Background: Healthcare for transgender people can be unsafe and inequitable. Objectives: To explore the experiences of care surrounding hysterectomy as part of female to male (FtM) gender affirming surgery. Design: Qualitative observational study Setting: Aotearoa/New Zealand Participants: Ten people (out 12 people) who underwent FtM over a four-year period. Results: No one person’s experience of the FtM journey was affirming across the whole surgery journey. Transgender health literacy was central to inclusive practice as it mediated bodily autonomy being upheld. FtM (hysterectomy) surgery was described as “ life-saving”. The physical care environment influenced the experience of the healthcare encounter. For example, the waiting room was intimidating, with a gendered clinic name and toilets. Some participants took a female support person/partner so that “ people looking would assume that I was there supporting her, not the other way around.” Communication misalignments were evident around information provided/understood about fertility and ovarian preservation, requirement of a pre-operative pregnancy test, and post-operatively, about bleeding and when sexual intercourse could be resumed. Participants were also placed in the position of both receiving care and providing education: “ I also shouldn’t have to be going in there for treatment, and then being expected to educate the medical professional that’s meant to be helping me… I’m not getting paid to give you a TED talk on how my trans body works.” Conclusions: A whole care pathway approach to increasing transgender health literacy will facilitate better alignments in communication, uphold bodily autonomy and lead to equitable inclusive practice.

Objective: To gain a deeper understanding of women’s experiences with accessing care for abnormal uterine bleeding (AUB), in order to inform future strategies in early detection of endometrial cancer. Design: We conducted semi-structured interviews with 15 women who attended their first gynaecological specialist consultation for abnormal uterine bleeding at Wellington Regional Hospital between October-December 2019. Inductive thematic analysis was used to decipher facilitators and barriers to care. Results: Thirty women were invited to participate in the study. The medium age of the final participant cohort was 45 years, with women self-identifying as New Zealand European (9/15), Māori (2/15) and Pasifika (4/15). All women had sought investigation for their AUB in primary care, for some women this was over a timeframe of many years. For all women, AUB had a significant and traumatic impact on their quality of life including their relationships and their work or education. Women described how they felt they often received inadequate care for AUB, and negative experiences with their general practitioner. Timely access was further compounded by feelings of embarrassment and that AUB was taboo subject and being able to discuss it with family, friends and their general practitioners. Conclusion: Women in our cohort experienced a multitude of compounding influences that acted as barriers to them having access to appropriate and timely care. Information campaigns that create awareness around ‘abnormal periods’ alongside better health provider practice guidelines for AUB investigation need to be a priority.