The study is based on the assumption that access to public restrooms, marked by insecurity, embarrassment, and transphobia, influences the toileting behavior of transgender individuals and may impact urinary health. The objective was to analyze toileting behavior in transgender people in Brazil and its association with lower urinary tract symptoms.

This is an exploratory-descriptive, cross-sectional study with a mixed-methods approach and convergent design. Data collection was conducted through an online questionnaire (Google Forms), including sociodemographic and clinical characterization, the application of the International Consultation on Incontinence Questionnaire – Female/Male Lower Urinary Tract Symptoms (ICIQ-FLUTS/MLUTS) to assess and quantify lower urinary tract symptoms, an adapted version of the Toileting Behavior–Women’s Elimination Behaviours (TB-WEB) to evaluate toileting behavior, and two open-ended questions regarding experiences with public restroom use. Quantitative data were analyzed using descriptive and inferential statistics (p < 0.05), and qualitative data were analyzed according to Bardin’s content analysis.

A total of 131 individuals participated, with a mean age of 28.1 years, predominantly trans men/transmasculine (51.91%), single (73.85%), and with higher education (71.76%). A high frequency of potentially harmful toileting behaviors was observed, including delaying urination (87.02%), straining to void (70.23%), and premature voiding (61.07%). Regarding public restroom use, 93.55% reported embarrassment, 89.25% insecurity, and 47.31% reported experiences of transphobia; additionally, 88.17% reported avoiding public restrooms. The most frequent lower urinary tract symptoms included overactive bladder, incomplete bladder emptying, and urinary incontinence, with variations across gender identities. A statistically significant association was observed between risky toileting behaviors and higher scores of lower urinary tract symptoms, particularly overactive bladder. Qualitative analysis identified two main categories: “negative experiences,” related to insecurity, prejudice, dysphoria, and inadequate structural conditions; and “adaptive experiences,” involving avoidance strategies, preference for safer environments, and behavioral adjustments.

The findings indicate that negative experiences in public restrooms, particularly those related to insecurity, embarrassment, and transphobia, influence the adoption of inadequate toileting behaviors, such as delaying, anticipating, or straining to void. These behaviors, often used as adaptive strategies in response to perceived hostile environments, are associated with higher scores of lower urinary tract symptoms. Avoidance of public restroom use and preference for environments perceived as safe contribute to changes in voiding patterns. In addition, the association between symptoms such as incomplete bladder emptying and urinary incontinence can be understood in light of these habits. This pattern is consistent with the minority stress model, which describes the impact of discrimination on health behaviors, and with findings indicating that avoidance of public restrooms is associated with the adoption of harmful urinary habits among transgender individuals.

Inadequate toileting behaviors among transgender individuals are associated with experiences of insecurity, embarrassment, and transphobia in public restrooms, contributing to the occurrence of lower urinary tract symptoms. It is essential to promote safer and more inclusive environments, as well as to strengthen health actions that consider the specificities of this population.

1. Bardin L. Ana´lise de Conteu´do. São Paulo: Edic¸o~es 70; 2011.
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James SE, Herman JL, RAnkin S, Keisling M, Mottet L, Anafi M. The report of the 2015 U.S. transgender survey [Internet]. National Center for Transgender Equality; 2016 Dec. Available from: https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf.