Abstract：
BACKGROUND: Canada\'s health care systems underserve people who are transgender and gender diverse (TGD), leading to unique disparities not experienced by other patient groups, such as in accessing gender-affirmation surgery. We sought to explore the experiences of TGD people seeking and accessing gender-affirmation surgery at a publicly funded hospital in Canada to identify opportunities to improve the current system.
METHODS: We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women\'s College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen\'s framework of lived body, lived time, lived space, and lived human relations.
RESULTS: We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women (n = 13) and White (n = 14). Participants lived in rural (n = 4), suburban (n = 5), or urban (n = 6) locations. Their median age was 32 (range 27-67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples\' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants\' intersecting identities and emotional pain (lived body); participants\' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants\' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants\' experiences of loss of trust and connection (lived human relations).
CONCLUSIONS: Our findings reveal TGD patients\' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences.
METHODS: We used hermeneutic phenomenology according to Max van Manen to conduct this qualitative study. Between January and August 2022, we conducted interviews with TGD people who had undergone penile-inversion vaginoplasty at Women\'s College Hospital, Toronto, Ontario, since June 2019. We conducted interviews via Microsoft Teams and transcribed them verbatim. We coded the transcripts using NVivo version 12. Using inductive analysis, we constructed themes, which we mapped onto van Manen\'s framework of lived body, lived time, lived space, and lived human relations.
RESULTS: We interviewed 15 participants who had undergone penile-inversion vaginoplasty; they predominantly self-identified as transgender women (n = 13) and White (n = 14). Participants lived in rural (n = 4), suburban (n = 5), or urban (n = 6) locations. Their median age was 32 (range 27-67) years. We identified 11 themes that demonstrated the interconnected nature of TGD peoples\' lived experiences over many years leading up to accessing gender-affirmation surgery. These themes emphasized the role of the body in experiencing the world and shaping identity, the lived experience of the body in shaping human connectedness, and participants\' intersecting identities and emotional pain (lived body); participants\' experiences of the passage of time and progression of events (lived time); environments inducing existential anxiety or fostering affirmation, the role of technology in shaping participants\' understanding of the body, and the effect of liminal spaces (lived space); and finally, the role of communication and language, empathy and compassion, and participants\' experiences of loss of trust and connection (lived human relations).
CONCLUSIONS: Our findings reveal TGD patients\' lived experiences as they navigated a lengthy and often difficult journey to penile-inversion vaginoplasty. They suggest a need for improved access to gender-affirmation surgery by reducing wait times, increasing capacity, and improving care experiences.
摘要：
背景：加拿大的医疗保健系统对跨性别者和性别多样化（TGD）的服务不足，导致其他患者群体没有经历的独特差异，例如接受性别确认手术。我们试图探索TGD人员在加拿大一家公立医院寻求和接受性别确认手术的经验，以确定改善当前系统的机会。
方法：我们根据MaxvanManen使用诠释学现象学进行了这项定性研究。在2022年1月至8月之间，我们对在女子学院医院接受阴茎倒置阴道成形术的TGD患者进行了采访，多伦多,安大略省,自2019年6月。我们通过微软团队进行了采访，并逐字抄写。我们使用NVivo版本12对转录本进行编码。使用归纳分析，我们构建了主题，我们将其映射到范·曼宁的活体框架上，活的时间，居住的空间，和生活的人际关系。
结果：我们采访了15名接受过阴茎倒置阴道成形术的参与者；他们主要自我确定为变性女性（n=13）和白人（n=14）。参与者住在农村(n=4)，郊区（n=5），或城市（n=6）位置。他们的中位年龄为32岁（27-67岁）。我们确定了11个主题，这些主题证明了TGD人民多年来的生活经历的相互联系的性质，从而导致接受性别确认手术。这些主题强调了身体在体验世界和塑造身份方面的作用，身体塑造人类联系的生活经验，和参与者的交叉身份和情感痛苦（活的身体）;参与者的时间流逝和事件进展的经验（活的时间）;环境诱导存在的焦虑或促进肯定，技术在塑造参与者对身体的理解中的作用，以及边缘空间(居住空间)的影响；最后，沟通和语言的作用，同情和同情，和参与者失去信任和联系的经历(生活中的人际关系)。
结论：我们的研究结果揭示了TGD患者经历了漫长且通常艰难的阴茎倒置阴道成形术的生活经历。他们建议需要通过减少等待时间来改善性别确认手术的机会，增加容量，改善护理体验。
方法：我们根据MaxvanManen使用诠释学现象学进行了这项定性研究。在2022年1月至8月之间，我们对在女子学院医院接受阴茎倒置阴道成形术的TGD患者进行了采访，多伦多,安大略省,自2019年6月。我们通过微软团队进行了采访，并逐字抄写。我们使用NVivo版本12对转录本进行编码。使用归纳分析，我们构建了主题，我们将其映射到范·曼宁的活体框架上，活的时间，居住的空间，和生活的人际关系。
结果：我们采访了15名接受过阴茎倒置阴道成形术的参与者；他们主要自我确定为变性女性（n=13）和白人（n=14）。参与者住在农村(n=4)，郊区（n=5），或城市（n=6）位置。他们的中位年龄为32岁（27-67岁）。我们确定了11个主题，这些主题证明了TGD人民多年来的生活经历的相互联系的性质，从而导致接受性别确认手术。这些主题强调了身体在体验世界和塑造身份方面的作用，身体塑造人类联系的生活经验，和参与者的交叉身份和情感痛苦（活的身体）;参与者的时间流逝和事件进展的经验（活的时间）;环境诱导存在的焦虑或促进肯定，技术在塑造参与者对身体的理解中的作用，以及边缘空间(居住空间)的影响；最后，沟通和语言的作用，同情和同情，和参与者失去信任和联系的经历(生活中的人际关系)。
结论：我们的研究结果揭示了TGD患者经历了漫长且通常艰难的阴茎倒置阴道成形术的生活经历。他们建议需要通过减少等待时间来改善性别确认手术的机会，增加容量，改善护理体验。
