• Ask, “When you do have sex with your partner, what do you do?” Here, you have to be very specific. Younger teenagers tend to be concrete thinkers, so don’t just ask “Are you sexually active?” Instead, try asking, “Have you ever had a penis in your mouth, vagina, or anus?” or “Do you use sex toys?”
• In terms of protection from STIs, you might ask, “Do you use condoms or a dental dam?”
• Ask, “Have you ever had an STI, and if so, how was it treated?”
• Ask, “What do you use for birth control?” either hormonal or barrier methods.
In addition to above questions, I would also ask about intimate partner violence. Often, health care providers may ask if their patient has been hit, punch, slapped, or kicked by their partners. But intimate partner violence can go beyond physical violence. It also involves emotional manipulation or birth control sabotage. Sometimes, it is better to ask if a patient has been forced to do something sexual with her partners when she didn’t want to. The patient may deny it, however, even though you highly suspect it. So it is better to remember to build a rapport, and when the patient is ready to get out of an abusive relationship, he or she will come to you for help.
Some clinicians have told me that they have a hard time asking sexual histories in LGBT youth because they’re afraid of offending them, especially when it comes to asking about sex with the opposite sex. This is a valid concern and an area of ongoing research, but I think that by making things normative, just like with any behavior, teens and young adults are more likely to disclose critical pieces of information. It is a good idea, then, to start off with “Because of homophobia, many LGBT youth may engage in heterosexual sex. Tell me, have you ever…”
By not assuming and asking specific questions, LGBT youth are more likely to tell their health care provider important information. With that information, health care providers can prevent many adverse health outcomes like teen pregnancy, STIs, and intimate partner violence. It also will give health care providers an opportunity to address the rampant stigma and discrimination that plagues this vulnerable population.
Here are some resources on sex and relationships in LGBT youth:
• The CDC 2015 STI Guidelines have a special section on STIs in men who have sex with men, women who have sex with women, and transgender men and women.
• Bedsider.org is an excellent website about birth control options and STI prevention for all sexual orientations and gender identities.
• Futures Without Violence provides resources for health care professionals to manage and prevent intimate partner violence.
References
2. National Transgender Discrimination Survey: Full Report. 2012.
3. MMWR Surveill Summ. 2011 Jun 10;60(7):1-133.
4. J Youth Adolesc. 2015 Jan;44(1):211-24.
5. Perspect Sex Reprod Health. 2008 Dec;40(4):212-7.
6. Sex Transm Dis. 2010 May;37(5):335-9.
7. Sexpress: The Toronto teen survey report. 2009.
8. Fletcher RC. Social context and social support: Exploring the lived experiences of LGBTQ youth who have been pregnant. [Master’s Project]: School of Public Health, University of Minnesota; 2011.
9. Can J Hum Sex. 2008;17(3):123-139.
Dr. Montano is an adolescent medicine fellow at Children’s Hospital of Pittsburgh of UPMC and a postdoctoral fellow in the department of pediatrics at the University of Pittsburgh. He has no relevant financial disclosures.