Article Figures & Data
Figures
- Figure 1.
Patient responses to question “Have you ever personally experienced any of the following symptoms that you attribute to tucking? (Please check all that apply).”
Note: n = 79.
Tables
Question/Response Theme Representative Responses Please identify the primary reason(s) that you tuck.
Response themes: Alleviate dysphoria, achieve a more feminine appearance, reducing presence of visible bulge in feminine clothing, reduce discrimination, improve safety“On a day-to-day basis, it’s simply for the general comfort of not having visible genitalia, as much of the clothing designed for women would appear awkward otherwise...”
“Because the thought of having my current genitalia causes me great emotional distress often known as dysphoria. Even the presence of a bulge can cause such.”“Dysphoria related to the genitals. While wearing tight clothing, the genitals can sometimes have a noticeable outline and bulge and it makes me feel extremely uncomfortable. It is also inappropriate to go out with that outline visible and can make me a target for discrimination.”
“I never understood why I had a penis. I felt like I was a female and wanted to look like one.”If you answered “Yes,” [to hearing about health side effects from tucking] what health side effects have you heard about?
Response themes: Pain/discomfort, swelling, hernia, damage, atrophy, infertility, skin irritation, testicular torsion, itchiness, circulation issues, UTI“Testicular torsion is one. As a trans person, the idea of having an issue with my testicles and having to bring that whole mess to a doctor’s office in a small town is horrifying. So I choose to only tuck if I’m doing something super formal.”
“I can’t actually think of anything in particular, merely that it is “unsafe” to tuck for extended periods of time without rest. I can also imagine that it isn’t exactly without risk, just from my basic understanding of anatomy.”“Theoretical risk of hernia after dilation of the inguinal canal, though I’ve never heard of it actually happening.”
“Sterilization, hernia, and in extreme cases, testicular torsion. Some mild ones like irritation and itchiness too.”
“I have received a few UTIs as my anatomy approximates my anus and meatus when I tuck. I clean thoroughly before dressing tucked, but on occasion must eliminate before the day is over…”If you answered “Not particularly comfortable” or “Not at all comfortable,” [to how comfortable are you with your health care provider examining your genitals for tucking related concerns] what can your health care provider do or say to help you feel more comfortable about and/or during this exam?
Response themes: Discuss tucking before exam, discuss preferred terminology for anatomy, quick exam if necessary, publicly support transgender individuals“Keeping it quick without much manipulation. Or some discussion about reasoning beforehand.”
“The problem is just having my genitals examined or touched. I don’t think there’s anything I can do.”
“I would feel more comfortable if they are educated about tucking and why it is necessary for many trans people.”“They are in the LGBTQ themselves and let me know about it or a history of support for the community and me in particular.”
“A health care provider that is publicly up front about their support for trans people.”
“Nothing. Most doctors don’t understand trans people’s needs.”If you are “very concerned” or “concerned,” which health side effects are of greatest concern to you?
Response themes: loss of circulation, nerve damage, impact on future surgical interventions“Anything that could medically go wrong with the penis. I don’t want to bring up any genital pain to a doctor, I don’t want a doctor to touch it at all. I’d rather just avoid all of that.” “Doing nerve damage which complicates the results of later genital reconstruction surgery, lessening feeling.” How, if at all, does tucking affect your mood?
Response themes: more comfortable, more confident, a necessary evil due to discomfort, more irritable, more paranoid“It makes me feel more comfortable and happy with myself. I feel less dysphoric.”
“Makes me feel better about wearing women’s clothing and not showing. I feel more like myself and more confident.”
“On an ordinary day, it makes me feel more comfortable in my clothes. If I’m particularly active and moving around a lot, it can sometimes feel irritating.”
“Tucking provides for a more confident feeling in appearance. (There is always concern of the tucking procedure failing at the most inconvenient time).”
“It can help relieve gender dysphoria, but in my opinion the potential for pain makes it not worth it. I have also started to feel more comfortable with my genitals, so I no longer feel the need to tuck.”
“When I was very early on in my transition it made me feel better to think less about how my genitals were there. There are other things that make me feel good so I don’t feel as reliant on tucking to feel good.”“Improves it, but only temporarily. It isn’t permanent and often the added pressure to the area makes me more aware of “it” which is the opposite of what I want.”
“Tucking, itself, doesn’t affect my mood so much as not tucking causes me to feel anxious and mildly paranoid about others’ possible attention.”
“It was a necessary evil. I did not want the parts to be there; tucking helped them appear not to be.”
“It makes me feel irritable, anxious, hypervigilant.”
“It makes me sad that I have to touch it on a day-to-day basis… and I’m mad at my higher power for putting me on this planet in the wrong body to be harassed and attacked on a regular basis…”
“Despite the pain and fear, when I tuck right, it is one of the best things ever. I look down and feel better about myself. Sometimes, the pain is worth it.”In order to help health care providers deliver the best possible care to transgender, non-binary, and gender non-conforming patients, what advice would you give health care providers when addressing the practice of tucking and the genital exam with a patient?
Response themes: Do not shame patients who tuck, discuss risks of tucking, provide resources for safe tucking practices, be compassionate/affirming, ask for preferred terms for patient anatomy, concern over whether tucking is genuinely a medical concern“... It is not a subject I am comfortable bringing up on my own, so to the best of my recollection I never discussed with my provider. That said, I would have welcomed advice on the topic pre-orchiectomy.”
“Use compassion to make sure that the patients have a method to deal with dysphoria during the exam and have a safe method to use in their day-to-day lives. Ask them what vocabulary they would like to use for their genitals.”
“Begin by asking first if it would be alright if you were to talk to a patient about it, and then asking if they would like resources on tucking, as well as explaining potential risks of tucking, finishing by informing the patient that if they were to tuck, it would be prudent to check for potential issues or complications, and that you would be capable of doing that AND that you could explain to them how to do it themselves.”
“Providing literature with proper techniques to safely tuck and avoid any long-term issues. Understanding the effects tucking can have on future SRS procedures.”
“... Whether a patient is tucking or not is not a concern of an endocrinologist or a medical physician. Unless it is obviously causing a medical issue. I believe, for some of us (myself included) it is so very important to tuck, that suffering from pain or minor medical issues is inconsequential… Compassion, empathy, kindness, understanding and an open mind are all traits that are greatly appreciated in this field obviously.”
“Be clear on the risks and likelihood of those risks with patients…”“It is a highly individualized practice… While it’s hard to offer advice for something with such little data, I think it’s important to emphasize it should not hurt, and that a patient should respond to pain by un-tucking and contacting their doctor. I imagine it’s similar to binding in that regard.”
“Anything whose negative effects are practical and whose positive effects are mental/social. I think some health care providers don’t form habits around exercising empathy when it comes to these things.”
“Have an empathetic ear when we talk about why we tuck and be respectful of the reasons why we do this.”
“That eliminating male genitalia is not the goal of every transwoman and thus a genuine preference not to tuck is possible.”
“I’m not quite sure. My resolution of “reclaiming my penis” is not something that I can recommend to others. Everyone’s dysphoria is different. I think the best thing to do is communicate the risks of tucking and help monitor them in patients.”
“My health care providers asked if I tucked and where I learned it and we had a great discussion on it. I think it was just the way they started the conversation, with understanding.”
“For many of us, the effects it has on our dysphoria greatly outweighs the health issues associated to it. For most trans females it’s just a way of life.”
“First, I would have them provide multiple ways of offering assistance/knowledge about tucking. They could offer to explain it, have literature, or some handy links for the patient.”LGBTQ = lesbian, gay, bisexual, and transgender, queer/questioning; SRS = sex reassignment surgery; tucking = genital tucking; UTI = urinary tract infection.
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