Last year my very good friend Dr. Monica Tschirhart was giving a lecture to some medical students in Oklahoma about LGBTQ+ health. She reached out and asked if I had anything to share. After giving it some thought, this was the feedback I gave her based on my own personal experience and stories from friends.
- LGBTQ+ people, particularly those in conservative areas, can be afraid of coming out, even to their healthcare provider. The most important thing you can do for them is make them feel comfortable talking about all aspects of their health, including their sex life. This may mean putting aside your personal beliefs or judgments — doing so will make you a better physician.
- Don’t assume the person you are interacting with is straight. Doing so by asking about their girlfriend/wife (if they present as male) or boyfriend/husband (if they present as female) already forces them to correct you, making the already stressful “coming out to the doctor” worse.
- Don’t assume that just because they are married they are straight, regardless if it’s from the intake form or a wedding band.
- If discussing their sexual practices, don’t use euphemisms – be direct. Like straight folks, “sex” means many things, oral sex, anal sex, etc. If they say they are having “safe sex” it could be they use condoms when having anal sex but are having unprotected oral sex. Also don’t cringe. If you can’t say “do you practice safe anal sex” without cringing, practice in the mirror until you do.
- Never, ever ask “are you the girl” or “are you the boy” regarding sex. If you’re comfortable with the terms, ask “do you bottom” or “do you top”. If you aren’t comfortable with those terms ask “are you on the receiving end or giving end of anal sex”. Again, practice in the mirror until you can say it without cringing.
- If asking about their sexual practices, don’t assume they are monogamous if they have a partner. LGBTQ+ folks are often non-monogamous and just because they have a partner/boyfriend/girlfriend/husband/wife doesn’t mean they’re only having sex with that person. And yes, most of the time their significant other is fully aware and OK with it.
- Don’t inadvertently out your patient. Unless they tell you differently, you should treat how they identify as confidential. LGBTQ+ folks can be fired for being gay, ostracized from their communities of faith, and worse. It’s sad, but there are good reasons why some people are still in the closet — particularly in conservative areas of the country. The moment you out them you’ve violated their trust and potentially their safety.
Daniel added these two very important points to the conversation:
- Treat your patients as individuals, not stereotypes. If you want to talk about sexual health, start by asking them about their sexual practices (or lack thereof) instead of assuming you know what “people like them” do based on their age, race, sexual orientation, gender identity, or whatever.
- Give your patients an opportunity to tell you what name and pronoun they want to be addressed by — and always use it, both in conversation with them and in conversation or notes about them.
This doesn’t even touch on PrEP, knowing the risk factors of STI transmission of different types of sex, etc which are all important but I think is somewhat secondary if the LGBTQ+ person won’t open up to begin with.
Dr. Tschirhart said that the students appreciated some of my comments and that it made it more real to them than some general statistics. And that’s just it — we’re people, not statistics or stereotypes.
The above is decidedly cis-gay-male centric based on my own experience. LGBTQ+ folks, what other things would you like doctors to know to provide great care for our community?
PS: The American Medical Association’s LGBTQ physicians resources page is a great springboard for doctors too.