The Color Atlas and Synopsis of Family Medicine, 3e

Chapter 13: Lesbian Gay Bisexual Transgender Health Issues

Ronni Hayon; Jarrett Sell; Matthew Witthaus

CARE FOR SEXUAL-MINORITY PATIENTS

PATIENT STORY

Ana is a 35-year-old woman who presents for a routine physical. In the past, you have discussed her social history and learned that she is divorced, has one child from that relationship, and has had a healthy relationship with her current live-in boyfriend for about 5 years. In reviewing her social history today, you inquire about relationships and she shares that she and her boyfriend have an open relationship and that she has had one new male partner and two new female partners in the past 3 months. She identifies as bisexual and polyamorous. She is "fluid bonded" (does not use barrier methods) with her primary partner, but uses barriers with her other partners. You offer STI screening today and together plan for regular screening in the future.

INTRODUCTION

The term "sexual minority" is an umbrella term that encompasses people whose sexual orientation, practices or identity differ from that of the larger surrounding society (Figures 13-1 and 13-2). Most commonly, it is used to refer to people who identify as lesbian, gay, bisexual, or queer.¹ Table 13-1 lists descriptions of sexual minority populations.

Population-based surveys show prevalence rates of sexual-minority adults in the United States ranging from 2.2% to 4.0%, depending on which survey is used.² Depending on how these questions are asked, and how safe respondents feel about answering these sensitive questions, surveys may not be an accurate reflection of prevalence and may underestimate rates of same-sex attraction and sexual behaviors.
Based on 2013 National Health Interview Survey (NHIS) data, the Centers for Disease Control and Prevention (CDC) reported that among adults in the United States, 1.6% identified as gay or lesbian, 0.7% identified as bisexual, and 1.1% identified as "something else," declined to answer, or stated "I don't know."³ NHIS data also showed significant differences in health status, healthcare service utilization, health-related behaviors, and healthcare access when comparing sexual minority people to those who identify as straight.

FIGURE 13-1

Marchers at a marriage equality rally in Madison, Wisconsin, holding a rainbow flag, sometimes referred to as the gay pride flag or LGBT pride flag. The rainbow flag is a symbol of lesbian, gay, bisexual, transgender and queer pride, and of LGBTQ social movements. (Reproduced with permission of Dutcher Photography LLC.)