Sexual Orientation

While in the process of discovering their adult identity, many adolescents have questions regarding sexual orientation, gender identity, or gender role. Concurrent heterosexual and homosexual feelings and attractions are common; a single or small number of same-sex sexual encounters are not necessarily predictive of a gay, lesbian, or bisexual identity as an adult. Predominantly homosexual attractions during adolescence, however, are unlikely to change with time. By maintaining an opening questioning style, such as asking, "When you think of people to whom you are sexually or romantically attracted, are they men, women, both, neither, or are you not sure yet?", the health care provider gives the adolescent permission to express their sexual orientation freely.

In an environment critical of their emerging sexual orientation, nonheterosexual adolescents may experience profound isolation and fear of discovery, which interfere with achieving the developmental tasks related to self-esteem, identity, and intimacy. Censure, alienation, and abandonment by the family of origin represent a particularly devastating consequence for many gay and lesbian teenagers. Nonheterosexual adolescents are more likely to have had sexual intercourse, to have had three or more sexual partners, and to have experienced sexual intercourse against their will, putting them at increased risk of STDs, including HIV infection. Nonhetero-sexual teenagers are more likely than heterosexual peers to start using tobacco, alcohol, and illegal drugs at an earlier age. They are also at higher risk of dropping out of school, becoming homeless, and turning to prostitution or drug trafficking for survival (Garafolo et al., 1998). They are often subjected to harassment and violence; 45% of gay men and 20% of lesbians surveyed were victims of verbal and physical assaults in secondary school, specifically because of their sexual orientation (Kreiss and Patterson, 1997).

Teenagers seeking family-planning or obstetric services are not necessarily heterosexual; bisexual and lesbian respondents are two to seven times more likely to become pregnant than their heterosexual peers (Saewyc et al., 2008). Although for American adults, no differences in suicide rates are detectable between heterosexual and homosexual cohorts, gay, lesbian, bisexual, and "not sure" high school students were three times more likely to report a suicide attempt than their heterosexual peers (Garafolo et al., 1998). Primary care providers who care for adolescents, especially gay, lesbian, or bisexual youth, should be alert to the possibility of depression and suicide. For support, clinicians can suggest they contact the Gay, Lesbian, Bisexual, and Transgender National Youth Talkline at 800-246-PRIDE or the Trevor Helpline (866-488-7386; 866-4UTREVOR), a 24-hour suicide prevention hotline that focuses on the needs of gay youth.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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