Dilating Health, Healthcare, and Well-Being: Experiences of LGBTQ+ Thai People

Abstract

How can the epistemological tools and frameworks of biomedical engineering and critical gender studies be used to contest each other’s work, engender new collaborations, and broaden our conceptual horizons as to the limitations and potentials of each discipline? On one hand, this study asks how the Thai sex/gender system affects the health, healthcare, and well-being of LGBTQ. To answer this question, I conducted 32 in-depth semi-structured interviews with Thai LGBTQ+ patients and healthcare providers. By analyzing these themes using Michel Foucault’s theory of biopower, Nancy Krieger’s eco-social model of health, and Paul Farmer’s concept of structural violence, I show how state, economic, and political powers impose a “power over life” through means of surveillance and disciplining which have explicit impacts on the health, healthcare, and well-being of LGBTQ+ Thai people. Much of this regulation and disciplining does not occur explicitly in healthcare settings; they are prevalent in all spaces throughout the life course. These contemporary forms of power are also genealogically linked to colonial pressures during the 19th and 20th centuries. The effects of these forms of regulation are physically embodied, resulting in differential health outcomes. If the structures in place that threaten the health and well-being of LGBTQ+ Thai people are largely social, political, and economic, what are the possibilities and limitations for biomedical engineering to address LGBTQ+ health needs? This process of inquiry resulted in the design of a prototype dilator for use after gender-affirming vaginoplasty. However, gender-affirming vaginoplasty is not simply a biomedical procedure; it is enmeshed in social, economic, and ontological problematics. In Thailand, gender-affirming vaginoplasty is not subsidized by insurance, and vaginoplasty is economically inaccessible to those most marginalized. Thus, contextualizing vaginoplasty and other biomedical interventions with the tools of critical gender theory allows us to assess if we are asking the right questions with regard to LGBTQ+ healthcare, and, if not, what questions should we be asking?