Plain Language Summary
This section addresses three populations that are consistently underserved and misunderstood in healthcare settings. Transgender people in correctional facilities face denied medical care, unsafe housing, and staff who lack basic training in gender-affirming practice. LGBTQ+ clients experiencing intimate partner violence are often invisible in research and clinical practice, which was built almost entirely around heterosexual couples. And kink-involved clients are frequently pathologized by providers who lack the training to distinguish consensual practice from abuse. In all three cases the harm is the same. Providers who do not know what they do not know end up reinforcing stigma, breaking trust, and failing the patients who need them most. These sources exist to close that gap.
✓ Do
- Train correctional and clinical staff in competent, patient-centered transgender healthcare that follows evidence-based standards of care.
- Respect the gender identity of incarcerated transgender individuals, including use of correct name and pronouns at all times.
- Provide comprehensive healthcare for incarcerated transgender people, including hormone therapy when medically necessary and mental health support for gender-related distress and trauma.
- Use shared decision-making with LGBTQ+ clients experiencing intimate partner violence. Work with the patient to understand their experience before jumping to solutions.
- Recognize that IPV occurs at equal or higher rates in LGBTQ+ relationships compared to heterosexual relationships, and adjust your screening and response accordingly.
- Understand kink affirmatively. Consensual kink is not inherently a sign of mental illness, trauma, or dysfunction. Assess context before drawing conclusions.
- Evaluate potential abuse in kink contexts using a full understanding of community standards like Safe, Sane, and Consensual rather than applying standard abuse screening without nuance.
✕ Don't
- Don't deny medically necessary treatment to incarcerated transgender individuals based on bias or lack of knowledge.
- Don't abruptly stop verified hormone therapy upon incarceration without medical justification.
- Don't subject transgender individuals to searches solely to determine genital status.
- Don't recommend resources to LGBTQ+ IPV clients without first confirming those resources are affirming and safe for their identity.
- Don't shame clients about their sexuality or situation. Shame causes withdrawal and reduces future disclosure.
- Don't pathologize kink. Do not assume kink interests indicate psychopathology or that they are automatically the result of past trauma.
- Don't apply decontextualized abuse screening questions in kink contexts without understanding the relationship dynamics involved.
Patient Voices
"Access to gender-affirming care is associated with increased quality of life and decreased rates of self-harm, including 44% and 73% lower odds of suicidality in transgender adults and youth respectively, compared to cohorts who do not receive gender-affirming care."
"I am viewed by prison staff as a male in men's prison who has a mental disorder. The vast majority of inmates view me as either a potential sex object or a target. I am given hormones but forced to refer to myself as a man, use a male name, present as a male inmate, and live in stressful semi-transitioned half-life."
"Affirming identity in the beginning of any kind of therapeutic medical relationship is really important. And simply that validation I think can be enough for people to open up, because then it's like okay for me to be who I am, and I don't have to be fearful or try to hide certain aspects of myself."
"If I don't know anything about you, I don't really want to tell you anything about me. Doctors have to put in the time to know a person. To develop trust."
"I think it's fundamentally changed my conception of myself, as a sexual being, and a trauma survivor, and the intersection between those two things."
"Even though it was just strictly BDSM, no actual sexual relationship, it was still some kind of intimacy, and I've never been so connected with anyone in my entire life. I've never felt so safe in a relationship."
Why These Sources Matter
Aldrich, Kant, and Gramszlo (2023) — Gender-Affirming Care, Incarceration, and the Eighth Amendment. AMA Journal of Ethics, 25(6)
Establishes that incarcerated people have a legal and ethical right to medical care including gender-affirming treatment. Identifies specific barriers including provider bias, lack of training, and housing policies that contradict a patient's gender identity.
National Commission on Correctional Health Care — Transgender and Gender Diverse Health Care in Correctional Settings (2020)
Position statement outlining the ethical and clinical standards that protect the physical and mental wellbeing of transgender people in correctional settings. Emphasizes individualized, respectful treatment and staff training.
Vera Institute — Advancing Transgender Justice
Centers the voices of transgender people in custody and documents the serious harms they face, including violence, unsafe housing, and inadequate healthcare. Offers concrete recommendations for correctional systems.
Morris et al. (2024) — Factors Influencing Shared Decision-Making Between Healthcare Providers and LGBTQ+ People of Color About Intimate Partner Violence. Journal of Interpersonal Violence, 40(1-2)
Qualitative study showing how intersectional identity shapes whether LGBTQ+ clients of color feel safe disclosing IPV to a provider. Makes the case for affirming, trust-centered clinical relationships.
Rhodes (2023) — Addressing Intimate Partner Violence with LGBTQ+ Clients. American Counseling Association
Documents how IPV theory and research have historically excluded LGBTQ+ experiences and what that means for clinical practice today. Provides a framework for more inclusive screening and response.
Sprott et al. (2023) — Clinical Guidelines for Working with Clients Involved in Kink. Journal of Sex and Marital Therapy, 49(8)
The primary clinical guideline resource for kink-affirmative care. Distinguishes consensual kink from abuse, addresses internalized stigma, and outlines what competent assessment looks like in practice.
TASHRA for Healthcare Providers
The Alternative Sexualities Health Research Alliance provides empirical research, clinical practice guidelines, continuing education, and peer consultation resources for providers working with kink-involved clients.
Kink Knowledgeable Training Program
A structured, multi-level online training program offering foundational to advanced clinical education on kink, BDSM, and related mental health topics, including continuing education credits and clinical supervision.
Resource Links
- AMA Journal of Ethics — Gender-Affirming Care, Incarceration, and the Eighth Amendment
- NCCHC — Transgender and Gender Diverse Health Care in Correctional Settings (2020)
- Vera Institute — Advancing Transgender Justice
- Morris et al. (2024) — Shared Decision-Making with LGBTQ+ People of Color About IPV
- ACA — Addressing Intimate Partner Violence with LGBTQ+ Clients
- Sprott et al. (2023) — Clinical Guidelines for Working with Clients Involved in Kink
- TASHRA — For Healthcare Providers
- Kink Knowledgeable Training Program