Sexual Orientation Question

[wish_me_luck]

I have been thinking about this lately...and I am being serious when I ask this; but, with all the advancements in knowing about risk factors for various diseases (especially STIs), what does sexual orientation have to do with anything?

What I mean is this--like HIV/AIDs, it was first thought to be a gay man's disease; now we know that it can be transmitted whether you are gay or straight. Another example would be all women getting pap smears whether they are a homosexual, bisexual, or heterosexual--what's wrong with just teaching all females to get pap smears as long as they have a cervix?...leaving it at a statement rather than asking their sexual preferences.

I just can't think of one disease or educational need that only applies to people who are homosexual or bisexual. All the ones I can think of are pretty universal diseases/health promotion exams/teachings. I just think it can lead to discrimination rather than anything good.

Thoughts?

[Rose_Queen, BSN, MSN, RN]

You may want to check out Primary System - GLMA Home Page. They have patient handouts that explain some of what you're asking. These handouts can be found at Primary System - Top 10 Health Issues

[KelRN215, BSN, RN]

Absolutely ask. The answer modifies both your assessment and screening tests.

Edit: At least in my job it matters.

I agree. Would you teach a gay man about using condoms to prevent pregnancy? What about a straight man? The motivation for a heterosexual sexually active 19 yr old male to wear a condom may be more related to his desire to not impregnate his partner than it is to his fear of catching an STI.

Would you feel the need to teach a lesbian about birth control pills? About diaphragms or cervical caps?

Sexual health is not just about STDs.

[SuzieVN]

Boston, how does it affect your job and screenings/assessments? I mean, if I went to you, and you asked me that question and I answered I sleep with women or both, what are you going to do assessment/screening/educational wise that is different than if I answered men? Either way, you would still do a pap smear, STI screenings (yes, HIV can still be passed female to female; although, the risk is much lower than female/male or male/male sex), and other routine assessments.

However, if you think being homosexual or bisexual is wrong (I am not accusing, just explaining), you might be apt to treat me differently (in a discriminatory way) than a patient who is heterosexual.

In the 1990's maybe, it would have been relevant to ask a man if he had sex with men. Since, like it says, STDs are all over the place and no longer confined to gays, straights, etc.- I don't see the point in questioning sexuality- other than maybe, 'do you have sex outside of your relationship, and if yes- are you taking precautions to protect that person from your indiscretions', and use it as a teaching opportunity. In fact, I find it rather ...lewd. All it can do is label him/her, with no benefit. But with a lot of potential harm.

[hiddencatRN, BSN, RN]

In the 1990's maybe, it would have been relevant to ask a man if he had sex with men. Since, like it says, STDs are all over the place and no longer confined to gays, straights, etc.- I don't see the point in questioning sexuality- other than maybe, 'do you have sex outside of your relationship, and if yes- are you taking precautions to protect that person from your indiscretions', and use it as a teaching opportunity. In fact, I find it rather ...lewd. All it can do is label him/her, with no benefit. But with a lot of potential harm.

Lol, asking about cheating and indiscretions is ok, but asking about partners and practices in order to tailor education and screenings leads to judgment?

[wish_me_luck, BSN, RN]

As far as condoms, I was always taught that it was not only to prevent pregnancy, but also STIs. BC pills have other uses, not only to prevent pregnancy. They can get a period on a predictable schedule among other uses.

[SuzieVN]

What do you want to ask about partners- are they male, female, both, half and half, in transition, tranny, etc? As far as practices, my post said to ask- is you are risking someone ELSE'S health, was what I meant to imply. If so, they need talked to, for sure. Doesn't matter the sex of the partners, my opinion. I know a LOT of gay men that are married to women, and have sex with men, and the women have no clue.

That said- how many people are honest about anything during an H&P?...

[hiddencatRN, BSN, RN]

What do you want to ask about partners- are they male, female, both, half and half, in transition, tranny, etc? As far as practices, my post said to ask- is you are risking someone ELSE'S health, was what I meant to imply. If so, they need talked to, for sure. Doesn't matter the sex of the partners, my opinion. I know a LOT of gay men that are married to women, and have sex with men, and the women have no clue.

That said- how many people are honest about anything during an H&P?...

So, "are you a cheating scumbag who needs a come-to-Jesus talk from your PCP" is not judgmental, but knowing that you need to discuss screening for rectal cancer, hepatitis and eating disorders with a gay man is being lewd and intrusive?

[KelRN215, BSN, RN]

As far as condoms, I was always taught that it was not only to prevent pregnancy, but also STIs. BC pills have other uses, not only to prevent pregnancy. They can get a period on a predictable schedule among other uses.

Of course condoms are not just for preventing pregnancy, my point is that you're not going to use "you don't want to accidentally get your partner pregnant" as a reason to encourage a gay man to use a condom. He's not worried about that, so telling him that is not going to increase the odds that he uses a condom. A heterosexual 20 year old college male on an athletic scholarship is probably much more concerned about the possibility of accidental fatherhood than his gay roommate is.

Birth control has other uses and I wound imagine providers would offer it to women with irregular periods or severe cramps regardless of her sexual orientation but in a woman who has regular periods and no complaints and is in a same-sex relationship, there's really no need to offer her the pill or encourage her to go on it. Providers often assume that teenage and college aged women "need" the pill when they very well may not and in order to assess whether or not it should be offered/prescribed, a full sexual history should be noted.

[SuzieVN]

Do only gays needs screened for rectal cancer? I miss your point. I'll say that 'nobody' I knows uses condoms, gay or straight, for any reason other than to avoid pregnancy. Even then, it seems abortion is not a troublesome option? Everyone has become complacent about 'VD'. That tells me the stereotypes about gays is alive and well. If you want to find out- check out the Westboro Baptist Church (youtube- 'the most hated family in america'). Point of the OP is valid, and factual. But I agree also that's it hard to get past ingrained stereotypes. But tell that to the thousands of teenagers every day that are contracting everything under the sun, because only 'gays get those diseases'...

[Rose_Queen, BSN, MSN, RN]

This is a link to an archived webinar that explains some of the unique health needs of GLBTQ patients: Primary System - Cultural Competence Webinar Series - Part 1

It's actually part of a series; part 2 is also available.

[katielea]

Wouldn't it make sense to ask so that it's clear that no one is making any assumptions?

If I'm a primary health care provider and I'm talking with my patient about sexual health and/or reproduction, we're probably also talking about their partner(s). I mean, unless said patient is totally sexually abstinent and intends to be forever. How can I discuss my patient's partner(s) without also knowing something about their sexual orientation?

Maybe it doesn't necessarily need to be a question in and of itself, but I think it's a bit silly to pretend that my primary health care provider can never know the gender of the person I'm in a relationship with.

[SuzieVN]

Were men asked if they were homosexual before HIV came on the scene..?