Clinical Considerations in the Care of Lesbian Gay and Bisexual Patients

All patients have the same medical needs and expectations, regardless of sexual orientation, such as accurate diagnosis and treatment and respectful communication. However, several issues are especially important to remember for the medical care of gay, lesbian, and bisexual patients.

Lesbians are less likely to obtain health maintenance services, including clinical breast examination, mammography, and cervical cancer screening than heterosexual women, perhaps because of an underinsured or uninsured status. Patients in same-gender couples are often not eligible for spousal health insurance benefits and may be less likely than their heterosexual counterparts to be adequately insured. Many lesbians mistakenly believe they do not need Papanicolaou smears. However, women self-identified as lesbian may have been a victim of childhood sexual abuse, had a remote history of consensual male sexual contact, or they are bisexual. Nulliparous lesbians are at a high risk for cancers of the breast, endometrium, and ovary. Female-to-female transmission of sexually transmitted diseases (STDs, including HIV infection) is much less efficient than male-to-female transmission; however, genital-oral sex and fomites such as sex toys can transmit gonorrhea and Trichomonas, respectively.

Gay men sometimes report difficulty in obtaining adequate health care caused by providers' bias and fear of discrimination. Any male patient who presents for treatment of urethri-tis should be asked about participation in oral-genital sex or receptive anal intercourse, because some treatment regimens for urethral gonorrhea and chlamydia are not effective against pharyngeal and anal infections. A careful exposure history should be taken, even if the patient self-identifies as heterosexual, because some heterosexual-identified men may have same-gender sexual experiences.

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