This week’s topic comes to us thanks to Dr. David Inwards-Breland, one of our fabulous adolescent medicine docs, who provided the materials. If you are interested in more on adolescent health, check out the Teenology 101 blog by Dr. Yolanda Evans and specifically the LGBTQ articles.
Materials for this week:
- Case and discussion
- Journal article summarizing practice guidelines for LGBTQ+ youth
- Article summarizing LGBTQ+ youth health care preferences
- Persons of non-binary gender, NEJM 2018
Take home points for LGBTQ youth health:
- What are some particular health care needs for LGBQT+ youth? Most people who identify as LGBQT+ are healthy, however, there is a disproportionate number of LGBTQ+ youth who face barriers to health care and mental health problems, usually as a result of sexual prejudice and lack of family/community support.
- How many teenagers identify as LGBTQ+? Recent studies estimate that somewhere between 3 and 10% of the adult population is LGBTQ+. Estimates in teenage years are difficult because the sexual identity is evolving. Around 25% of 12 year olds feel uncertain about their sexual orientation.
- How should we approach sexual health discussions? Begin to talk to patients separately from their parents by age 11 or 12 to allow them to speak with you confidentially. In visits with adolescents, we should explicitly remind them of confidentiality and use non-judgmental, gender-neutral language. Tailor the HEADSSS assessment to their age and development. In the study on LGBTQ+ youth health care preferences linked above, youth felt that provider qualities and interpersonal skills were just as important as provider knowledge and experience, and they placed little importance on a provider’s gender and sexual orientation.
- What are ways to ask about sexual attraction and sexual identity? We can explain to patients we ask about their sexual health as part of routine visits because it’s an important part of life, and we want all youth to feel comfortable and supported. We should ask adolescent patients about who they feel attracted to: “Do you feel attracted to girls, boys, both or neither?” Asking about gender identity can be done as: “do you identify with being male, female, both or neither?”
- What are risks for STIs among LGBTQ+ patients? We should provide counseling about safe sex and birth control to all adolescents. Female patients that identify as lesbian may still have male partners, so may be at risk for STIs and pregnancy and should have PAP smears. Male patients have higher rates of STI exposure (in King Co in 2015 exposure rate was 44% among 15-19 yo men who have sex with men). Patients with high risk for HIV infection should be considered for pre-exposure prophylaxis (PrEP).