Who is Lesbian, Gay, Bisexual, or Transgender?
Assuming the most recent data to be correct, 5–9% of men are gay and 3–4% of women are lesbian. Kinsey’s original reports put these numbers at 10% for men and 2–6% for women. A recent international review reports that ≤15% of men report same-sex sexual activity at some time during their lives. An additional small percentage of the population experiences gender identity disorder or identify as transgender. These numbers suggest that physicians will provide care for lesbian, gay, bisexual, or transgender (LGBT) patients regardless of geographic location, or the ethnic, religious, socioeconomic, or gender demographics of their practice, and perhaps without knowing.
ESSENTIALS OF DIAGNOSIS
The first step in providing high-quality healthcare to LGBT patients is a thorough and sensitive sexual history.
History forms can facilitate this, if items include options relevant for LGBT patients, for example, “marital status” should include options for domestic partner.
Comprehensive information about behavior is necessary as a foundation for optimal education and health screening.
Knowing which patients are LGBT is the first and most important step in providing superior care—even if patients do not self-identify as LGBT but engage in same-sex sexual encounters. Accomplish this by taking a thorough and sensitive sexual history with all new patients and any time sexual behavior may be relevant to diagnosis and management.
Taking the Sexual History
The process of taking a sexual history begins with creating a safe environment. As sexual and gender-variant minorities, many LGBT people have faced discrimination and may fear sharing the details of their sexual lives with a healthcare provider. To further complicate matters, many healthcare providers may avoid discussing sexuality and sexual orientation details with patients, especially with adolescents, because often physicians do not feel they have the skills needed to address issues of sexual orientation. By providing literature in the office relevant to LGBT patients and by displaying positive, reassuring symbols (eg, a rainbow flag or equal sign), physicians can help their patients feel more at ease. History forms should include the full range of patient responses and not contain wording that ignores LGBT patients’ lives; such forms could facilitate conversation about sensitive topics. Physicians can overcome their own discomfort by routinely taking sexual histories.
The goal of taking a sexual history is to identify behaviors that can affect a patient’s health. Whether a man who has sex with men (MSM) self-identifies as gay or bisexual is important for understanding his social and psychological situation, but less relevant in terms of screening for and treating organic disease processes. It is worth prefacing all sexual history taking by informing the patient that the discussion will remain entirely confidential, and that the reason why each question must be answered in full, although the questions may seem too personal and invasive, is so that the physician can provide the ...