Addressing Sexual Orientation in Healthcare

Medical providers may often ignore the sexual orientation of a patient, for a variety of reasons, but doing so can cause a patient’s comprehensive health to also be ignored(1). Whether the topic is uncomfortable for a provider, a patient, or both should not influence care. Maybe a provider simply doesn’t see the necessity in inquiring about sexual orientation. Nurses Announcements Archive Article

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Addressing Sexual Orientation in Healthcare

According to the American Psychological Association, sexual orientation "refers to the sex of those to whom one is sexually and romantically attracted to." Sexual orientation impacts health in several ways, from communicable diseases, like HIV/AIDS, to mental health. Research has found that gay and bisexual men have a higher risk of major depression, bipolar disorder, and generalized anxiety disorder than heterosexual men. The Centers for Disease Control and Prevention (CDC) states that this increase can be partly attributed to discrimination and/or a lack of familial support2. One study found that gay, bisexual, and lesbian youth are twice as likely to attempt suicide as their heterosexual peers.3 These mental health risks cannot and should not be overlooked.

Understanding sexual orientation and how to nonjudgmentally approach it is vital to providing excellent patient care. Heterosexual, homosexual, gay, lesbian, bisexual - these are the common words that people use to label their sexual orientation. The fact that these words are labels is an important distinction to understand because labels try to fit people or things in a box that might not truly fit. With that said, a majority of people will identify with one of these labels, so here's a quick review of what they mean:

1) Heterosexual: A person who is sexually attracted to the opposite gender.

2) Homosexual: A person who is sexually attracted to the same gender.

3) Gay: A man who is sexually attracted to the male gender.

4) Lesbian: A woman who is sexually attracted to the female gender.

5) Bisexual: A person who is sexually attracted to both the female and male genders.

6) Asexual: A person who is not sexually attracted to either gender.

Some men will identify as heterosexual, but they also have sex with men. Therefore, in HIV/AIDS prevention work, public health uses the term "men who have sex with men" (MSM) because MSM refers to a behavior and not a sexual orientation label. Additionally, the term "women who have sex with women" (WSW) is used to denote a sexual activity and not a sexual orientation identity. Public health is typically unconcerned with a sexual orientation label; instead, the concern lies in educating people about health and safer sex practices.

In some instances, using specific labels can risk people identifying with a sexual orientation that differs from their sexual activity. Some people don't identify with any of these labels, so they either refuse to label their sexual orientation or decide to choose an alternative label. Understanding a patient's sexual practices, not simply their identified sexual orientation, allows the healthcare provider to better understand the patient's holistic health risks.

Since using a sexual orientation label has the potential to mislabel a patient's sexual activity, there is a strategy that can help bypass this issue: ask questions that are focused on sexual activity, not sexual orientation labels. During a health history with a sexually active patient, it is informative and nonjudgmental to ask the patient if they are having sex with men, women, or both, as opposed to simply assuming the gender(s) of a patient's sexual partner(s). This information can be gathered passively by including the question and answer choices on a self-assessment form that the patient fills out. It can also be done directly by providing privacy during the intake process and by taking time to educate the patient on the purpose behind the questioning so that they understand the goal is to provide a safe place for communication to be exchanged and to enable the healthcare provider to better assess health risks and develop an appropriate plan of care.

When first meeting a patient, instead of asking if they have a husband or wife, ask if they have a significant other. This is an easy method that healthcare providers can utilize to show patients that they are in an atmosphere with providers who are open to all sexual orientations. It is possible to avoid forcing patients to use sexual orientation labels, and by doing so, the healthcare provider can gain a better understanding of their patients.

The role of the healthcare provider is to provide patients with excellent care and education that is patient-specific. Building a discrimination-free health zone will have the potential to improve the health and lives of all patients, regardless of sexual orientation or sexual activity.

[1] National LGBT Health Education Center. (2013). Collecting Sexual Orientation and Gender Identity Data in Electronic Health Records. Take the Next Steps. Retrieved from http://www.lgbthealtheducation.org/wp-content/uploads/COM-2111-Brief_Collecting-SOGI-Data.pdf

[2] Centers for Disease Control and Prevention. (2016). Mental Health. Retrieved from Mental Health | Gay and Bisexual Men's Health | CDC

[3] Centers for Disease Control and Prevention. (2016). Stigma and Discrimination. Retrieved from Suicide and Violence Prevention | Gay and Bisexual Men's Health | CDC

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Specializes in ICU.

But when gay and lesbian people get married, they call their partner wife or husband. At least my married gay and lesbian friends do. They call each other husband or wife. So, it's not discrimination to ask that.

I guess im tired of the word discrimination. It's not used in the correct context anymore. Just like bullying. It's one of those red-hot words people use these days to grab attention and it's not used in the correct context.

I'm not married. But I do have a significant other. I'm heterosexual. Another frustrating "article".

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Specializes in Critical Care, Education.

Yep - we ask marital status. It is no longer "discriminatory" to do so as everyone can become legally wed if they so desire. If unmarried, we go through the process of determining their designated advocate - who is entitled to participate in care / healthcare discussions... again, not discriminatory. Sexual preferences are a non-issue in the normal course of a very brief hospital stay or visit for medical treatment.

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I feel like I'm in sixth grade when I read stuff like this...I know what those words mean...I've lived in the US my whole life and been in health care for over 30 years. I'm not an idiot.

If I'm speaking to an adult and I say something he or she is uncomfortable with or that is inaccurate, I expect that person to be a grown-up and politely let me know how they would like me to address their situation or significant "other". I, in turn, will also be a grown up, be gracious and move on.

Why do so many people insist that being gay means someone is so fragile? I'm not gay, but I'd think it would come across as condescending and paternalistic.

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I feel like I'm in sixth grade when I read stuff like this...I know what those words mean...I've lived in the US my whole life and been in health care for over 30 years. I'm not an idiot.

If I'm speaking to an adult and I say something he or she is uncomfortable with or that is inaccurate, I expect that person to be a grown-up and politely let me know how they would like me to address their situation or significant "other". I, in turn, will also be a grown up, be gracious and move on.

Why do so many people insist that being gay means someone is so fragile? I'm not gay, but I'd think it would come across as condescending and paternalistic.

It's not that they are fragile, it's that we shouldn't have to constantly correct people from assuming one thing or another. Using asexual, non-binary terms like "partner" or "significant other" prevents the practitioner from making assumptions that are not conducive to proper care. Having to constantly correct people who make assumptions about us is a burden. It's not necessarily bullying, but it's annoying as hell.

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Specializes in SCRN.

Gay persons can have a husband or a wife, just like heterosexuals. This article is like pouring substance from one empty bucket into another empty bucket - nothing accomplished.

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Specializes in SCRN.

And, yeah, try asking every patient are they having sex with men, women ,or both, and face the fury most of the time. Great job.

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Specializes in CEU Courses for Nurses.

Thank you for the comments; appreciate all these different points of views!

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Specializes in Family Medicine, Tele/Cardiac, Camp.

I think a lot of us already do many of these things in our practice, but it's definitely something that should be more stressed within academic settings. Teaching less experienced nurses (or providers) not to make assumptions really does positively impact patient care in that not only do we better know what to look for (as far as increased instances of GYN cancers in lesbian woman, suicidal ideation in bisexuals, gay men (though not exclusively) with STD's in their throats, etc), but we also create more receptive approach-able environments in which individuals who have been dismissed their whole lives can now feel comfortable to discuss their personal life and sexual practices. I know I've always appreciated it when my providers dig a little deeper upon my answering "no" to the question "are you having sex?" or haven't flinched when I've asked "define sex" as my female partner waited for me in the waiting room.

Thanks for the refresher, CareerSmart Learning.

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Yep - we ask marital status. It is no longer "discriminatory" to do so as everyone can become legally wed if they so desire. .

Not really, I am only allowed to have one wife in USA. Many parts of the world allow a man to have more than one wife. Very biased in my opinion.

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Specializes in Family Nurse Practitioner.

Trolly McTrollface strikes again.

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Not really, I am only allowed to have one wife in USA. Many parts of the world allow a man to have more than one wife. Very biased in my opinion.

Oh my... How is that an even vaguely relevant response to HouTx's post? She didn't mention or even allude to polygamy. All she said was that everyone can become legally wed if they so desire. How did you make the leap to marrying any number of people? You're not by any chance trying to provoke a reaction? :lol2: I'm sure you can do better, I dare you... ;)

As far as asking patients about their sexual orientation or marital status I seldom have a reason to inquire about the former in the specialty I work, only the latter. I'll usually just phrase the question "do you have a spouse or significant other?" regardless if I'm asking a male or female patient. That way I've made no assumptions regarding the gender of their spouse/partner and the patient can answer husband or wife if they wish to.

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