Denied Relief: The Chronic Pain of Bathroom Bans

AI disclosure: N/A

The nurse asked if I was sure I had another urinary tract infection (UTI). It was my fifth that year. I was seventeen. Going in and out of urgent care for antibiotics started to feel routine, as did adjusting my posture as I sat through my classes to minimize a festering pain in my abdomen and lower back. 

My freshman year of high school, after coming out as trans masculine, I started using the boys' bathroom only during classes or when I knew fewer students would be there. The next year I was called into a sit-down meeting with a guidance counselor, an assistant principal, and the principal of my school. They informed me that I could only use the girls' bathroom or the gender-neutral one in the opposite wing. They also told me they had called my parents and let them know that disciplinary action was being taken against me due to using the boys’ bathroom. I told them how unsafe a call home could be for youth like me. I was out to my parents already, but that did not save me from the shame they felt I deserved for breaking the rules. The gender-neutral bathroom, which was near the gym and far from my classes, also required a key from a PE teacher to access. To avoid the further embarrassment of being forced into the girls’ room and missing portions of my class, I was going up to 8-12 hours a day without using the bathroom. Unfortunately, this is a common experience for many trans people—over 60% of surveyed transgender people reported restroom avoidance, and around 30% have reported restricting eating or drinking. When trans people are forced to hold their bladder for hours and hours, there are real consequences on our bodies. 

UTIs and other lower urinary tract issues can significantly impact quality of life, as common symptoms include severe pain and changes in urgency, frequency, and even incontinence. After two years of bathroom avoidance during school, I was developing UTIs almost monthly. The individual infections escalated to a constant dull pain in my abdomen that kept me in bed for days at a time. It was not until my fourth year of symptoms that I was diagnosed with interstitial cystitis (IC) and finally put on an effective treatment plan. IC is “characterized by lower abdominal pain and pressure upon filling of the bladder that has lasted for more than 6 months and is accompanied by at least one additional symptom, such as frequency or urgency.” It is a subcategory of bladder pain syndrome characterized by an active inflammation of the bladder. Years of research suggest a significant association between clinical levels of anxiety and lower urinary tract issues and dysfunction. I doubt my school wanted to cause UTIs or IC, but policy choices nonetheless can cause harm to our health. 

Throughout those years, I met with school board members, delegates, and other elected officials to explain my experiences. I spent my afternoons doing homework, evenings writing testimony, and weekends meeting with other advocates in my area. I later learned that much of what I was practicing through trial and error is community organizing. A coalition of marginalized students and their families created a list of three demands to take to our county school board: 1) the creation of a superintendent advisory council with representatives from marginalized communities, 2) anti-bias training for faculty and staff about gender, sexuality, disability, and race, and 3) an updated anti-discrimination policy that included gender identity and sexuality. Hands sweating and voice shaking, I gave testimony monthly to the school board for about two years before our demands were met. 

As an undergraduate student, I got an internship with the newly elected state delegate from my hometown. There, I co-authored HB145, which became the “Model Policies for The Treatment of Transgender Students in Virginia’s Public Schools”. I was nineteen years old, writing a policy that would have protected fourteen-year-old me not just from discrimination, but also from the health consequences associated with it. It was the first time I was on the other side of political power, and I wanted to ensure that no trans kid would have to go through what I did.

HB145 Bill Text: “Public elementary and secondary schools; treatment of transgender students; policies. Requires the Department of Education to develop and make available to each school board, no later than December 31, 2020, model policies concerning the treatment of transgender students in public elementary and secondary schools that address common issues regarding transgender students in accordance with evidence-based best practices and include information, guidance, procedures, and standards relating to (i) compliance with applicable nondiscrimination laws; (ii) maintenance of a safe and supportive learning environment free from discrimination and harassment for all students; (iii) prevention of and response to bullying and harassment; (iv) maintenance of student records; (v) identification of students; (vi) protection of student privacy and the confidentiality of sensitive information; (vii) enforcement of sex-based dress codes; and (viii) student participation in sex-specific school activities and events, excluding athletics, and use of school facilities. The bill requires each school board to adopt, no later than the beginning of the 2021-2022 school year, policies that are consistent with but may be more comprehensive than such model policies developed by the Department of Education. This bill is identical to SB 161.”

Two years after these policies were enacted, they were redrafted by Governor Youngkin, titled “Model Policies on Ensuring Privacy, Dignity, and Respect for All Students and Parents in Virginia’s Public Schools”. I found out the changed policy had been released when I started receiving calls from local news outlets. My stomach sank when I read the new policies. Forced outings went from a banned practice to policy: “No policy, guidance, training, or other written material issued by the [School Division] may encourage or instruct teachers to conceal material information about a student from the student’s parent, including information related to gender.” Bathroom access changed to denial: “Students shall use bathrooms that correspond to his or her sex.” The only exception or appeal for students was laid out as the following: “Students with a diagnosis of gender dysphoria made by a licensed health care provider should consult with their school’s Americans with Disabilities Act (ADA) coordinator regarding any requested services.” I knew from my own experience that bathroom access restrictions through state mandate would cause mental and physical harm to trans youth.

Governors have come and gone. Policies have been drafted and redrafted. But my chronic pain is still a policy failure that could have been avoided. Public policy discourse often centers on constitutionality and perceived fairness, but rarely does it discuss that policy choices can impact our bodies. The first step of any policy change should be to evaluate the harm that might follow. For trans people, discrimination is not just an idea on paper, but a lingering harm to our bodies that causes real health disparities. Transgender Americans’ health cannot continue to be treated as collateral damage in political fights.

About the author

Anthony “Bo” Belotti has spent the last 10 years engaging in movement work. Having achieved their Bachelor's in Political Science and Queer Studies from Virginia Commonwealth University in 2022, he is now pursuing a Master's of Public Policy from Georgetown University. Bo, as a community organizer and policy professional, is deeply interested in closing the gap between those who are impacted by a policy decision and those who have the most power over those decisions. He is a trans masculine, queer, and chronically ill person based in Washington, D.C.

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Instagram: @BoBelotti