Who Is Lesbian, Gay, Bisexual or Transgender?
Assuming the most recent data are 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 notes that up to 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 identifies as transgender. These numbers suggest that, regardless of a physician's geographic location, or the ethnic, religious, socioeconomic, or gender demographics of their practice, and perhaps without the physician's awareness, he or she will provide care for lesbian, gay, bisexual, or transgender (LGBT) patients on a routine basis.
- The first step in providing high quality health care 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" includes options for domestic partner.
- Comprehensive information about behavior is necessary as a foundation for optimal education and health screening.
The first and most important step in providing superior care for lesbian, gay, bisexual, and transgender (LGBT) patients, as well as for patients who do not self-identify in any of these categories but engage in same-sex sexual encounters, is knowing who they are. This can be accomplished by taking a thorough and sensitive sexual history with all new patients and at any time when 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 health care provider; in addition, many health care providers may avoid discussing these intimate details with their patients. By providing literature in the office that reaches out to LGBT patients and by displaying symbols such as a rainbow flag, physicians can help their patients feel more at ease. History forms completed by patients should be phrased to include the full range of patient responses and not have wording that ignores LGBT patients' lives; such forms may also facilitate conversation about sensitive topics. Physicians can overcome their own discomfort by routinely taking sexual histories. Both inside and outside the examination room, physicians can also help fight entrenched prejudice by modeling tolerance and speaking out against bias with colleagues, students, and staff.
The goal of 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 ...