In the current era of exploring changing sexual behavior, promoting and supporting the diversity of pleasure, the sexual health and rights of sexual minorities are getting more public attention, among which the "Fourth Love" emerges as a distinctive group within the framework of Chinese culture. Fourth Love refers to a loving relationship between couples of the opposite sex where the woman assumes the traditional male gender role and the man assumes the traditional female gender role, and always accompanied by a special pattern of sexual behavior that women penetrate the men's anus using their fingers or a device. This theoretical article begins by introducing and discussing the historical background, core concept "Fourth Love" and its related categories. Subsequently, we start from Judith Butler's gender performativity theory and interpret the Fourth Love from the perspective of "de-naturalization" and argue that the gender performativity theory provides a reasonable explanation for the gender characteristics (female top and male bottom) of the Fourth Love. Finally, we posit a discussion and outlook on the survival and development of the Fourth Love in the fields of sexual health, sexual pleasure, sexual right, and family and marriage, and calls for more understanding and psychological support from the society for them.
Purpose: Culture and stigma-relevant issues discourage transgender individuals in China from gender identity disclosure, which may limit their access to comprehensive health care services. This study evaluates how gender identity disclosure to healthcare professionals would facilitate healthcare services in China.
Methods: A cross-sectional study was conducted in nine cities across mainland China from December 2019 to June 2020 among transgender individuals. Participants completed questions covering socio-demographic information, Human Immuno-Deficiency Virus and Sexually Transmitted Infections (HIV/STI) testing habits, sexual risk behaviors, and access to medical and mental health services for the past 3 months.
Results: A total of 277 eligible transgender individuals with a mean age of 29 ± 8 years old completed the survey. Overall, 56.0% (155/277) had disclosed their gender identity to health professionals. 83.9% had ever tested for HIV (with HIV prevalence of 12.9%), 54.2% had tested for STIs, 62.6% had used hormone therapy, and 12.3% had undergone gender-affirming surgery. Multivariable logistic regression showed that participants who had ever disclosed their gender identity to healthcare professionals were more likely to have tested for STIs (aOR = 1.94, 95%CI: 1.12-3.39) and HIV (aOR = 1.72, 95% CI 0.82-3.39), received hormone intervention therapy (aOR = 2.81, 95%CI: 1.56-5.05), and used pre-exposure prophylaxis (PrEP) (aOR= 3.51, 95%CI: 1.12-10.97) compared to non-disclosers.
Conclusions: Our study demonstrated strong correlations between gender identity disclosure and healthcare services usage among Chinese transgender individuals. Facilitating the gender identity disclosure of transgender individuals to healthcare professionals with caution would be useful for improving their access to care.
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