LGBTQ Patients and Sexual Health Care: 7 Easy Tips for You
LGBTQ patients and sexual health care is a hot topic. Even well before nursing school, I heard of health care providers and the health care system overall struggle to understand LGBT health and the needs of the LGBT community. I also heard that many LGBTQ patients struggled with accessing care, receiving culturally competent care, paying for health care, and being respected from health care centers.
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I was pretty shocked to learn that, even in the most progressive of health places or institutions, there was still a ton of stigma and uncertainty around LGBTQ patients and sexual health care.
Being a sexual health educator and wanting to learn more about providing the best care possible to future patients, I did my own research. I volunteered with the amazing Fenway Health. Fenway mostly worked with LGBTQ patients in sexual health care and other types of primary care. But, I still had questions. I wanted to learn more.
I’m going to share what I learned LGBTQ patients and sexual health. Trust me, learning inclusive language and making your sexual health assessment more inclusive is easy once you get the hang of it.
LGBTQ Patients and Sexual Health: Defining the Acronym
Truthfully, I’m still surprised how it’s 2022 and there are health care professionals who have not heard of the acronym LGBTQ. That’s ok! You can learn something new every day. So, let’s begin.
- L – lesbian
- a woman attracted to another woman
- G – gay
- a man attracted to another man
- B – bisexual
- a person attracted to men and women
- T – trans/gender diverse
- someone whose gender identity or expression does not align with their sex assigned at birth
- Q – queer
- someone who is not heterosexual
- Let’s also add in some other identities!
- I – Intersex
- People born with any of several sex characteristics including chromosome patterns, gonads, or genitals that, according to the Office of the United Nations High Commissioner for Human Rights, “do not fit typical binary notions of male or female bodies”
- A – asexual
- someone who does not experience sexual attraction
Why Do I Need to Know This?
Let’s talk about why this is important. Most of us were raised in societies where we were taught that men should only be with women, women only with men, and anything outside of this is unacceptable. Oh, and that sex outside of marriage is bad. And that sex is only penis in vagina, nothing else, no sex toys or lube or anything like that. Mass acceptance of heterosexuality and stigmatization of non-heterosexuality are both the results of the way society works. And society, especially America, is heavily influenced by colonialism, slavery, genocide, and more.
In many parts of the world pre-colonization, non-heterosexual couples were common. Being gay is nothing new. Trans and gender diverse people have existed for centuries and were often revered and worshipped. Fast forward to 2022 and many countries now have legislation where it is legal to terminate employment, deny health care, deny housing, and more to LGBTQ people.
As a result, anything or anyone who is non-heteronormative (anything that deviates from heterosexuality), threatens social order. The way “things should be” is a constant power struggle. Until now.
LGBTQ patients and sexual heath intersect at the margins since mainstream society does not like to talk about either. The phrase LGBTQ is extremely popular now with several pieces of legislation in Congress, and sexual health education is still severely lacking in many schools. For LGBTQ patients and sexual health needs, it is often a risk to be openly non-heteronormative and to discuss sexual behaviors with a health care provider. And even in places where sexual health is discussed, it is often from a heteronormative lens, where only penis and vagina sex is mentioned.
What about oral sex? Anal sex? Sex toys? Sex with more than one person? All these things are critical to determining the needs for STI testing, STI prevention education, and more. Yet, these topics are often overlooked in many health care places, even in sexual health clinics. :/
When thinking about providing care to LGBTQ patients and sexual health care in particular, I want you to think about the stigmas that LGBTQ people face daily as a result for being different, unwanted, and often times, unwelcome.
LGBTQ Patients and Sexual Health: Taking a Good Sexual Health History
Now that I’ve defined LGBTQ, let’s talk about how to take a good sexual health history. A sexual health history is a series of questions the patient completes. It is is often used to determine what tests can be done and what patient education can occur.
This is great if a provider is comfortable talking about sexual health. This is not great if the provider is uncomfortable with LGBTQ patients and sexual health. So, first, before getting into providing care to LGBTQ patients and sexual health care, ask yourself. How do you feel about LGBTQ patients? How do you feel about sexual health?
If you don’t feel comfortable with both, it’s going to be pretty obvious to your patients. So, this is a time for you to reflect to see if providing care to LGBTQ patients and sexual health services are within your comfort level. If not, refer. Take time to learn more about the needs of your LGBTQ patients and sexual health.
If you’re comfortable with LGBTQ patients and sexual health, great!
Here are some tips to taking a good sexual health history and providing LGBTQ patients with the care they deserve.
- Set the tone
- Do you have a rapport with this person?
- Talk about other things before jumping into sexual health, such as lifestyle, or other health conditions, or what brings this person into your clinic today
- Be clear and take the time to answer questions in detail
- Do you have a rapport with this person?
- Consider culture and circumstance
- Everyone is influenced by their upbringing and surroundings when it comes to sexual health!
- Before asking the questions, say something like this…
- “I am going to ask you some personal questions about your sexual health. I ask these questions on everyone I see in order to provide the best care possible and determine what tests or education can be done today. If you do not feel comfortable answering these questions, you may decline. And if you need me to clarify anything, you are more than welcome to let me know. How does that sound to you?”
Here are some things to avoid saying when obtaining a sexual health history!
- Avoid asking how many partners have you had sex with
- Can come off as judgmental whereas asking about a partner or partners leaves it more open
- Avoid asking if they had sex in exchange for money or housing
- People fear being criminalized for sex work since having sex for money is illegal in America.
- Avoid synonyms for penis and vagina like dick or pussy
- Be comfortable saying penis, vagina, or terms that this person might use for their genitals, such as front hole or bottom
- Avoid asking if their partners are male or female
- Gender binary concerns because not all males have penises and not all females have vaginas
Thank you so much for reading about LGBTQ patients and sexual health care! Tell me what you think about the intersections of LGBTQ patients and sexual health.
If you have any tips for providing care to LGBTQ patients and sexual health overall, feel free to leave a comment!
See you next Wednesday!
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Hatcher, R, et al. (2018). Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc.
Percat, A. and Elmerstig, E. (2017). “We should be experts, but we’re not.” Sexual counseling at the antenatal care clinic. Sexual and Reproductive Healthcare, 14, 85-90. https://doi.org/10.1016/j.srhc.2017.10.001
Worly, B. et al. (2021). Sexual Health Education in Obstetrics and Gynecology Residencies-A resident physician survey. The Journal of Sexual Medicine, 18(6), 1042-1052.