LGBTQ+ sexual health discussions may be particularly difficult for patients who’ve felt stigma and judgmental attitudes inside of health care and out. But as neglect can lead to harm, having these conversations in an atmosphere of trust is critical.

“Sexual health is part of general health. It’s part of caring for the whole patient. People live healthier lives and may even lead longer lives when we have these conversations,” said Kari J. Zahorik, M.D., family medicine physician with Norton Community Medical Associates – Mid City Mall.

Dr. Zahorik believes that providers are responsible for creating an environment where all people feel comfortable and safe to get the help they need.

“LGBTQ+ patients tend to be marginalized and often traumatized populations. If we’re not engaging in conversations around sexual health and asking important questions, we can’t fully help someone,” Dr. Zahorik said. “It’s our job to make sure everyone understands how to protect and take care of themselves. If someone feels uncomfortable discussing their sexuality, issues could be going undetected. Failing to open doors further marginalizes and creates barriers to health.”

Sexually transmitted infections (STIs) and unplanned pregnancies become more likely without proper sexual health education and resources. Other aspects of wellness, such as mental health, can deteriorate as well. The LGBTQ+ community is at higher risk for depression, anxiety, substance abuse and suicide. Lacking options for inclusive sexual health care can add to trauma and worsen mental conditions.

Be a part of the solution

Trust is fundamental to the relationship between patient and provider. If a patient doesn’t feel that they can trust their provider, they may not return for care, and their health may suffer. Familiarity often must be achieved first before trust and comfort can follow.

“As providers, we can build trust by making sexual health a routine part of our questioning. That means asking the right questions and asking in a way that’s inclusive and sensitive to everyone’s needs,” Dr. Zahorik said.

Making sexual health discussions a regular part of checkups can help normalize these important topics. You also may find that explaining why you are asking about sexual health can put the conversation in the context of effective care. Using inclusive language also can help prevent interactions that may damage trust.

Dr. Zahorik stresses that the importance of conversations on sexual health can’t be overstated.

“These are life and death situations. If we aren’t having these discussions and helping folks figure out how to have healthy practices, we’re truly shortening peoples’ lives,” Dr. Zahorik said.

Tips for sexual health conversations with LGBTQ+ patients

• Don’t make assumptions — normalize questions about sexual health and sexual orientation as part of your routine. Ensure patients know that the same questions are asked of everyone and that they are asked for the sake of their health.
  • Do you have a partner?
  • Are you monogamous or do you have other partners?
  • Is your partner male, female, both?
• Inclusive care builds trust: Ask and use preferred name and pronouns. Look for and record notes on preferences in electronic health records. If information isn’t prominently displayed, consider using features such as sticky notes for your own information, and talk to others about how you can better record the information for all to see within your health system.
• Everyone makes mistakes. Apologize when you do, but be careful not to over-apologize and risk prolonging trauma or making a patient feel like they are in the wrong.
• It’s great to show an interest in your patients, but keep it within reason. Appearing over-curious may seem condescending or display ignorance to the needs of this patient population.
• Leave your bias at the door. Health care isn’t about personal beliefs or judgments, but rather doing what’s best for the well-being of the patient.
• Create a culture of inclusivity. Educate your staff so they can also provide inclusive care. Click here for a publication on inclusive care from The Fenway Institute.
• Leverage all resources at your disposal. Engage in training and education opportunities.