Pediatric Primary Care Case Studies (57 page)

   Feeling guilty about their sexual orientation

   Worrying about the response from their families and loved ones

   Being teased and ridiculed by their peers

   Worrying about AIDS, HIV infection, and other STDs

   Fearing discrimination when joining clubs or sports, seeking admission to college, and finding employment

   Fearing rejection and harassment by others

What health issues might you see in LGBT adolescents?

Health Issues Related to LGBT Adolescents

Health Risk Behaviors

LGBT adolescents are at a higher risk for increased use of tobacco, drugs, and alcohol than their heterosexual counterparts, due to increases in social, identity, legal, and discriminatory stressors.

Sexually Transmitted Disease Risks

Because of certain sexual practices performed by LGBT individuals, they are potentially at risk for STDs. These practices include anal and/or vaginal coitus, oral sex, and casual or multiple sex partners. Sexually transmitted infections can include herpes, chlamydia, gonorrhea, trichomoniasis, syphilis, genital warts (HPV), human immunodeficiency virus (HIV), and hepatitis. Furthermore, even though adolescents identify as LGBT, they may not necessarily limit their sexual practices to those of their identified sexual preference. As such, they may be at risk for any or all of the same consequences as their heterosexual counterparts.

Mental Health and Violence Risks

As a result of perceived or real homophobia and increases in other stressors, LGBT adolescents are more likely to suffer from depression. LGBT adolescents also are at risk for violence, both from society at large and in their partnered relationships. It is a misperception to assume that persons in LGBT relationships do not suffer from intimate partner violence.

Healthcare Needs

LGBT adolescents (and adults) may avoid medical care and appropriate health screenings because of a misperception that they are only necessary
for heterosexuals. For example, lesbian or transgendered nonsurgical female to males (FTMs) may avoid getting regular Pap smears because they believe they aren’t at risk for cervical cancer or choose to ignore the existence of sexual organs they were originally born with. Lesbians and FTM transgendered individuals may be at higher risk for breast cancer because they may be less likely to bear children or lactate.

Lesbians appear to have a better body image; they are often less concerned with being thin for society’s sake and as a result may be
more
inclined to be overweight or obese than heterosexual women. This, in turn, increases the risk of health problems associated with obesity, including diabetes, heart disease, hypertension, and cancers of the uterus, ovaries, breast, and colon.

Lesbians are less likely to use oral contraceptives and other forms of hormonal birth control and so are at greater risk for endometrial, breast, and ovarian cancers.

How will you respond to what Cassandra has told you?

When her mother leaves the room, you let Cassandra know that you can see that she and her mom have a difference of opinion on whether she should be on birth control. At this point, you question whether Cassandra has told her mother that she is a lesbian, and encourage her to talk to her mother when she reveals that she has not.

You keep in mind that although teenagers may not respond fully with eye contact or verbally, they “hear” everything said to them. It is important to convey a sense of acceptance of her from the beginning of the encounter.

You reassure Cassandra that people not only have different preferences in sex partners, but also have a variety of ways of enacting their sexual orientation and that you respect people’s individuality. It’s essential to let her know that you are here to provide the kind of information and support she needs to stay healthy and feel positive about herself, to answer questions, and to provide a place to talk personally about anything that affects her body, just as you do for all of your patients.

What important points would you consider during your discussion with Cassandra?

The following points would be important to discuss with Cassandra:

   Identify that you are aware of a conflict between the patient and her mom. Use a respectful, straightforward, “coaching” approach allowing space for thinking between points.