Talking about sex with a doctor is never easy. For most, it’s a conversation that’s nearly impossible to get through without blushing, cringing, or squirming. But while questions about sexual activity can be awkward and uncomfortable for anyone, they are particularly anxiety-provoking and stressful for LGBTQ+ and gender non-binary individuals. Many LGBTQ+ patients worry that transparency about their sexual orientation or gender identity will be met with hostility and judgment, and unfortunately many have had negative interactions with healthcare providers in the past. According to a study by Lambda Legal, nearly 56 percent of lesbian, gay, and bisexual patients and 70 percent of transgender and gender non-conforming individuals have experienced discrimination in a healthcare setting. Meanwhile, another study found that only 16 percent of LGBTQ+ people choose to inform their doctor of their sexual orientation because of these concerns.
While coming out is a personal choice, however, being open and honest with your provider may be critical in managing your health. Understanding your sexual activity and gender preference can help a doctor personalize your care plan, as well as your in-office experience.
Why is it important to come out to your doctor?
Though it may not seem necessary to reveal your preferred pronouns or sexual behaviors to your doctor, this information is key in determining your course of care. LGBTQ+ patients have a unique set of healthcare needs and risks that cisgender, heterosexual individuals do not. Research shows, for instance, that members of the LGBTQ+ community are at higher risk of substance abuse and addiction. Lesbian women are less likely to have regular cancer screenings. And LGBTQ+ individuals experience more depression and anxiety than their heterosexual peers and are more likely to attempt suicide.
One Medical provider, Samuel Fam, DO says transparency about sexual orientation and gender can help your doctor tailor a care plan to your specific needs: “It's important for individuals to be open about their sexual orientation, gender identity and sexual practices as this information will help their provider customize a unique care plan for them according to known or expected needs of individuals in similar demographic groups. While your provider is hopefully already prompting conversations on these topics, being open and forthcoming with this information could change recommended screenings or treatments for things like cancer, STIs, mental health, safety and well-being, and vaccines for prevention of transmittable infections.”
Coming out to your doctor can also enable them to make your visits more comfortable. If you identify as male, for instance, or have had a hysterectomy (removal of the uterus) your doctor will be able to avoid questions about pregnancy. Likewise, knowing your sexual history can help them avoid making assumptions about your partners and relationships. “Disclosing this information can reduce the risk of providers and their teams misgendering or referring to parts of a person with labels that make them feel uncomfortable and less likely to get care when needed in the future,” says Fam.
How to have the conversation
Ultimately the decision to tell your provider about your sexual orientation or gender identity is yours alone. But if you do decide to share this information with your provider, you may be unsure about how to start the conversation. Here are some tips for finding and being open with your provider:
Do your research
When looking for a new provider, it can be helpful to get recommendations from your community. One Medical provider, Nina Metsovaara, MD recommends asking within your network: “I always tell people to do their research before they show up to a new practice if they can. I find most LGBTQ+ patients find their provider by word of mouth from their community or partners, as well as internet community boards.” You can also use online directories like the Gay and Lesbian Medical Association's Healthcare Provider Directory or ask your local LGBTQ+ health center. At One Medical, you can find each of our providers’ bios online with a short description of their areas of expertise. Many have indicated a specific interest in LGBTQ+ and transgender care on their profiles. You can also call before booking an appointment to inquire about a provider’s experience with LGBTQ+ patients.
Set the agenda
Rather than bringing this topic up during a separate appointment, it may be helpful to schedule a visit specifically for this conversation. “Whether with an existing provider relationship or a new provider, setting the agenda for this visit helps the provider identify that this is something important and valuable for the individual's well-being, as well as create space for asking questions, both to and receiving from the patient,” says Fam. “Simply asking to discuss sexual and gender health can prompt the provider to help navigate the conversation and meet the goals and intentions of the visit, while building trust and safety in the patient-provider relationship.” Setting your sexual orientation and gender as the reason for your visit will help your provider prepare, as well as save you the anxiety and discomfort of trying to direct the conversation.
Bring a friend
It can be difficult being vulnerable with a stranger. If you’re anxious about talking to your provider, bring a close friend, family member, or partner as support. Just having someone you trust in the room can be calming. If you choose to bring your partner, simply introducing them as such may also be an easy way to “come out” or bring up the topic of conversation indirectly.
Make a list of questions
Write out a list of questions or goals for your conversation with your provider ahead of time so you don’t forget anything. Given that this is a vulnerable conversation, it can be easy to be distracted by nerves. You may even want to include questions about the provider’s experience. “Consider asking them how much experience or interest they have with queer and trans healthcare and if they have ever had a trans or queer patient before to try and see if it's a safe space,” says One Medical provider Calvin Gilbert, FNP. It’s also okay if you don’t know what the right questions are. “It’s ok not to know what you need to be aware of,” says Fam. “Making that known internally and externally with a simple phrase like, ‘I don't know if there is anything I need to be aware of to help me stay healthy,’ can help relieve that burden of responsibility off of the patient.”
Only share what you’re comfortable with
You may find that you aren’t ready to share the full details of your sexual activity right off the bat and that’s okay. “You may be asked specific questions and you don't have to answer them until you feel comfortable,” says Gilbert. “If you aren't ready to discuss details, you can keep it more vague at first. You can say things like, ‘I've been exploring my gender identity and might want to discuss hormones at some point, what would that look like?’” Trust takes time to build. The more you talk about this subject with your provider, the more comfortable you’ll become.
Have the conversation when you feel comfortable
Since this conversation may leave you feeling vulnerable or exposed, you should do whatever you can to maximize comfort. For some, that may mean asking the doctor to talk for a few minutes before you undress and switch into a gown. For others, that may mean talking in an office outside of the exam room entirely. Decide whether you’ll feel most at ease bringing this up at the beginning or at the end of the visit.
Know that it’s okay to feel like someone might not be the right provider for you
Finally, you should never feel stuck or obligated to stick with a provider. You can shop around as much as you want. “ Remind yourself that you have a right to have a provider who you feel comfortable with,” says Gilbert. “If your conversation doesn't go well, it’s okay to ask to meet with someone else to discuss your options, questions, or concerns.”
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, Portland, the San Francisco Bay Area, Seattle, and Washington, DC.
Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. The One Medical Group entities and 1Life Healthcare, Inc. make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.