Editorial Comment: The Experience of Bladder Health in Community-Dwelling Sexual and Gender Minority Individuals Within the RISE FOR HEALTH Study

Bladder health in sexual and gender minority (SGM) populations remains critically understudied. Although some studies have suggested an increase in pelvic floor muscle tone in SGM,1 this paper makes an important contribution by showing how stigma, social determinants, and restricted restroom access shape lower urinary tract outcomes.2 The authors highlight the role of socioecological discrimination—manifesting as preemptive or delayed voiding—in driving physiological changes through chronic stress, hypervigilance, and behavioral adaptation, ultimately affecting quality of life.3 However, the authors also acknowledge that several key clinical dimensions require further exploration. Without data on prior gender-affirming surgeries, it is difficult to separate urinary symptoms caused by surgically altered anatomy from those driven by environmental stressors. Age-related changes and the presence of natal structures, such as the prostate in some assigned-male-at-birth or intersex individuals, are also essential to distinguish socially mediated symptoms from anatomically or physiologically based conditions. Equally important is the relationship between intimacy, emotional well-being, and sexual function. For transgender individuals, the presence or absence of surgically constructed functional genitalia may influence both urinary and sexual health, as well as self-perception. By contrast, cisgender lesbian individuals may retain native anatomy and associated urinary physiology, potentially leading to distinct symptom patterns and care-seeking behaviors. Understanding these differences is crucial for advancing SGM bladder health research. Integrating surgical history, anatomy, sexual function, and emotional health into future studies will clarify underlying mechanisms and support more precise, equitable, and culturally responsive interventions.