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?

[wish_me_luck, BSN, RN]

Ok. It's un-full now. Send away.

[BostonFNP, APRN]

The only gender-specific teaching should happen during puberty when bodies are changing - after that both men and women need to be equally informed and prepared for whatever sexual health issue they may be faced with.[/quote']

What about menopause? What about prostate or breast or cervical or penile or ovarian cancer? What about UTI prevention? What about RA or lupus? What about gallstones or migraines? Or osteoporosis?

[SuzieVN]

[quote=logank622;

My short answer to the OP's question is that no, sexual orientation shouldn't matter anymore. The only gender-specific teaching should happen during puberty when bodies are changing - after that, both men and women need to be equally informed and prepared for whatever sexual health issue they may be faced with.

I agree, and as I might have mentioned, I know tons of closeted gays, they'd never admit to being gay to anyone, anyway. Some won't admit it to themselves, even.

[logank622]

What about menopause? What about prostate or breast or cervical or penile or ovarian cancer? What about UTI prevention? What about RA or lupus? What about gallstones or migraines? Or osteoporosis?

I understand what you're saying, but I'm speaking in terms of sexual health. And regardless, if I were married, I would want to know about my wife's health issues as well as my own. What if I cook all the meals and my wife needs to increase her calcium intake due to osteoporosis? Why is she always getting UTIs? What can I do to help my wife through menopause? As nurses, we need to ask the right questions to determine what education to provide - it may cross gender lines and we should be comfortable with that.

[BostonFNP, APRN]

I understand what you're saying, but I'm speaking in terms of sexual health. And regardless, if I were married, I would want to know about my wife's health issues as well as my own. What if I cook all the meals and my wife needs to increase her calcium intake due to osteoporosis? Why is she always getting UTIs? What can I do to help my wife through menopause? As nurses, we need to ask the right questions to determine what education to provide - it may cross gender lines and we should be comfortable with that.

I am not sure how much nursing experience up have so I will speak generally.

I understand the basis of what you are saying, however, it is not your position as a provider to discuss an individuals private health information with their spouse without their consent. The "right questions" are about the patient. Crossing "gender lines" involves being comfortable having uncomfortable conversations not trying to avoid them. You can't miss diagnosing HIV because you spent your time teaching a male patient about the use of his wife's Premarin cream.

[wish_me_luck, BSN, RN]

Yeah, you have to have consent to do that, logan. I am mainly just wondering peoples' thoughts on whether asking the question about "do you sleep with men, women, or both?" is relevant still, given the knowledge and evidence we have in this day and age or do you feel like it is just going to lead to discrimination?

[BostonFNP, APRN]

Yeah you have to have consent to do that, logan. I am mainly just wondering peoples' thoughts on whether asking the question about "do you sleep with men, women, or both?" is relevant still, given the knowledge and evidence we have in this day and age or do you feel like it is just going to lead to discrimination?[/quote']

I think there are two questions in that:

1. Should providers ask? Yes.

2. Should patients answer? This is entirely up to them to answer truthfully, abstain, or other. As a provider, I hope they answer honestly, because it will improve my ability to care for them. If they don't, then that's fine with me. I will try to improve our relationship so maybe next time they will.

[wish_me_luck, BSN, RN]

True. I appreciate you jumping in on this. It would probably be obvious if they abstained from answering unless they were questioning or unsure themselves.

Other opinions, please. I want a conversation. I think this is a topic that should be discussed--I know when I was in school, the sections dealing with gay/lesbian care was skipped. Boston, I appreciate your points--I didn't think of it that way.

[grownuprosie]

BC pills have other uses, not only to prevent pregnancy. They can get a period on a predictable schedule among other uses.

I think part of it is making sure that your time with the provider is spent on information that is important to you. One of the new OBGYNs that I worked with came out of her exam room bright red in the face one day. She had asked her patient what kind of birth control she was using. The woman said, "none". The doc gave the whole sermon on different BC methods. The woman was too polite to interrupt, just answered questions that she was asked(none of which were what is the gender of ther person you have sex with?). At the end of the lesson, she thanked the doc but said that she and her female partner would not need any birth control. Had period issues been present, that information might have been relevant but it just was not for a monogamous lesbien without any gyn issues.

In the case of nursing, it is part of assessment. If you are at risk of pregnancy, I will tell you how to prevent it. But I will not know unless I ask.

If i remember correctly, arent straight women the fastest growing HIV population, anyway? so asking if you are gay is not diagnostic for HIV. Asking how many partners is really relevant though.

[jadelpn, LPN, EMT-B]

Basic health care teaching aside, there are reasons that one would ask about not so much orientation but specific activities--ie: STD's and the risk of herpes transmission can be complicated--mouth to where ever, where ever to mouth--

Anal sex and the risk of UTI's in females when that is the first thing that happens in an encounter, and then moves to lady partsl sex without condoms, impactation from anal sex. not using a dental dam....

So taking orientation specifically out of the equation, it is so important to be able to assess and discuss all sorts of things that people engage in that are non vanilla in nature.

A number of state Gay/Straight alliances have specific courses for CEU's and certifications to create "safe zones" as if most patients feel that they are being judged--regardless of orientation, but specifically raw for the gay/bi/transgender communities, it can be almost impossible to get to the root of a health issue.

[CountryMomma, ASN, RN]

As a bisexual student, I am going to add both what they just taught me in class, with my experience on the other end of the desk.

Yes, it still matters, and still needs to be asked.

First and foremost in my mind: GLBQT teens have one of the highest rates of suicide and peer abuse out of all the teens. Knowing that the teen you are seeing is exploring or has identified as GLBQT indicates that a mental health screening may be in order, as well as a social/school screening.

From the other side of the desk: When I am with a female partner, I prefer not being offered condoms and spermicide. Dental dams are very welcome, though! Others have already discussed why knowing the preferences of the client can help tailor the care and education given. The gay men I am friends with do not care to sit through a lecture on preventing pregnancy.

Also, knowing the situation in which the client lives and loves helps tailor your domestic abuse screenings. GLBQT are much less likely to report or admit the abuse, and may face intense difficulties when placed into a shelter. Gay men and genderfluid folk have a huge obstacle in obtaining emergency shelter in a domestic abuse situation.

It's about *how* you ask, and how you respond. Earn trust and one will receive truth.

[SuzieVN]

As a bisexual student, I am going to add both what they just taught me in class, with my experience on the other end of the desk.

Yes, it still matters, and still needs to be asked.

First and foremost in my mind: GLBQT teens have one of the highest rates of suicide and peer abuse out of all the teens.

There is still a stigma, as evidenced by these young people suiciding, with being labeled- again, it's not safe to disclose that to anyone, depending on where you are. (Kansas, in paricular). Hate crimes are still common. Knowing about these suicides, that you mention- please explain why it needs to be asked?

Sex is sex. Fluids are fluids. Orifices are orifices. You can teach anyone sex education without knowing if they are gay/ straight/ bisexual, or a top or a bottom or this or that. Why the need to delve into the issue of gay or straight? By merely ASKING a teenager if he may be gay? The damage has already been done. Totally different if he walks in, says "Hey, Doc- guess what? I'm GAY! Can you teach me how not to contract HIV?"