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Sexual & Reproductive Health Services

2SLGBTQIAA+ people have a wide range of sexual and reproductive care needs. Sexual and reproductive care is an important part of 2SLGBTQIAA+ peoples overall wellbeing. However, it can be difficult to find information that is up-to-date, accurate, and reflects the experiences of 2SLGBTQIAA+ people. In this section, you will find resources that are specific to 2SLGBTQIAA+ communities and how/where to get the care you need and desire.

Sexual health covers a range of topics including preventing pregnancy, increasing pleasure, testing for STIs, and HIV/AID care. Sexual health also extends to how you talk about sex with a doctor or sexual health nurse, when to test and what to test for, and simply having the knowledge to keep you and your sexual partners safe and informed. Reproductive care is a part of sexual health and includes contraceptive options, fertility preservation, family planning, and abortion care. 

Where To Get Care

Gynecologists

Dr. Jeanne Bernardin (Currently on leave)

Region:  Moncton

Mailing Address:  100 Arden St. Suite 123, Moncton, NB, E1C 4B7

Telephone:  506-855-0062

Fax:  506-855-0064

 

Dr. Stéphane Foulem

Region:  Moncton

Mailing Address:  100 Arden St. Suite 427, Moncton, NB, E1C 4B7

Telephone:  506-855-6700

Fax:  506-389-2141


Capital OBGYN 

Dr. Erica Frecker, Dr. Christa Mullaly, Dr. Kimberly Butler, Dr. Jessica Bossé, Dr. Stephanie Coady, Dr. Shannon Laity, Dr. Kirsti Ziola

Region:  Fredericton        

Mailing Address:  201-1015 Regent St., Fredericton NB, E3B 3Y9

Telephone:  506-457-2113

 

Dr. Erin Hemsworth

Region:  Moncton

Mailing Address:  100 Arden St. Suite 223, Moncton, NB, E1C 4B7

Telephone:  506-382-2163

Fax:  506-854-9738


Dr. Carole LeBlanc

Region:  Moncton

Mailing Address:  100 Arden St. Suite 516, Moncton. NB, E1C 4B7

Telephone:  506-857-4242

Fax:  506-854-2556

Dr. LeBlanc has experience following transwomen after they have received genital surgery (penectomy, vaginoplasty, clitoroplasty, vulvoplasty). Patients can be seen 2-3 months post-op or sooner if concerns (the 6-week follow-up is usually done via a teleconference with the patient’s surgeon).

 

Dr. Suma Satya

Region:  Saint John

Mailing Address:  122-555 Somerset St, Saint John, NB E2K 4X2

Telephone:  506-214-6581

Dr. Jill Hudson

Region: Fredericton 

Email: drjillhudsonoffice@gmail.com 

Office phone: 506 459-6601

Fax: 506 459-6667.

Sexual health care includes, but is not limited to: contraception; consent; sexual activities; relationships and intimacy; sexual pleasure; HIV/AIDS care; comprehensive sex ed; STI testing; pap testing, and prostate exams.

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Sexual Health

Types of Contraceptives 

Patch

Condom

Sponge

Ring

Vaginal / Front Hole Condom

Emergency Contraceptive

Injectable Contraceptive

Birth Control Pills

Spermicide

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Surgical
Sterilization

Cervical
Cup

Contraceptive Implant

Hormonal LUD

Copper LUD

Multiload LUD

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Vasectomy Surgery 

Tubal Ligation

HIV/AIDS

What is HIV/AIDS?

HIV stands for Human Immunodeficiency Virus, a virus that can weaken a person's immune system. HIV lowers your body’s self-defense mechanism against illness and disease. There are two main different strains of HIV, HIV-1 and HIV-2. The most common form of the virus is HIV-1, which accounts for around 95% of all world infections. HIV-2 is much less common and is genetically distinct from HIV-1. HIV-2 is known to be less infectious and to progress more slowly, resulting in fewer deaths. Among the existing HIV-1 and HIV-2 categories, there are different subtypes of the virus which represent a variety of transmission speeds and infection progressions.

When untreated, HIV can lead to AIDS, Acquired Immuno-Deficiency Syndrome. AIDS progressively compromises your immune system, leaving your body more vulnerable to different infections and diseases. Given modern advances in HIV research, HIV-positive people who have access to treatment do not develop AIDS, and live healthy lives without being able to transmit the virus.

How is HIV transmitted?

There are only five bodily fluids that can transmit HIV. Transmission can occur when one of these fluids enters the bloodstream of somebody else:

  • Anal fluids

  • Blood

  • Breastmilk

  • Semen (including pre-cum)

  • Vaginal fluids

 

These fluids can transmit HIV through broken skin, the opening of external genitals, internal genital linings, rectum, or foreskin. The main ways HIV is passed are through sex and by sharing needles. It can also be passed from parent to child through birth or breast/chestfeeding.

What is PrEP?

Although there is no cure for HIV, treatment ensures that people living with HIV can live healthy lives without the risk of transmitting the virus to their sexual partners. HIV treatment ensures one’s viral load is suppressed (reduced to undetectable levels), which means somebody cannot transmit HIV to others. The earlier somebody starts treatment after being diagnosed, the better for one’s health. People with an undetectable viral load are untransmissable (U=U), as treatment keeps the virus under control.

 

HIV Pre Exposure Prophylaxis (PrEP) is an important and underutilized area of HIV prevention. Rather than a physical barrier such as condoms, PrEP is a chemical barrier. It prevents the HIV virus from replicating in the body, leading it to die out and not get a hold of a person’s immune system. Essentially, PrEP works by preventing the HIV virus from reproducing. Although PrEP prevents HIV, it does not prevent other STIs, like syphilis, gonorrhea, chlamydia, etc.

Cost of PrEP

Folks who do not have HIV and want to prevent it can access PrEP can access it through the The New Brunswick Prescription Drug Program (NBPDP).  There is a cost and a copayment associated with NBPDP, which is based on your annual earnings.  If you are not eligible for NBPDP, you can apply for NBDP. The differences are as follows:

The New Brunswick Prescription Drug Program (NBPDP) 

The New Brunswick Prescription Drug Program (NBPDP) provides prescription drug benefits to eligible residents of New Brunswick. Eligible beneficiary groups include SeniorsNursing home residentsAdults in licensed residential facilities (Special Care Homes)Social Development ClientsHIV/AIDSCorrectional Services. NBPDP covers PrEP and antiviral therapy for HIV.

 

New Brunswick Drug Plan

The New Brunswick Drug Plan is a prescription drug plan that provides drug coverage for uninsured New Brunswick residents who have an active Medicare card. Premiums are determined based on income and members will be required to pay a 30 per cent copayment, up to a maximum amount per prescription. PrEP is covered under the NBDP.

 

For medication related to the treatment of HIV (e.g., Truvada) you can access funding through the NB Prescription Drug Program HIV/AIDS Plan. This program provides prescription drug coverage for certain antiretroviral drugs used to treat HIV/AIDS to eligible residents of NB. Residents with an active Medicare card who have been diagnosed with HIV and have been registered in the plan by their PCP are eligible for coverage. If a patient has existing drug coverage with another drug plan, they must submit a letter from their existing drug plan confirming that the required drugs are not listed on the plan’s formulary.

 

Beneficiaries of the HIV/AIDS Plan are eligible for certain antiretroviral drugs that are listed on the NB Drug Plans Formulary as benefits for the HIV/AIDS Plan. 

The HIV/AIDS Plan has an annual registration fee of $50 and a copayment. The copayment is the portion of the prescription cost paid by the patient each time they have a prescription filled. The copayment is 20% of the prescription cost up to a maximum of $20. The copayment ceiling is $500 per family unit per plan year.

Reproductive care is health care for the purpose of preventing pregnancy, terminating a pregnancy, managing pregnancy loss, or improving birthing person health and birth outcomes. Reproductive health care includes, but is not limited to: contraception; sterilization; preconception care; fertility care, birthing person care; abortion care; and counseling regarding reproductive health care.

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Reproductive
Care

Fertility Preservation and Family Planning

Every person will have a unique journey in their decision-making and planning around reproduction. Some may choose to pursue gender-affirming care before reproductive planning, and others may decide to postpone accessing GAHT or surgery until they have a reproductive plan in place. 

Though there are numerous ways that people may create families without the use of their own gametes, many people have a wish for genetically-related children. Patients who are planning to conceive in the near future may even wish to delay medical transition in order to minimize the need for harvesting, storage and/or advanced reproductive technologies (ARTs), which can be costly and involve procedures that can intensify feelings of gender dysphoria.

Resources from AART

Directed egg donation provides the opportunity for one person to donate their eggs to another person whom they know. This occurs through a procedure called IVF.

Sperm donation is the process in which one individual (donor) produces a sperm sample, with the purpose of donating the sperm to another individual or couple.

This means that the embryo provided by the intended parents is placed in the uterus of the gestational carrier, by way of a frozen embryo transfer.

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Egg freezing, also known as mature oocyte cryopreservation, is a method where eggs are harvested from a person's ovaries and are frozen unfertilized and stored for later use.

Donor insemination (DI) involves placing previously frozen sperm from a donor in the uterus at the time of ovulation. DI is one option available for achieving fertility where there is no partner producing sperm.

Sperm cryopreservation (sperm banking) is a method used to preserve sperm by cooling and storing sperm at a low temperature. The sperm can be thawed and used at a future date for insemination or fertilization.

In most cases, testosterone-based hormone therapy leads to reversible amenorrhea (i.e., the absence of menstruation) without depletion of ovarian follicles (i.e., a small, fluid-filled sac in the ovary that contains one immature egg). However, there may be an adverse effect on the growth of follicles, particularly in the more mature stages of follicular development. Unfortunately, research in this area remains limited. 

 

While many gender-diverse people with uteri have intentionally become pregnant after discontinuing testosterone to pursue pregnancy, folks may wish to consider postponing testosterone initiation if they would like to become pregnant in the future, since fertility may be permanently affected. While ideally completed prior to starting hormones, fertility preservation can also be performed following (temporary or permanent) discontinuation of testosterone. 

 

For gender-diverse people with uteri who are concerned about fertility loss after testosterone use, or for those planning to have hysterectomies (removal of the uterus) and oophorectomies (removal of the ovaries), there are currently two options for fertility preservation:
 

Oocyte (Egg) banking involves hormone-induced ovulation and the retrieval of the eggs using a needle, guided by ultrasound, inserted through the vaginal wall into the ovary. Many cryogenically frozen eggs do not survive because they are sensitive to the freezing and thawing process. Additionally, cryopreservation can also be done concurrently with gender-affirming gonadectomy.

 

Embryo banking is egg retrieval (as above) followed by immediate fertilization and banking of the embryo. It has a better success rate, but the sperm donor (whether known or anonymous) must be chosen at the time of the egg retrieval.
                                                

Despite reduced fertility during testosterone administration, it should not be considered an adequate method of contraception. It should be noted that folks with uteri can still become pregnant while on testosterone. Once testosterone is initiated, your provider should check with you periodically regarding your sexual health needs.

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The administration of estrogen-based gender affirming hormone therapy results in a reduction of testicular volume (i.e., volume of sperm) and has a suppressive effect on sperm motility and density. Sperm motility and density can also be further impacted by the practice of tucking. 

 

A gender-diverse person who has external gonads and plans to have them removed must bank sperm beforehand to retain the option of having genetically-related children. For best results, it is recommended that folks bank their sperm prior to starting hormones. For those already using hormones, a suspension of hormone treatment is recommended for a few months so that sperm production and quality can recover prior to banking. If interrupting hormone treatment is not an option, poor quality semen can still be frozen for later use, which may include assisted reproductive technologies. In cases where sufficient sperm cannot be produced through ejaculation, fertility clinics can provide surgical options for sperm extraction. 

 

For gender-diverse people with sperm who are concerned about fertility loss after estrogen use, or for those planning to have an orchidectomy (i.e., removal of enteral gonads/testes) there are currently two options for fertility preservation:

 

Sperm cryopreservation (freezing) is a technique utilized to store sperm at very low temperatures for future use.  Sperm cryopreservation following ejaculation is the simplest and most reliable form of preservation. STBBI screening (i.e., chlamydia, gonorrhea, HIV, syphilis and hepatitis serologies) is required prior to banking, and PCPs can expedite the process for patients by completing these tests prior to referral.

 

Testicular sperm extraction (TESE) involves percutaneous removal of sperm from the testes or epididymis under local anesthetic. This procedure may be considered when ejaculation is overly burdensome or difficult. Resulting sperm counts are often low and thus multiple samples and/or the use of in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) may be required. 

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In children who have initiated natal puberty, fertility preservation options include sperm, oocyte, and embryo cryopreservation. Currently, it is not possible for children who have not undergone natal puberty (and who may have used gender-affirming hormones) to preserve gametes. Prolonged pubertal suppression using puberty blockers is usually reversible and should not impair resumption of puberty upon stopping puberty blockers.

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