Sexual Orientation is a Pediatric Issue

Pediatricians encouraged to create healthy environment for LGBTQ youth

Young people who come out as gay may be faced with discrimination at school and even at home. The pediatrician's office could be one place these youth feel comfortable talking about their sexual identity.

A recent statement released by the American Academy of Pediatrics (AAP) is urging pediatricians to talk to children and teenagers about their sexual orientation and behavior.

The statement recommends that pediatricians train themselves and their staff to use gender-neutral language and not assume their patients to be heterosexual.

Make sure your child is comfortable with their pediatrician.

Lesbian, gay, bisexual and transgender youth are more at risk for mental instability, dangerous behavior and sexually transmitted diseases than their heterosexual peers.

The AAP statement concludes that when pediatricians help to create a healthy environment and encourage a positive self-image for lesbian, gay, bisexual and transgender youth, these young people are less likely to engage in risky behaviors and more likely to lead a healthy and happy life.

The new policy statement released this week by the AAP details new guidelines on how to improve treatment of LGBTQ (lesbian, gay, bisexual, transgender, questioning) children and teenagers.

This statement explained that simply being a LGBTQ youth is not risky behavior in itself; rather, it's the social stigma, homophobia and cultural heterosexism (assumption that someone is straight) that can lead to psychological distress. This distress can be accompanied by risky behaviors that can lead to poor mental health, sexually transmitted diseases and substance abuse.

Sexual orientation is defined in the statement as "an individual's pattern of physical and emotional arousal toward other persons." The terms lesbian, gay and bisexual refer to sexual orientation.

People who identify as "transgender" have a gender identity that does not match their anatomic sex (male or female) as determined at birth by their genitals. This emotional and mental distress is referred to as "gender dysphoria". Being transgender does not refer to sexuality, but the identity is included in the "sexual minority" group because of social and cultural gender norms that can cause stigma and alienation.

The "Q" in LGBTQ refers to "questioning" because not all youth figure out their sexuality quickly, so many often experiment for some time. This group of youth can engage in sexual activity with the same sex even if they do not identify as gay, lesbian or bisexual.

Sexual minority youth are more likely to suffer from depression, suicidal thoughts and actions, substance abuse, social anxiety, altered body image, and other mental disorders. They most often suffer higher rates of depression than their heterosexual peers, and they are twice as likely to consider or commit suicide. Sexual minority youth are also more likely to be homeless at a young age.

A large issue revolves around the dangerous sexual behavior that affects many sexual minority youth. Substance abuse and poor mental health can lead to unprotected sexual acts that put these youth at major risk for teenage pregnancy, and the contraction of STDs, especially HIV and AIDS. On top of that, sexual minority youth are statistically more likely to have had sexual intercourse before the age of 13.

These kids and teenagers need a safe space to confidentially discuss both their physical and mental health without fear of violence, stigmatism or rejection.

The AAP statement encourages pediatricians to educate themselves and their office staff about the unique risks and experiences that come with being a sexual minority youth. The study suggests conduct an open and confidential conversation about sexual activities and behaviors, as well as personal identity. It is not the doctor's job to inform parents about their child's sexual identity or behavior in order to avoid any potential backlash or disapproval from home.

The statement also encourages pediatricians to use gender-neutral terms and questions to make patients feel comfortable discussing their behaviors and feelings and questions about their sexuality or behavior. When looking at STD risk, the study suggests asking about the gender of sexual partners and frequency of sexual behavior in order to adequately assess risk of disease.

The statement, based on recent guidelines released by the Center for Disease Control (CDC), recommends that specific testing measures be used based on identity and behavior. For example, men who have sex with men are encouraged to be tested for anal abnormalities.

Likewise, women who have sex with women are encouraged to be tested for bacterial, viral and protozoan infections that could come from both male and female partners. Cervical screening and HPV vaccinations are also encouraged for women who have sex with women.

The statement suggests that pediatricans help transgender patients find supportive counseling that may or may not lead to hormone therapy. Transgender youth are often at risk for seeking out non-prescribed hormones or other body altering substances or treatments to change their bodies to a gender opposite their anatomic gender.

Parental support is integral to sexual minority youth leading healthy lives throughout and after the coming out experience. Pediatricians are encouraged to help parents of sexual minority youth understand and support their children and teenagers throughout the process.

However, the statement encourages doctors to not let parental disapproval change the course of treatment for a patient. The statemen urges doctors to check in with parents throughout treatment and offer resources to aid parental understanding and support.

Other recommendations from the statement include creating a youth-friendly office environment that welcomes every sort of identity and behavior, including health forms and questionnaires that do not assume that the patient or parents of the patient are heterosexual.

Ultimately, the statement encourages pediatricians to gain the knowledge and resources to answer questions and correct any misinformation regarding LGBTQ health in order to show sexual minority youth that being LGBTQ is normal.

The AAP says that, if these guidelines and recommendations are followed, the risk factor and health disparities for LGTBQ youth have the potential to decrease and allow for a happy and healthy transition and life.

This policy statement was released June 24 in the online edition of Pediatrics, the official journal of the AAP.