Human Sexuality Flashcards
Physicians attitudes and knowledge - biases in healthcare
18.7% sometimes or often uncomfortable providing care to gay patients, 23% reported that same sex relationships were always/almost always wrong and 9% were sometimes wrong. Physicians are less comfortable talking about sex with opposite-sex patients and with patients <18 or >65
A survey of the American Public - biases in healthcare
30.4% will change provider if they were gay/lesbian and 35% would change practices if they found out gay/lesbian providers worked there.
Guiding assumptions
Everyone has a sexual orientation, a gender identity, and a gender expression. Everyone falls on a scale of somewhere between purely heterosexual and purely homosexual, but where they fall might change over time. People’s gender identity and expression might also change over time.
Understanding sexual orientation
Includes sexual identity, attraction, and behavior
Identity
How a person self defines or labels their sexuality. Languages change over time. As people go through the process of understanding their sexuality over time, they may change how they identify
Traditional labels of identity
Gay, lesbian, bisexual, straight, homosexual, heterosexual, and asexual
Other terms to describe sexual identity
Queer, same-gender loving, polyamorous, pansexual,
Behavior
Generally refers to the gender of a person’s sexual and romantic partners. Sexual identity might not always align with sexual behavior. Understanding behavior also involved learning about specific sexual behaviors that individuals engage in with their partners (not just oral, vaginal, or anal sex)
Attraction
Refers to the gender(s) a person is attracted to, does not always align with behavior or identity. There is variability across life course; desire to be with same gender may never be acted on, some do not discover attractions until later in life.
Gender identity
A person’s internal sense of being a man/male, woman/female, both, neither, or another gender
Gender expression
Manner in which a person represents or expresses their gender identity
Cisgender
When a person’s gender identity corresponds with their assigned sex at birth
Transgender
Umbrella term for people whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth.
Transitioning
A term used to describe the period during which a transgender person begins to express their gender identity
Transgender individuals may alter their physical appearance
Through hormonal therapy and/or surgery, in order to affirm their gender identity, though some choose not to do so at all
Trans men
People assigned female sex at birth but who identify as male may call themselves transgender men, female-to-male
Trans women
People assigned male sex at birth but who identify as female may call themselves transgender women, male-to-female
Gender identity and expression
People whose gender identity and/or expression falls outside the gender binary (male or female) may refer to themselves as genderqueer, gender fluid, gender non-conforming, non-binary, agender, bigender, pangender, or other terms.
Alternative Constructs of Gender Identity: Terminology Follows Concept
Individual construct/gender affirmation believe that the identity begins in the head. Medical construct/gender assignment/reassingment/transitioning believe that the identity begins at the biological level of the genitalia.
LGBTQ demographics in the US
2.2-4% (5.3-9.5 mil) people self identify as LGB. 0.6% (1.4 mil) people self identify as transgender.
Same-sex sexual contact
In the last year, women 3%, men 4%. In a person’s lifetime, women 4.3-11.2%, men 6-9.1%
Changing social landscape
LGBTQ youth are coming out and transitioning genders earlier and are often living in family home. Increased public support for LGBTQ people and LGBTQ-specific protections. 2015 - marriage equality. 2016 - end ban on transgender military service
Stigma, discrimination, and inequality
LGBQ persons exhibit higher rates of victimization and violence than do heterosexual peers. Trans women experience the highest rates of violence and victimization, especially trans women of color.
Unequal protections under the law
52% of LGBTQ population lives in states that do not prohibit employment discrimination based on sexual orientation or gender identity
Primary drivers of LGBTQ health disparities
Stigma, discrimination, and inequality
Overview of LGBTQ health disparities
LGBQ people generally report poorer health when compared to heterosexual people. Transgender people generally report poorer health when compared to cisgender and LGBQ people.
Differences between and within groups for LGBTQ health disparities
By sexual orientation and by gender identity and expression; Transmen and transwomen have different health needs; Where someone is in their coming out and identity process influences their mental/emotional health; By race/ethnicity, age, class, education, employment status, housing, etc.
Health Concerns of LGBTQ Youth (12-24 years)
Lack of family acceptance and support. Lack of safety: bullied and targeted at home, at school, and in community. Alcohol, tobacco, and other drug use. Runaway and homelessness. Depression, anxiety, and poor mental health. Suicide and non-suicidal self-injury. Unintended pregnancy, STIs, and HIV
Health concerns of lesbian and bisexual women
Increased rates of major depression, anxiety, and PTSD and suicidality (and this increases when person is not out). Increased rate of smoking, physical inactivity, and obesity/overweight. Increased rate of alcohol use and abuse, especially increased among bisexual women. Increased rates of breast and cervical cancer, fewer full term pregnancies and health screenings. Decreased personal safety, increaed hate crimes and sexual and domestic violence.
Health concerns of gay and bisexual men
Increased rates of major depression, anxiety, and suicidality, higher when not out. Increased rates of alcohol, tobacco, and other drug use. Increaed risk for anal cancers and some men show an increased rate for prostate/testicular/colon cancer. Increased body image problems and eating disorders. Increased STIs, viral hepatitis, HIV/AIDS (Black MSM disproportionately impacted relative to all groups). Decreased personal safety, increased hate crimes and sexual and domestic violence.
Health concerns of transgender persons
Increased rates of poor mental health and suicidality. Decreased personal safety, increased hate crimes, sexual and domestic violence. Increased rates of alcohol, tobacco, and other drug use/abuse. Increased rates of STIs and HIV. Access with hormones - street based or from provider. Structural barriers: name change, legal documents, employment, housing, incarceration. Barriers to care: discrimination, provider hostility/insensitivity, gender binary in forms, incorrect use of pronouns.
Life cycle
Coming out (life course), dating/relationships/partners, marriage and commitment, family formation and parenting (adoption or reproduction), legal issues and protections, employment benefits, and aging.
Aging when gay
Older adults often experience greater isolation and fewer family or community supports; Less likely to be “out” than younger LGBTQ peers; elders may face discrimination in long term care facilities. Need for advance directives, especially in cases where long term partners are not married
When communicating with patients…
Mirror their language, using the pronouns they use. Use gender neutral terms and pronouns
Taking a health history
Ask your pt the same thing you would for all your patients. Get to know them as a person and avoid judgement. Ask about comfort with sexuality, STIs, sexual behavior, and gender identity.
Coming out and transitioning genders
Can happen at any age regarding sexual orientation or gender identity. Ask patients if they have family, friends, partner, and community support. If not, connect them with local and national groups.
Core of the cross cultural interview
Encompasses respect, curiosity, and empathy
