Experts offer advice on asking young patients about sexuality and gender identity

Key takeaways:

• Nearly 80% of adolescents and young adults surveyed were comfortable discussing their gender identity and sexual orientation with their PCP.
• PCPs should have safe, open conversations with their young patients.

Most young people said primary care physicians should ask patients their age about sexual orientation and gender identity, according to research presented at the American Academy of Pediatrics National Conference & Exhibition.

Jessica Pourian, MD, a fellow in clinical informatics at the University of California, San Francisco’s department of pediatrics told Healio that it is important for PCPs to know their patients’ gender identity and sexual orientation.

“Not only is this information needed for routine preventive health screening, but using the correct name and pronouns has been shown in previous studies to be critical for the patient-provider relationship,” Pourian said.

Although there is some research on adult patients disclosing these details, Pourian said, “to our knowledge, there have been no previous studies asking adolescents how they would like to be asked this sensitive information.”

“We want our patients to feel comfortable coming to our clinic and discussing their health openly, so we wanted to ask them how they would prefer to talk about their sexual orientation and gender identity,” she said.

Pourian’s research included 260 patients aged 10 to 26 years who responded to a survey a medical assistant administered during in-person visit check-ins. About one-third of the participants were aged 18 to 20 years. Half the participants were gender diverse; 52% were lesbian, gay or bisexual; and 38% identified as a part of both groups.

The results

Pourian and colleagues found that the vast majority of adolescents and young adults surveyed — almost 80% — were comfortable discussing their sexual orientation or gender identity with their PCPs.

Michelle Forcier, MD, MPH, a professor of pediatrics at Brown University who was uninvolved in the study, said young people “are open to learning more about their bodies, about their growth and development, including gender and sexuality.” These findings, she said, further demonstrate that young people want to have conversations about these “important aspects of their growth and development” with trained professionals.

“Youth understand that gender and sexuality [are] deeply personal and important to discuss,” Forcier said. “They are not afraid of acknowledging that these aspects of development of course impact their daily lives and well-being.”

Pourian and colleagues also found that 64% of participants said it was important for PCPs to ask about a patient’s chosen name, pronouns and gender identity, but more gender-diverse youth agreed that this was important (83% vs. 45% of cisgender youth). Nearly all — 96% — of gender-diverse youth agreed they wanted their chosen name and pronouns displayed in electronic health records.

Additionally, participants perceived asking about sexual orientation as less important than gender identity; 56% of lesbian, gay and bisexual youth agreed it was important compared with 38% of heterosexual youth.

The survey results also indicated that PCPs can integrate routine collection of patients’ sexual orientation and gender identity “into their workflow in whichever way works best for their practice,” Pourian said. That could be a direct question from the physician in the exam room, part of the nurse intake when taking vitals or a standard questionnaire at registration.

“There were no significant differences in preferences between being asked in person by a nurse or social worker, on paper at registration, or via electronic tablet or personal phone questionnaire,” Pourian said. “This is very encouraging as a provider.”

However, she said being asked by a physician was the most popular option among the respondents.

Having sensitive conversations

When PCPs are having these conversations with their patients, Forcier said it is important to take into account where a patient is developmentally, their family support, their own personal experience and what they might want to address.

“Healthy development is about learning and growing into yourself,” Forcier said. “When physicians ask patients about themselves, including about gender, sexuality and diverse identities, like any conversation, language, tone and general openness and kindness make the conversation not stigmatizing but safe and welcome.”

To ensure LGBTQ+ patients have a positive experience in their practice, Pourian said PCPs “can just ask the patient directly, in a kind and respectful way.”

“I believe it is important not to make any assumptions about sexual orientation or gender identity,” Pourian said. “There’s no need to shy away from questions on sexual orientation and gender identity. Teens of all sexual orientations and gender identities believe these questions to be important and are open to having a conversation about it.”

‘A generational shift’

A recent small, qualitative study published in the Annals of Family Medicine indicated that transgender patients are often asked irrelevant, stigmatizing questions and have some hesitation disclosing their identities to their provider, often deciding between facing the risks associated with transphobia and those associated with clinicians not having all possibly relevant information.

The wide difference in the studies’ results indicates the importance of age as a factor in these conversations, Pourian said.

“I believe there has been a generational shift. I think young people today are much more open about discussing sexual orientation and gender identity as compared to decades past,” she said.

Overall, Forcier said, she and many colleagues working with LGBTQ+ youth “understand that they are mostly looking for knowledgeable adults and professionals, in safe spaces, to provide them with accurate information, supportive resources, and caring acceptance in order to safely navigate puberty.”

“Youth, understandably, are curious and want to understand and have some control over what happens to them and their bodies,” she said. “Youth understand much more about consent, autonomy, and diversity than previous generations of adults. Youth are expected to explore gender and sexual identities as a part of becoming a healthy adult. They get that.”

References:

• Adolescents and young adults of all identities open to discussing sexual identity and gender identity with doctors. https://www.eurekalert.org/news-releases/1004617. Published Oct. 20, 2023. Accessed Oct. 27, 2023.
• Alpert AB, et al. Ann Fam Med. 2023;doi:10.1370/afm.3010.