgical care, especially in certain geographical areas.  Frequently, medically-necessary services and medications are excluded from healthcare plans for trans* patients and can be prohibitively costly.

I am not aware of any disparities specifically related to environmental health.

WVE: While trans* people taking hormones don’t have menses, genderqueer or gender variant people who don’t have access to or choose to take hormones may still produce menses, correct?

JR: I always say treat the organ not the gender.  If you have breasts, you need breast cancer screening and if you have a cervix you need regular pap tests–r egardless of gender identity.  

WVE: What are some ways that a group like Women’s Voices for the Earth, which strives to be a good ally to LGBTQ people, can discuss toxic chemicals in feminine care products without isolating people who may have been born with female genitalia but who don’t necessarily identify as female? 

JR: When it comes to discussing toxic chemicals in feminine care products, I would avoid making assumptions about gender identity. Someone may have a uterus and require the use of tampons but identify as male or genderqueer.  Avoid using gender pronouns when discussing these products and it would be helpful to refer to specific items like tampons or pads rather than the term “feminine” care products as masculine-identified people may find that alienating.

WVE: In your experience as a physician, have you seen situations where corporate profits trump public health? (The goal of our Detox the Box campaign is to convince P&G to take harmful chemicals out of Tampax and Always products). 

JR: Unfortunately, corporate profits trumping public health is part of the American way. Look at the history of the tobacco industry. Now we have the fast food and soda industries contributing to rampant obesity and diabetes. I do not believe our farm subsidies of corn and soybeans for the production of processed foods improve public health, nor do I think eating meat that has been raised with antibiotics and hormones in a factory farm is healthful.

WVE: What are some of the risks associated with douching, feminine sprays, feminine wipes, over-the-counter anti-itch creams, feminine deodorants, etc.? In your practice, do you discuss these risks with clients? 

JR: I discourage use of these products as I feel they are completely unnecessary, and they can be harmful. The vagina contains self-regulating, healthy balances of different kinds of bacteria. Use of these products will disrupt the normal bacterial flora and cause overgrowth of certain bacteria that leads to itching and discharge. Also these products tend to contain numerous chemicals that can cause allergic reactions resulting in uncomfortable or painful rashes and swelling. Some of these chemicals such as phthalates can cause hormonal problems and birth defects in baby boys’ reproductive systems.

WVE: Do you see these products being used by lesbian/bi/queer or trans* people? Our Chem Fatale report highlights racial disparities in use patterns of these products, but we don’t have research on the lesbian/bi/queer or trans* people.

JR: Fortunately, I see these products used infrequently by lesbian/bi/queer/trans* patients.  I think LGBTQ patients may be less apt to fall for a heterosexist-marketing scheme telling them that their vaginas are dirty and smelly and need deodorizing.

April 7, 2014

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