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Lesbian, gay, bisexual, and transgender (LGBT) people have become more openly accepted into the framework of society. Likewise, the medical literature has expanded its discussion of the health needs of LGBT 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 be able to ascertain the sexual orientation of patients; communicate acceptance and understanding of LGBT health issues; screen for conditions amenable to behavioral medicine; and provide information and resources specific to the needs of LGBT patients. Providers can use these skills to provide access to competent medical care for LGBT patients.

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Lesbians and gay men make up anywhere from 1 to 10% of the general population—depending on the source quoted and the sampling method used in the study. In most studies, self-identified bisexuals are a small fraction of the lesbian or gay population. Whatever the exact percentage, however, in absolute terms, LGBT persons constitute a significant group of patients with unique medical, psychological, and social needs. Many primary care providers care for LGBT patients without being aware of the patients' sexual orientation or gender identity and are therefore unable to recognize or acknowledge their unique needs.

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Sexual Orientation, Sexual Behavior,& Identity

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Sexual orientation refers to sexual attraction to another person, including fantasies and the desire for sex, affection, and love. Sexual orientation is distinct from and not necessarily predictive of sexual behavior or activities. Being gay, lesbian, or bisexual assumes awareness of this sexual attraction to people of the same gender or both genders, respectively, and development of an identity based on this awareness. This identity is formed by emotions, psychological responses, societal expectations, individual choices, and cultural influences. Most lesbians and gay men prefer the terms lesbian and gay, because such terms incorporate emotions, behavior, and a cultural system, as well as sexual orientation. Compared to the term homosexual, often interpreted as more clinical and sometimes pejorative, gay and lesbian are viewed as nonjudgmental.

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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 or have sexual partners of the opposite gender. In fact, most lesbians have had at least one sexual experience with a man, but would not self-identify as bisexual. On the other hand, some men and women who identify as bisexual enter into and codify long-term relationships with a partner of the opposite gender while maintaining sexual relationships with partners of the same gender. Because of the variable relationship between orientation, behavior, and identity, physicians must remain sensitive, open-minded, and nonjudgmental (see "Doctor–Patient Interactions," below).

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Race and ethnicity have a strong influence on sexual identity and behavior. "Down low," a popular term coined ...

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