Reply to Comment on Hardacker, C.T.; Baccellieri, A.; Mueller, E.R.; Brubaker, L.; Hutchins, G.; Zhang, J.L.Y.; Hebert-Beirne, J. Bladder Health Experiences, Perceptions and Knowledge of Sexual and Gender Minorities. Int. J. Environ. Res. Public Health 2019, 16, 3170.

We appreciate your comments and concerns about our manuscript in IJERPH on Bladder Health Experiences, Perceptions and Knowledge of Sexual and Gender Minorities [...

Bladder Health Experiences, Perceptions and Knowledge of Sexual and Gender Minorities.

While recent efforts have been made to understand the bladder health experiences, perceptions, and knowledge of cisgender adolescent females and women, virtually nothing is known about the bladder health experiences of people who identify as sexual and gender minorities (SGMs). A community-based participatory research approach using a focus group methodology to engage 36 adult participants who identify as SGM, including individuals who identify as gender non-conforming, queer, transgender (trans) men, or lesbian, in one of six focus group discussions on bladder health. Using directed content qualitative data analysis from the six unique focus groups, three interrelated themes were revealed: gender socialization of voiding behavior and toilet environment culture producing identity threats, and risks to gender affirmation; consequences of hetero-cis normative bathroom infrastructure necessitating adaptive voiding behaviors; and, physical and psychosocial consequences of chronic anxiety and fear are associated with voiding experiences.