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.
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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.
