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?
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, 126–129]. 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.
Conclusion
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.
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