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Sexual Diversity
At genderandhealth.ca you can find a variety of self-learning modules that explore aspects of gender and health, one in particular explores Gender and Sexual Diversity. The following suggestions are taken from the "Practicing Without Bias" section of that module.
In this section you will find suggestions on how to ask about things you might not know about. You can also learn how to demonstrate your openness to others whose lives may be different from yours. Some of these approaches can be applied to any area of difference- for example asking about family in an open way is relevant for families with same-sex parents, but also for children and adults in blended or single parent families or families formed through adoption.
Some Suggestions for talking about...
...Confidentiality
"For the medial records/charts, I usually write down significant relationships in a patient’s life. Do you feel comfortable with having me writing down: that you’re gay/lesbian/etc.? or that you’re in a relationship/having sex with someone of the same gender?"
"If not, how would you prefer I worded it? Would you rather I use some types of symbols?"
...Sexuality with adolescent or young adult patients
"Have you ever dated or gone out with someone?"
"Have you ever had sex with another person? If yes, have your partners been males, females, or both?"
"Some of the teens I work with have feelings of attraction to members of the same sex. This is perfectly OK but can worry some teens a lot. So I’m wondering, do you ever have these kinds of feelings or worries?"
"Do you have any questions about sex or sexuality?"
"Have you ever experienced any homophobic incidents in health care? Are you happy with the services you had from your previous providers who know (or do not know) about your sexuality?"
...Significant Relationships and/or Family
COMMUNICATION KEY | AVOID | TRY INSTEAD |
Don’t assume heterosexuality | "Are you married?" for your female patients - "Do you have a husband or boyfriend?" for your male patients - "Do you have a wife/girlfriend?" |
"Do you have a significant other or life partner? Is your partner a man or a woman? How long have you and your partner been together?" "What is your current relationship status? e.g. single (dating, live-in/cohabiting), married, domestic partnership/civil union, separated/divorced, widowed, etc.?" "Who do you include in your (chosen) family? Tell me about the supporters in your life?"
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Include same-sex partners |
for women - "Is your husband here with you today?"
for men - "Is your wife in the waiting room?"
| "Is your partner waiting for you outside?" "Would you like to include your partner in discussion about your treatment?" "Is there anyone you would like to bring with you to your next appointment?" "Have you included your partner in your will / power of attorney / medical directive? In your hospital visitation privileges?" |
Be open minded about family | Don’t assume that family is nuclear or only based on biology |
"Who do you live with at home?
"Do you or your partner(s) have any children?" "Do any children live in your household?’ "If so, are they your children, are they your spouse or partner’s children? If children from previous relationship, do you have shared custody with ex-spouse or partner?" "Do you want to start a family? Would you like to have children? Are there any questions you have or information you would like with respect to starting a family?"
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Validate the families and lives of your pediatric and adolescent patients |
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"Tell me about your family." "How many parents do you have? Tell me about your parents." "How do other people feel about your two mothers or two fathers? How do other people feel about your parent(s) being gay/lesbian/transgender?"
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Ask about identity |
"Many people identify themselves with certain groups. In terms of your sexual identity or orientation, do you see yourself as: Gay, lesbian, bisexual, and/or queer? Straight or heterosexual ? Not sure? Don’t know? Other? Do you have any concerns related to your gender identity or your sex of assignment?" "Do you identify as male, female, or transgendered? (If transgender: male-to-female, female-to-male, or other)?"
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To make your health care services accessible to LGBTI people, remember to:
* Listen and be supportive. Assure confidentiality
* Never make assumptions! Ask if you’re not sure ASK
* Eliminate homophobic and judgmental attitudes
* If patient seems offended, apologize and ask how you can be more inclusive
* Recognize non-traditional families, acknowledge the same-sex partner/parent
* Learn about health care needs of LGBTI people
* Avoid referral to homophobic health care providers [1] [2][3][4][5][6]
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1. Allen LB, Glicken AD et al. (1998). Adolescent health care experience of gay, lesbian, and bisexual young adults. J Adolesc Health 23(4): 212-220.
2. Harrison A. Primary care of lesbian and gay patients: educating ourselves and our students. Family Medicine. 1996;28: 10-23.
3. Jugovic PJ, Baitar R, McAdam LC (2004). Fundamental clinical situations: a practical OSCE study guide. 4th edition. Toronto: Elsevier Canada.
4. Perrin EC (2002). Sexual orientation in child and adolescent health care. New York: Kluwar Academic/Plenum Publishers.
5. Perrin E & Kulkin H. Pediatric care for children whose parents are gay or lesbian. Pediatrics. 1996;97(5): 629-635.
6. White J & Levinson W. Primary care of lesbian patients. Journal of General Internal Medicine. 1993;8:41-47.
9. Peterkin AD & Risdon C. Caring for lesbian and gay people: a clinical guide. 2003. Toronto: University of Toronto Press. these suggestions adapted from pp. 101, 178, 190.