Sexual Orientation

Participants were first asked a question about their natal sex (Step 1): “What sex were you assigned at birth, on your original birth certificate? (check one)” with three response options: “Male,” “Female,” or “Prefer Not to Answer.” The overall proportion of participants who endorsed “Prefer Not to Answer” was low (n = 44). These participants were excluded from analysis. Next, participants were asked about their current gender identity (Step 2): “What is your current gender identity? (check one)” with six response options: “Male,” “Female,” “Male-to-Female,” “Female-to-Male,” “Other (Specify),” and “Prefer Not to Answer.” Participants who selected “Prefer Not to Answer” (n = 101) were excluded from analysis.
The response option “Other (Specify)” offered participants an open-ended write-in to describe their current gender identity. A total of 432 participants selected “Other (Specify)” of whom 4.6% (n = 20) left the write-in option blank. These 20 participants were excluded from analysis. Two independent coders sorted qualitative responses (n = 412) and grouped them by thematic category to examine potential problems with item interpretation. The majority of write-in participants interpreted gender identity to mean sexual orientation identity, most commonly gay (59.5%) or bisexual (28.2%). After confirming their assigned sex at birth was male and their write-in response was not a transgender or other gender identity, these participants were re-coded as cisgender male. Overall, 2.2% (n = 9) listed an “Other” write-in that was correctly classified as a gender identity (not sexual identity or a sexual role), most commonly travesti (66.7%; n = 6). These were categories as other gender category.
Natal sex/gender identity status was operationalized by cross-classifying participants according to assigned sex at birth and current gender identity as follows: (1) “Male”: participants who checked “Male” assigned birth sex and checked “Male” for gender identity; (2) “MTF spectrum”: participants who checked “Male” assigned sex and who endorsed a “Female,” “MTF,” or “Other” (re-coded as described above) gender identity; (3) “FTM spectrum”: participants who checked “Female” assigned birth sex and who endorsed a “Male,” “FTM,” or “Other” (re-coded as described above) gender identity. Table 2 (Column A) shows the initial coding using the two-step method. Thirty-five cases appeared misclassified after initial coding (30 cases assigned male birth sex who self-identified FTM, 4 cases of female birth sex who identified as female, and 1 case of female birth sex who identified as male-to-female). These were excluded from analysis. Cleaned and coded two-step categorized gender is shown in Table 2 (Column B). Overall, 190 (0.54%) transgender participants were identified.

The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium was established in 2015 to expand research, practice, and policies beyond the detection and treatment of LUTS to the promotion and preservation of bladder health and prevention of LUTS in girls and women.^{43 (link)} While many multidisciplinary research networks focus on pelvic floor dysfunction and LUTS, the PLUS Consortium stands alone in its focus on prevention. The PLUS Consortium is comprised of a transdisciplinary network of professionals, including community advocates, health care professionals, and scientists specializing in pediatrics, adolescent medicine, gerontology and geriatrics, nursing, midwifery, behavioral medicine, preventive medicine, psychiatry, neuroendocrinology, reproductive medicine, female pelvic medicine and reconstructive surgery, urology, infectious diseases, clinical and social epidemiology, prevention science, medical sociology, psychology, women’s studies, sexual and gender minority health, community-engaged research, community health promotion, scale development, research methods, and biostatistics. Early conversations between network members acknowledged the diversity of girls and women with respect to sexual orientation and gender identity (SOGI). Members agreed to include SOGI measures in PLUS studies and to develop inclusion/exclusion criteria for cisgender and transgender individuals that fit the scientific objectives of each study.
To shift research, practice, and policies to a focus on health, the PLUS Consortium identified two initial tasks that it pursued in parallel. First, the Consortium drafted a definition of bladder health.⁴⁴ Consistent with the World Health Organization’s definition of health,⁴⁵ the PLUS Consortium conceptualizes bladder health as “a complete state of physical, mental and social well-being related to bladder function, and not merely the absence of LUTS,” with function that “permits daily activities, adapts to short term physical or environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational or other activities).” Second, the Consortium adopted a prevention science paradigm and developed a conceptual framework to guide the Consortium’s initial prevention research agenda. The Consortium began this task by establishing a shared understanding of prevention science among its diverse members. The Consortium then drew from separate, but complementary theoretical traditions and contemporary writings to develop the PLUS conceptual framework. The purpose of this manuscript is to describe the PLUS approach in developing a conceptual framework to guide the Consortium’s initial prevention research agenda.