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INTRODUCTION

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people face many challenges when approaching the health care system. Among the most important is finding access to effective, informed, and affirming care. The medical literature has expanded its discussion of the health needs of LGBTQ people, though often addressing the issues from a strictly sexual behavior perspective (e.g., “men who have sex with men”). Specific knowledge and skills are essential for the health care provider to ascertain the sexual orientation and gender identity of patients; communicate acceptance and understanding of LGBTQ health needs; screen for conditions amenable to behavioral and biomedical interventions; and provide information and resources specific to the lives of LGBTQ patients. Only by employing these skills can providers ensure competent medical care for the LGBTQ community.

DEFINITIONS & CONCEPTS

LGBQ people make up anywhere from 1% to 10% of the general population—depending on the source quoted and the sampling method used in the study. Recent estimates suggest that transgender and gender nonbinary (TGNB) people make up 1.4% of the population in the United States. Whatever the exact percentage, LGBTQ persons constitute a significant group of patients with unique medical, psychological, and social needs. Sexual orientation and gender identity are largely invisible. Consequently, many health care providers caring for LGBTQ patients do not recognize or acknowledge their identities and unique needs.

Sexual Orientation, Sexual Behavior, & Identity

Sexual orientation refers to attraction to another person, including fantasies and the desire for sex, affection, and/or love. Sexual orientation is distinct from and not necessarily predictive of sexual behavior or activities. Identifying as gay, lesbian, bisexual, and/or queer assumes awareness of this sexual attraction to people of the same gender or other genders, respectively, and the development of one’s identity based on this awareness. Emotions, psychological responses, societal expectations, individual choices, and cultural influences are all factors that form this identity. Compared to the term homosexual, often interpreted as more clinical and sometimes pejorative, gay, lesbian, bisexual, and queer are more accepted terms.

Sexual orientation, sexual behavior, and identity are interrelated but function independently. Most self-identified lesbians and gay men are sexually active with a partner of their own gender. However, despite this identity, some lesbians and gay men are celibate (not having sex with other people) or have sexual partners of other genders. Because of the variable relationship between orientation, behavior, and identity, clinicians must remain sensitive, open-minded, and nonjudgmental (see section “Provider–Patient Interactions”).

Many LGBTQ people hold intersectional identities, including gender, race, ethnicity, religion, and ability. Individuals from racial and ethnic minority communities may be less likely to identify as LGBTQ due to the complex interactions of homophobia (see section “Homophobia & Transphobia”), religious influences, and cultural norms. Cultural factors, such as race and ethnicity, do not seem to hamper the formation of identity but may delay the ...

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