The Importance of Disclosure for Sexual Minorities in Oncofertility Cases

Are you having sex?

Are you sexually active with men, women, or both?

What type of sex do you have?

 Prompts: oral, vaginal, anal

For each type of sex, are you using barriers or condoms?

If yes, how often do you use them?

 Prompts: every time, not with primary partner

Do you have any questions about the use of barriers?

What keeps you from using barriers?

Table 13.2
Dos and don’ts in taking a sexual history (Makadon et al. [123])

Do begin with a statement explaining that you ask these questions of all your patients and that the questions are vital to the patient’s overall health

Don’t make assumptions about past, current, or future sexual behavior

Do avoid language that presumes heterosexuality

Don’t assume that a person who identifies as lesbian or gay has never had an opposite-sex partner

Do check yourself for judgmental facial expressions, body language, and tone of speech

Don’t assume that an LGBTQ person does not have (or lacks the desire to have) children or has never been pregnant

Do be prepared to answer questions about STI and HIV transmission risk for various sexual activities relevant to LGBTQ people

Do note that transgender individuals, men who have sex with men, and those who engage in high-risk sexual activities are at increased risk for contracting HIV and certain STIs

Do screen and treat according to the CDC guidelines (www.​cdc.​gov/​std/​treatment)

Do realize that although STIs are less common among lesbians, clinicians should still screen all women for STI risk, regardless of sexual orientation. The more sexual partners a woman has (female or male), the greater her risk. Bacterial vaginosis may be more common in women who have sex with women than in the general population

Do consider the overall health of patients who present with sexual functioning concerns, including their psychological status, physical wellness, and relationship health

The Joint Commission, the Centers for Disease Control and Prevention (CDC), and the Institute of Medicine (IOM) all recommend sexual orientation, and gender identity should be collected in patient medical records [5, 126129]. CDC and IOM further recommend the aggregation of these data to ensure these populations are represented in clinical research and to reduce health disparities in the population [5, 129]. Figure 13.1 below provides sample wording for the collection of sexual orientation and gender identity on a medical form.


Fig. 13.1
Sample language for a medical form (Makadon et al. [123])


Healthcare providers in the oncology care setting are increasingly called to understand the unique needs of, and provide care to, a diverse patient population [19, 130]. While great strides have been made over the last decade with respect to cultural competence, there is a growing awareness that diversity spans beyond minority groups solely based on race and ethnicity and includes sexual minority groups that have long been marginalized in the US healthcare system. Our review specifically discusses the challenges of AYA LGBTQ patients in the context of cancer-related infertility and fertility preservation. However, many of the issues and considerations that we have discussed as well as the suggestions we provide can be used to more broadly impact and improve healthcare for sexual minority groups.



Fredriksen-Goldsen KI, Kim HJ, Barkan SE, Muraco A, Hoy-Ellis CP. Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. Am J Public Health. 2013;103(10):1802–9. Pubmed Central PMCID: Pmc3770805, Epub 2013/06/15. eng.PubMedPubMedCentral


Spectrum Center. LGBT terms and definitions [internet]. Ann Arbor: Spectrum Center; 2015. [cited 2015 Jul 20], Available from: ​internationalspe​ctrum.​umich.​edu/​life/​definitions.


Johnson CV, Mimiaga MJ, Bradford J. Health care issues among lesbian, gay, bisexual, transgender and intersex (LGBTI) populations in the United States: introduction. J Homosex. 2008;54(3):213–24. Epub 2008/10/02. eng.PubMed


Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: National Academies Press; 2011.


Institute of Medicine. Collecting sexual orientation and gender identity data in electronic health records. Washington, DC: National Academies Press; 2013.


UC Berkeley Gender Equity Resource Center. Definition of Terms [Internet]. Berkeley: UC Berkeley Gender Equity Resource Center; c2014 [updated 2013 Jul; cited 2015 Jul 21]. Available from: ​geneq.​berkeley.​edu/​lgbt_​resources_​definiton_​of_​terms.


Gender and Sexuality Center. LGBT Vocab 101 [Internet]. Northfield: Gender and Sexuality Center; [date unknown] [updated 2014 May 27; cited 2015 Jul 21]. Available from: ​apps.​carleton.​edu/​campus/​gsc/​students/​ally/​lgbtvocab/​.


Gates GJ. How many people are lesbian, gay, bisexual, and transgender? Los Angeles: The Williams Institute, University of California, Los Angeles School of Law; 2011.


Durso LE, Meyer IH. Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sex Res Social Policy. 2013;10(1):35–42.PubMed


Hart SL, Bowen DJ. Sexual orientation and intentions to obtain breast cancer screening. J Womens Health (Larchmt). 2009;18(2):177–85. Pubmed Central PMCID: Pmc2945722, Epub 2009/02/03. eng.


Tracy JK, Lydecker AD, Ireland L. Barriers to cervical cancer screening among lesbians. J Womens Health (Larchmt). 2010;19(2):229–37. Pubmed Central PMCID: Pmc2834453, Epub 2010/01/26. eng.


Tracy JK, Schluterman NH, Greenberg DR. Understanding cervical cancer screening among lesbians: a national survey. BMC Public Health. 2013;13:442. Pubmed Central PMCID: Pmc3693978, Epub 2013/05/07. eng.PubMedPubMedCentral


Newman PA, Roberts KJ, Masongsong E, Wiley DJ. Anal cancer screening: barriers and facilitators among ethnically diverse gay, bisexual, transgender, and other men who have sex with men. J Gay Lesbian Soc Serv. 2008;20(4):328–53. Pubmed Central PMCID: Pmc3002049, Epub 2008/10/01. Eng.PubMedPubMedCentral


Potter J, Peitzmeier SM, Bernstein I, Reisner SL, Alizaga NM, Agenor M, et al. Cervical cancer screening for patients on the female-to-male spectrum: a narrative review and guide for clinicians. J Gen Intern Med. 2015;30(12):1857–64. Epub 2015/07/15. Eng.PubMedPubMedCentral


Lutz AR. Screening for asymptomatic extragenital gonorrhea and chlamydia in men who have Sex with men: significance, recommendations, and options for overcoming barriers to testing. LGBT Health. 2015;2(1):27–34.PubMed


Dodge B, Van Der Pol B, Rosenberger JG, Reece M, Roth AM, Herbenick D, et al. Field collection of rectal samples for sexually transmitted infection diagnostics among men who have sex with men. Int J STD AIDS. 2010;21(4):260–4. Epub 2010/04/10. eng.PubMed


McKay B. Lesbian, gay, bisexual, and transgender health issues, disparities, and information resources. Med Ref Serv Q. 2011;30(4):393–401. Epub 2011/11/02. eng.PubMed


National Alliance on Mental Illness. Mental health issues among gay, lesbian, bisexual, and transgender (GLBT) people [Internet]. Arlington: National Alliance on Mental Illness Multicultural Action Center; 2007 [cited 2015 Jul 21]. Available from: ​www.​nami.​org/​Content/​ContentGroups/​Multicultural_​Support1/​Fact_​Sheets1/​GLBT_​Mental_​Health_​07.​pdf.


Quinn GP, Sanchez JA, Sutton SK, Vadaparampil ST, Nguyen GT, Green BL, et al. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J Clin. 2015;65:384.PubMedPubMedCentral


Almeida J, Johnson RM, Corliss HL, Molnar BE, Azrael D. Emotional distress among LGBT youth: the influence of perceived discrimination based on sexual orientation. J Youth Adolesc. 2009;38(7):1001–14. Pubmed Central PMCID: Pmc3707280, Epub 2009/07/29. eng.PubMedPubMedCentral


Burgess D, Tran A, Lee R, van Ryn M. Effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons. J LGBT Health Res. 2007;3(4):1–14. Epub 2008/12/02. eng.PubMed


National Institutes of Health. Plans for Advancing LGBT Health Research [Internet]. Bethesda: U.S. Department of Health and Human Services; 2013 [updated 2013 Jan 4; cited 2015 Jul 21]. Available from: ​nih.​gov/​about/​director/​01032013_​lgbt_​plan.​htm.


Margolies L. Bisexual Women and Breast Cancer [Internet]. Santa Monica: National LGBT Cancer Network; c2015 [updated 2013 Oct 7; cited 2015 Jul 21]. Available from: ​cancer-network.​org/​cancer_​information/​bisexuals_​and_​cancer/​bisexual_​women_​and_​breast_​cancer.​php.


Brown JP, Tracy JK. Lesbians and cancer: an overlooked health disparity. Cancer Causes Control. 2008;19(10):1009–20.PubMed


NIH LGBT Research Coordinating Committee. Consideration of the institute of medicine (IOM) report on the health of lesbian, gay, bisexual, and transgender (LGBT) individuals. Washington, DC: National Institutes of Health; 2013.


Boehmer U, Miao X, Maxwell NI, Ozonoff A. Sexual minority population density and incidence of lung, colorectal and female breast cancer in California. BMJ Open. 2014;4(3):e004461. Pubmed Central PMCID: Pmc3975738, Epub 2014/03/29. eng.PubMedPubMedCentral


Boehmer U, Miao X, Ozonoff A. Cancer survivorship and sexual orientation. Cancer. 2011;117(16):3796–804. Epub 2011/05/11. eng.PubMed


Boehmer U, Ozonoff A, Miao X. An ecological analysis of colorectal cancer incidence and mortality: differences by sexual orientation. BMC Cancer. 2011;11:400. Pubmed Central PMCID: Pmc3188512, Epub 2011/09/23. eng.PubMedPubMedCentral


Boehmer U, Ozonoff A, Miao X. An ecological approach to examine lung cancer disparities due to sexual orientation. Public Health. 2012;126(7):605–12. Pubmed Central PMCID: Pmc3389196, Epub 2012/05/15. eng.PubMedPubMedCentral


Quinn GP, Schabath MB, Sanchez JA, Sutton SK, Green BL. The importance of disclosure: lesbian, gay, bisexual, transgender/transsexual, queer/questioning, and intersex individuals and the cancer continuum. Cancer. 2015;121(8):1160–3.PubMed


Dahan R, Feldman R, Hermoni D. Is patients’ sexual orientation a blind spot of family physicians? J Homosex. 2008;55(3):524–32. Epub 2008/12/02. eng.PubMed


Kamen CS, Smith-Stoner M, Heckler CE, Flannery M, Margolies L, editors. Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers. Oncol Nurs Forum. 2015;42(1):44–51: NIH Public Access.

Sep 24, 2017 | Posted by in GYNECOLOGY | Comments Off on The Importance of Disclosure for Sexual Minorities in Oncofertility Cases
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