Gay, Lesbian, Bisexual, Transgender, and Questioning Youth

1. Gay, Lesbian, Bisexual, Transgender, and Questioning Youth

2. Objectives • By the end of this presentation, participants will be able to: • Identify 3 risk factors faced by GLBTQ youth • Discuss the ways that homophobia contributes to GLBTQ health outcomes • List 3 elements of GLBTQ competent healthcare delivery • Describe resources for GLBTQ youth

3. What is Healthy Sexuality?

4. Resilience of GLBTQ Youth • Many GLBTQ teens lead normal, productive lives • Usually develop resilient adaptations to social biases and mistreatment • Many develop and possess remarkable strength and self-determination

5. Effects of Homophobia

6. GLB Youth Sexual Behaviors

7. Homophobia as a Barrier to Healthcare

8. Creating a Safe Space

9. Case: Joseph • Joseph is a 13-year-old male who comes to the clinic with his mother. She is concerned that: • Most of his friends are girls • He is drawn to traditionally feminine activities • She caught him wearing his sister’s clothes

10. How does Joseph’s mother’s disclosure make you feel?

11. Confronting Personal Biases

12. What do the mother’s concerns reveal about Joseph’s sexuality? • Very little • Joseph may be questioning his sexuality and/or gender identity but dress and other outward appearances do not indicate sexual orientation or identity

13. Sexual Attraction Sexual Orientation What is gender identity? Personal conception of oneself as male or female Paradigm of Sexuality Sexual Behavior Biological Sex Gender Identity/ Expression

14. Awareness of Gender Identity

15. Biological sex does not always match gender identity Gender Identity/ Expression

16. Sexuality Model XY XX Biological Sex Male Intersexed Female Gender Identity/ Expression Masculine Androgynous Feminine

17. Transgenderism

18. Approaching Gender Identity with Adolescent Patients Ask: When you think of yourself as a person, do you think of yourself as male, female, both, or another gender?

19. Case: Joseph • Joseph tells you that he is not sure if he thinks of himself as a girl or a boy. • He feels “okay” with this but it makes him sad that his mother is so upset with him. • What can you do?

20. Case: Joseph

21. Case: Sophia • Sophia is a 16-year-old female who comes to the clinic for a physical. • On her intake form, she indicates she is sexually active but not on contraception. • How do you discuss sensitive issues with your young patients?

22. H: Home • E: Education • E: Eating Habits • A: Activities • D: Drugs • D: Depression • S: Sexuality

23. Case: Sophia • As you begin the sexual interview, Sophia discloses that she self-identifies as a lesbian.

24. Sexual Orientation Sexual Attraction Paradigm of Sexuality Sexual Behavior Biological Sex Gender Identity/ Expression

25. Sexual Orientation Defined

26. Determinants of Sexual Orientation • Sexual orientation is not a choice • Most likely determined by combination of influences: • Genetic • Hormonal • Environmental

27. Awareness of Sexual Orientation • First awareness of homosexual attraction occurred at: • ~9 for males • ~10 for females • Studies indicate many GLB youth self-identify at ~ age 16

28. Sexuality Model XY XX Biological Sex Male Intersexed Female Gender Identity/ Expression Masculine Androgynous Feminine Sexual Orientation Neither Women Both Men Other

29. Prevalence of GLBQ Youth • Difficult to ascertain • Majority of states do not include questions regarding sexual orientation in YRBS

30. 2007 Vermont Youth Risk Behavior Survey

31. Sexual Orientation & Adolescents: Growing Up Today Study (97-03) N= 7750 N=5700 Corliss H, et al Arch Pediatr Adolesc Med. 2008;162(11):1071-1078.

32. Sexual Orientation: MN HS Student Sample Ramefedi GJ. Pediatrics 1992;89:714-721.

33. Case: Sophia • Sophia self-disclosed her sexual orientation. • If she had not, would you approach this topic with your patient?

34. Discuss Sexuality in Clinical Encounters • Most GLBTQ youth are “invisible” and often will not raise issue until asked • Asking normalizes notion that there is a range of sexual orientations and gender identities

35. What percent of pediatricians believed they should assume all patients are heterosexual unless told otherwise? • 11% • 22% • 33% • 55%

36. What percent of physicians include sexual orientation in sexual histories for patients at any age? • 12% • 22% • 32% • 52%

37. What percent of physicians could identify three major local resources for GLBTQ youth? • 7% • 17% • 37% • 57%

38. Asking About Sexual Orientation • How can you respectfully ask about sexual orientation? • Are you sexually attracted to guys, girls, or both? • When you think of yourself in a relationship is it with a guy, a girl, or both?

39. Case: Sophia • How do you respond to Sophia’s disclosure?

40. Patient Disclosure: “Coming Out”—What Next?

41. Case: Sophia • Sophia discloses that her parents are aware of her sexual orientation and are accepting. • She currently does not have a girlfriend. • What other questions should you ask?

42. Sexual Orientation Sexual Attraction Sexual Behavior Paradigm of Sexuality Biological Sex Gender Identity/ Expression Does Sexual Orientation Always Match Sexual Behavior?

43. Case: Sophia While respecting Sophia’s identification, you should inquire about sexual behaviors with males.

44. Case: Sophia • Sophia discloses that she is currently having sex with a “friend.” • She says meeting guys is easier since there aren’t many girls who are out in her school. • Discuss contraception and condom use.

45. Contraceptive Use • Young women who identified themselves as “unsure” of their sexual orientation are: • Almost twice as likely to report no contraceptive use at last sex

46. Pregnancy Risk

47. Contraceptive Counseling • Discuss hormonal methods of contraception • Introduce EC and offer an advanced prescription with refills

48. STI Risk and Women who Have Sex with Women

49. STI Prevention Counseling • Sex toys • Do not share insertive sex toys without a condom • Wash sex toys after each use • Dental dam use with oral sex • Condom use when having sex with a male

50. Sophia: Case Wrap Up