Hijra tend to have few options for earning a wage, with many turning to sex work and others performing ritualistic songs and dances. They are integral to several Hindu ceremonies, such as dance programs at marriage ceremonies. They may also earn a living by going uninvited to large ceremonies such as weddings, births, new shop openings and other major family events, and singing until they are paid or given gifts to go away. The ceremony is supposed to bring good luck and fertility, while the curse of an unappeased hijra is feared by many. Hijra often engage in prostitution and begging to earn money, with begging typically accompanied by singing and dancing. Some Indian provincial officials have used the assistance of hijras to collect taxes in the same fashion—they knock on the doors of shopkeepers, while dancing and singing, embarrassing them into paying. Recently, hijras have started to found organizations to improve their social condition and fight discrimination, such as the Shemale Foundation Pakistan. Religious castration
Castration as part of religious practice, and eunuchs occupying religious roles, have been established prior to classical antiquity. Archaeological finds at Çatalhöyük in Anatolia indicate worship of a Magna Mater figure, a forerunner of the goddess Cybele found in later Anatolia and other parts of the near East. Later Roman followers of Cybele were called Galli, who practiced ritual self-castration, known as sanguinaria.
Esophageal strictures
Esophageal cancers

Esophagitis
GERD
Eosinophilic esophagitis – a disease commonly associated with other atopic diseases such as asthma, food allergies, seasonal allergies, and atopic skin disease
Mallory-Weis tears – tears of the superficial mucosa of the esophagus that are subsequently exposed to gastric acid commonly due to vomiting and/or retching
Chemical esophagitis – related to the intake of caustic substances, excessive amounts of hot liquids, alcohol, or tobacco smoke
Infections may explain heartburn symptoms. These especially include CMV and certain fungal infections, most common in immunocompromised persons

Stomach
Peptic ulcer disease – can be secondary to H. Pylori infection or heavy NSAID use that weakens stomach mucosal layer. Pain often worsens with eating. Stomach cancer

Intestines
Intestinal ulcers – generally secondary to other conditions such as H. Pylori infection or cancers of the GI tract. Pain often improves with eating. Duodenitis – inflammation of the small intestine. May be the result of several conditions

Gallbladder
Gallstones

Pancreas
Pancreatitis – can be autoimmune, due to a gallstone obstructing the lumen, related to alcohol consumption. Hematology
Pernicious anemia – can be autoimmune, due to atrophic gastritis. Pregnancy
Heartburn is common during pregnancy having been reported in as high as 80% of pregnancies. It is most often due to GERD and results from relaxation of the lower esophageal sphincter (LES), changes in gastric motility, and/or increasing intra-abdominal pressure. The onset of symptoms can be during any trimester of pregnancy.