Adolescent sexuality and disclosure

Adolescence is a time of rapid growth and development both physically and emotionally. Some of the major tasks of adolescent development include developing a stable identity (this includes sexual and gender identity) and establishing independence from parents. This separation process from parents is often buffered by peer relationships. By the end of adolescence, those who are healthy and mature in their sexuality are able to:^1,2,3

• Identify and live according to their own values and take responsibility for their behavior.

• Practice effective decision-making, and develop critical-thinking skills.

• Affirm that human development includes sexual development, which may or may not include reproduction or sexual experience.

• Seek further information about sexuality and reproduction as needed and make informed choices about family options and relationships.

• Interact with all genders in respectful and appropriate ways.

• Affirm their own gender identity and sexual orientation, and respect the gender identities and sexual orientations of others.

• Appreciate their body and enjoy their sexuality throughout life, expressing sexuality in ways that are congruent with their values.

• Express love and intimacy in appropriate ways.

• Develop and maintain meaningful relationships, avoiding exploitative or manipulative relationships.

• Exhibit skills and communication that enhance personal relationships with family, peers, and romantic partners.

Anywhere from 5% to 10% of teens identify as lesbian, gay, or bisexual (LGB).⁴ For these teens, the development of a sexual identity can add additional challenges to the development process, particularly if youth do not feel supported by family, peers, and their communities. Previous columns have addressed the role family acceptance can play in promoting the healthy development of sexual minority youth. Likewise, peer relationships also can play an important role in an adolescent’s development and health.

Dr. Gayathri Chelvakumar

Some factors that can promote resilience and counteract stigma that LGB youth may face include:⁵

• Acceptance.

• Competence.

• Higher levels of self-esteem and psychological well-being.

• Strong sense of self and self-acceptance.

• Strong ethnic identification.

• Strong connections to family and school.

• Caring adult role models outside the family.

• Community involvement.

For some youth who may not be able receive acceptance from their families, peers and trusted adults may fill in this role and serve as a “chosen family.” A chosen family is commonly understood to mean a group of people who deliberately chose one another to play significant roles in each other’s lives even though they are not biologically or legally related. These relationships may be in addition to or in place of traditional family relationships. These connections can increase a youth’s sense of acceptance and connectedness and help promote resiliency.

Adolescents often may struggle on the decision of when to “come out” or disclose their sexual orientation to friends and family, and may ask their health care providers for advice. The number one consideration when making a decision about disclosure is safety. Unfortunately, some family members and peers may not react in a supportive manner to a youth’s disclosure, and disclosure may result in being kicked out, financial coercion, bullying, physical violence, or alienation. In these cases, youth may choose to delay disclosure until they are in a more supportive environment, and health care providers can play an important role in validating and affirming patients’ identities and maintaining confidentiality as appropriate. LGB youth should be counseled to consider the when, who, and how of their disclosure. They also should plan for how they might deal with a negative or rejecting response. Some tips are included below.⁵

When

• You are ready.

• You are comfortable with your identity.

• You want to share information with people you trust and are close to.

• You have a plan for support if you are not accepted (particularly when coming out to family).

Who

• Someone you know well and expect to be supportive.

• Someone you trust, feel safe with, and who can keep information confidential if needed (may need to explore school’s privacy and confidentiality policies if disclosing to a teacher or school personnel).

• Be clear about who else information may be shared with and who NOT to share with.

How

• Be sure you are prepared. You may want to talk to other sexual minority youth or adults who have come out, attend LGBTQ groups/forums, or seek out Internet resources to learn about others’ coming out experiences. These sources may serve as a support for you should you experience any negative or rejecting responses.

• Make sure you have support resources in place prior to coming out.

• Coming out by letter allows you time to carefully word what you want to say, and allows the other person time and privacy to consider their response.

• If coming out in person, try to choose a quiet private space, and try to choose a time when everyone is relaxed and well-rested.

• If concerned about your safety, make sure other people are immediately accessible if needed.

• Plan what you are going to say, how you might end the conversation, and how you may want to talk about it later.

• Listen actively to what the other person has to say.

• Avoid any alcohol or drugs, as these may affect your mental and emotional state and responses.

• Avoid coming out because of pressure from others or because you are angry.

Youth should be reminded that people’s responses may not always be predictable. It is important to note that for many individuals, coming out may be a lifelong process and occur in stages, beginning with close friends or family members and progressing from there. In the age of social media, youth should be reminded that disclosures through social media may be widely accessible, are easily shared, and may be difficult to remove. For youth who do not have supportive peer groups, and may not be able to disclose their sexual identity, providing support resources can be helpful.

Dr. Chelvakumar is an attending physician in the division of adolescent medicine at Nationwide Children’s Hospital and an assistant professor of clinical pediatrics at the Ohio State University, both in Columbus. She has no relevant financial disclosures. Email her at pdnews@frontlinemedcom.com.

Resources for sexual minority youth and peers/families

Gay-Straight Alliance Network: gsanetwork.org

Gay Lesbian Straight Education Network: Information for Students: glsen.org/students

Sexuality Information and Education Council of the United States: www.siecus.org

The Trevor Project: Help and Suicide Prevention: www.thetrevorproject.org

It Gets Better Project: http://www.itgetsbetter.org/

Family and Ally Organization: PFLAG: https://www.pflag.org/

Advocates for Youth Parent Tips: http://www.advocatesforyouth.org/parents/173-parents

References

1. “Adolescent Sexuality,” by Michelle Forcier, MD, in Up to Date. Updated March 2017.

2. Pediatrics. 2016 Aug;138(2). pii: e20161348.

3. The Guidelines for Comprehensive Sexuality Education: Grades K-12 (Washington, D.C.: Sexuality Information and Education Council of the United States, 2004).

4. MMWR Surveillance Summaries, 2016, Aug 12;65(9):1-202.

5. “Sexual minority youth: Epidemiology and health concerns,” by Michelle Forcier, MD, and Johanna Olson-Kennedy, MD, in Up to Date.