Tips for treating LGBT adolescents

To best serve their adolescent patients, physicians must be comfortable discussing sexuality and be open-minded, said Warren Seigel, MD, in an OMED presentation Monday on treating lesbian, gay, bisexual and transgender youth.

One of the first steps to treating LGBT teens is making them feel comfortable enough to share their orientation or gender identity. Some of the common reasons they don’t disclose include:

• They don’t realize the appointment is confidential.
• They fear the doctor’s reaction.
• The physician assumes they are heterosexual.

Physicians can counter some of these roadblocks by not making assumptions and by informing patients that the meeting is confidential. Another crucial step to providing LGBT-affirming care is for physicians to understand their own biases and be willing to put them aside, noted Dr. Seigel, who is the director of adolescent medicine at Coney Island Hospital in Brooklyn, New York.

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“Facing our own personal biases allows us to give competent care to all of our patients,” he said. “We know that provider discomfort can be very damaging for all of our patients, but it’s particularly damaging for adolescents.”

If physicians don’t feel they can adequately set aside their own biases, they have an ethical responsibility to refer patients to physicians who can provide them with the care they need, Dr. Seigel said. However, the AOA Code of Ethics advises physicians not to decline to treat patients on the basis of sexual orientation or gender identity.

Broaching the topic

The easiest way to bring up the topic of sexuality is to ask all patients a few standard questions to clarify both their sexual orientation and their sexual behavior. These are also important questions to ask because a patient’s sexual behavior does not always line up with his or her sexual orientation, Dr. Seigel noted. For instance, some women who identify as lesbians also have sex with men; men who identify as heterosexual may also have sex with men.

Dr. Seigel shared a few of the specific questions he asks his patients:

• Are you sexually attracted to guys, girls, both or neither?
• When you see yourself in a romantic relationship in the future, do you imagine your future partner as a man, a woman, or either?

“Asking these questions normalizes the topic,” Dr. Seigel said. “All of your patients, whether they’re gay, lesbian, bisexual, transgender or heterosexual—it teaches them something. It teaches them that there is a wide range of sexual orientations and gender identities, that you are aware of them, and that you are accepting of everybody who comes in your office.”

For more information on treating LGBT youth, physicians can visit the Physicians for Reproductive Health website to download a version of the presentation Dr. Seigel gave at OMED.