LGBT

Question 0

Define social norms.

Answer 0

Belief systems about what is normal, acceptable, and ideal

e.g. male and female are separate categories distinguished by anatomy, men are masculine and women are feminine

Question 1

What people are considered LGBT?

Answer 1

Sexual & gender minorities who fall outside the social/cultural norms regarding sex, relationships, and gender.

Experience marginalisation and discrimination.

Question 2

Define sexual orientation.

Answer 2

Direction of sexual interest, especially seen to be dictated by physiology rather than societal factors.

note: sexual attraction includes feelings, behaviours, and identity (which may or may not coincide)
e. g. someone may identify as heterosexual, but have sex with men

Question 3

Describe the gender binary model.

Answer 3

Two separate categories: male & female

Clearly distinguished by anatomy

Men should look and act masculine, women should look and act feminine

Question 4

What is the difference between gender identity and gender role/expression?

Answer 4

Gender identity = internal perception and experience of gender

Gender role/expression = way person lives in society and interacts with others

Question 5

Define the term transgender.

Answer 5

Umbrella term for those whose gender identity/expression differs from their birth sex

Includes transsexuals, transvestites, cross-dressers, genderqueer

Question 6

Define the term transsexual.

Answer 6

Someone who feels a consistent and overwhelming desire to transition and fulfil their life as a member of the opposite sex

note: not all trans people are transsexual; people who do not conform to gender norms and do not wish to surgically alter their bodies to “fit” either gender category

Question 7

How does LGBT discrimination affect health?

Answer 7

• increased stress
• low self-esteem
• isolation
• increased conflict
• sub-culture
• distrust of authorities (reporting of mental health problems)
• discriminatory healthcare (refusal of treatment)

Question 8

What are some specific health needs of LGBT individuals?

Answer 8

STIs:

• HIV & syphilis more common in men who have sex with men but many never have HIV test
• women who have sex with women can contract STIs

Cancer:

• lesbians should still have smears (may have had sex with men, HPV can be transmitted between women, & 10% of lesbians have abnormal smears)
• men who have sex with men more likely to contract anal cancer

Higher rates of substance use including smoking, alcohol, recreational drugs

Higher levels of stress-related mental health problems, including anxiety, depression, suicidality

Question 9

Give some examples of LGBT discrimination in healthcare in the past.

Answer 9

Homosexuality listed as mental disorder under DSM until 1973 and under ICM until 1992

Transgender listed as mental disorder

Aversion therapy (electric shock, lobotomy) practised until the 1980s

Inappropriate questions and comments, prejudice, not respecting confidentiality

Question 10

Give some examples of ethical guidelines and laws which have improved LGBT healthcare.

Answer 10

GMC 2006: do not let views prejudice treatment, challenge colleagues’ behaviour

Tomorrow’s Doctors 2009: respect all patients, colleagues, and others regardless of their sexual orientation

Equality Act 2010: illegal to discriminate on grounds of sexual orientation or gender identity in provision of goods and services, in education, and in the workplace

Question 11

What are some important issues concerning communication with LGBT patients?

Answer 11

Assumptions e.g. patient has opposite sex partner, married men do not have anal sex, “butch” women do not need contraception

Language used

Coming out

Confidentiality

Reflect

Homophobia