Transgender patients often cause confusion in emergency rooms when their genitals don’t match their listed gender, a Thursday New York Times op-ed explained.

Many times the awkwardness stems from the transgender patient’s gender identity not aligning with their private parts, emergency room physician Helen Ouyang writes.

“Sometimes the patient is registered as the wrong gender immediately from triage, resulting in a strained communication from the get-go,” Ouyang says.

When a transgender man comes in and reveals a vagina, staff does not always know how to react properly. Staff are often unsure how to refer to the patients, so they resort to calling the transgender patients “they,” the op-ed says.

“Other times, a staff member lets out a surprised gasp as a patient undresses for a physical exam. Then there are the moments when providers call a patient a ‘he/she’ or ‘they’ on rounds,” Ouyang says.

Ouyang claims the problem for this is “ignorance” and a lack of understanding on the health care needs of gay and transgender people.

“None of this, for the most part, is out of malice. Instead it’s because of our own ignorance — and stems from our lack of education and training on providing sensitive and evidence-based care for transgender patients,” Ouyang continues.

She proposes multiple ways for healthcare providers and doctors to educate themselves on transgender health issues. After all, learning about transgender healthcare is as important as learning how to revive a patient from a heart attack, Ouyang claims.

“But the first step is simply recognizing our own deficiencies-and realizing that learning about transgender health is a pressing as mastering dosages of the newest cholesterol- lowering drug or memorizing the latest protocol for resuscitating a patient from cardiac arrest,” she writes.

Two transgender employees with the University of Wisconsin recently sued their employees and some state insurers because their health plans do not pay for their gender re-assignment surgery.

The transgender employees, both men who transitioned to women, argued that their insurance plans “single out transgender employees for unequal treatment by categorically depriving them of all medical care for gender dysphoria.”

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