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Gay, Lesbian, Bisexual, Transgender, and Questioning Youth. Objectives. By the end of this presentation, participants will be able to: Identify 3 risk factors faced by GLBTQ youth Discuss the ways that homophobia contributes to GLBTQ health outcomes

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Objectives
Objectives

  • By the end of this presentation, participants will be able to:

    • Identify 3 risk factors faced by GLBTQ youth

    • Discuss the ways that homophobia contributes to GLBTQ health outcomes

    • List 3 elements of GLBTQ competent healthcare delivery

    • Describe resources for GLBTQ youth



Resilience of glbtq youth
Resilience of GLBTQ Youth

  • Many GLBTQ teens lead normal, productive lives

  • Usually develop resilient adaptations to social biases and mistreatment

  • Many develop and possess remarkable strength and self-determination






Case joseph
Case: Joseph

  • Joseph is a 13-year-old male who comes to the clinic with his mother. She is concerned that:

    • Most of his friends are girls

    • He is drawn to traditionally feminine activities

    • She caught him wearing his sister’s clothes




What do the mother s concerns reveal about joseph s sexuality
What do the mother’s concerns reveal about Joseph’s sexuality?

  • Very little

  • Joseph may be questioning his sexuality and/or gender identity but dress and other outward appearances do not indicate sexual orientation or identity


Gay lesbian bisexual transgender and questioning youth

Sexual sexuality?

Attraction

Sexual

Orientation

What is gender identity?

Personal conception of oneself as male or female

Paradigm of

Sexuality

Sexual

Behavior

Biological

Sex

Gender

Identity/

Expression



Gay lesbian bisexual transgender and questioning youth

Biological sex does not always match gender identity sexuality?

Gender

Identity/

Expression


Sexuality model
Sexuality Model sexuality?

XY

XX

Biological Sex

Male

Intersexed

Female

Gender Identity/

Expression

Masculine

Androgynous

Feminine


Transgenderism
Transgenderism sexuality?


Gay lesbian bisexual transgender and questioning youth

Approaching Gender Identity with Adolescent Patients sexuality?

Ask: When you think of yourself as a person, do you think of yourself as male, female, both, or another gender?


Case joseph1
Case: Joseph sexuality?

  • Joseph tells you that he is not sure if he thinks of himself as a girl or a boy.

  • He feels “okay” with this but it makes him sad that his mother is so upset with him.

  • What can you do?


Case joseph2
Case: Joseph sexuality?


Case sophia
Case: Sophia sexuality?

  • Sophia is a 16-year-old female who comes to the clinic for a physical.

  • On her intake form, she indicates she is sexually active but not on contraception.

  • How do you discuss sensitive issues with your young patients?


Gay lesbian bisexual transgender and questioning youth

  • H: Home sexuality?

  • E: Education

  • E: Eating Habits

  • A: Activities

  • D: Drugs

  • D: Depression

  • S: Sexuality


Case sophia1
Case: Sophia sexuality?

  • As you begin the sexual interview, Sophia discloses that she self-identifies as a lesbian.


Gay lesbian bisexual transgender and questioning youth

Sexual sexuality?

Orientation

Sexual

Attraction

Paradigm of

Sexuality

Sexual

Behavior

Biological

Sex

Gender

Identity/

Expression



Determinants of sexual orientation
Determinants of Sexual Orientation sexuality?

  • Sexual orientation is not a choice

  • Most likely determined by combination of influences:

    • Genetic

    • Hormonal

    • Environmental


Awareness of sexual orientation
Awareness of Sexual Orientation sexuality?

  • First awareness of homosexual attraction occurred at:

    • ~9 for males

    • ~10 for females

  • Studies indicate many GLB youth self-identify at ~ age 16


Sexuality model1
Sexuality Model sexuality?

XY

XX

Biological Sex

Male

Intersexed

Female

Gender Identity/ Expression

Masculine

Androgynous

Feminine

Sexual Orientation

Neither

Women

Both

Men

Other


Prevalence of glbq youth
Prevalence of GLBQ Youth sexuality?

  • Difficult to ascertain

  • Majority of states do not include questions regarding sexual orientation in YRBS



Gay lesbian bisexual transgender and questioning youth

Sexual Orientation & Adolescents: Growing Up Today Study (97-03)

N= 7750

N=5700

Corliss H, et al Arch Pediatr Adolesc Med. 2008;162(11):1071-1078.


Sexual orientation mn hs student sample
Sexual Orientation: MN HS Student Sample (97-03

Ramefedi GJ. Pediatrics 1992;89:714-721.


Case sophia2
Case: Sophia (97-03

  • Sophia self-disclosed her sexual orientation.

    • If she had not, would you approach this topic with your patient?


Discuss sexuality in clinical encounters
Discuss Sexuality in Clinical Encounters (97-03

  • Most GLBTQ youth are “invisible” and often will not raise issue until asked

  • Asking normalizes notion that there is a range of sexual orientations and gender identities


Gay lesbian bisexual transgender and questioning youth
What percent of pediatricians believed they should assume all patients are heterosexual unless told otherwise?

  • 11%

  • 22%

  • 33%

  • 55%


What percent of physicians include sexual orientation in sexual histories for patients at any age
What percent of physicians include sexual orientation in sexual histories for patients at any age?

  • 12%

  • 22%

  • 32%

  • 52%


What percent of physicians could identify three major local resources for glbtq youth
What percent of physicians could identify three major local resources for GLBTQ youth?

  • 7%

  • 17%

  • 37%

  • 57%


Asking about sexual orientation
Asking About Sexual Orientation resources for GLBTQ youth?

  • How can you respectfully ask about sexual orientation?

  • Are you sexually attracted to guys, girls, or both?

  • When you think of yourself in a relationship is it with a guy, a girl, or both?


Case sophia3
Case: Sophia resources for GLBTQ youth?

  • How do you respond to Sophia’s disclosure?



Case sophia4
Case: Sophia resources for GLBTQ youth?

  • Sophia discloses that her parents are aware of her sexual orientation and are accepting.

  • She currently does not have a girlfriend.

  • What other questions should you ask?


Gay lesbian bisexual transgender and questioning youth

Sexual resources for GLBTQ youth?

Orientation

Sexual

Attraction

Sexual

Behavior

Paradigm of

Sexuality

Biological

Sex

Gender

Identity/

Expression

Does Sexual Orientation Always Match Sexual Behavior?


Case sophia5
Case: Sophia resources for GLBTQ youth?

While respecting Sophia’s identification, you should inquire about sexual behaviors with males.


Case sophia6
Case: Sophia resources for GLBTQ youth?

  • Sophia discloses that she is currently having sex with a “friend.”

  • She says meeting guys is easier since there aren’t many girls who are out in her school.

  • Discuss contraception and condom use.


Contraceptive use
Contraceptive Use resources for GLBTQ youth?

  • Young women who identified themselves as “unsure” of their sexual orientation are:

    • Almost twice as likely to report no contraceptive use at last sex


Pregnancy risk
Pregnancy Risk resources for GLBTQ youth?


Contraceptive counseling
Contraceptive Counseling resources for GLBTQ youth?

  • Discuss hormonal methods of contraception

  • Introduce EC and offer an advanced prescription with refills


Sti risk and women who have sex with women
STI Risk and Women who Have Sex with Women resources for GLBTQ youth?


Sti prevention counseling
STI Prevention Counseling resources for GLBTQ youth?

  • Sex toys

    • Do not share insertive sex toys without a condom

    • Wash sex toys after each use

  • Dental dam use with oral sex

  • Condom use when having sex with a male


Sophia case wrap up
Sophia: Case Wrap Up resources for GLBTQ youth?


Case lola
Case: Lola resources for GLBTQ youth?

  • Lola is a 17-year-old female who comes to your office for a routine appointment.

  • During the HEEADSS assessment, you discover that Lola is living with friends.


Case lola1
Case: Lola resources for GLBTQ youth?

  • She is not doing very well in school and describes her mood as “down” on most days.

  • When you ask if there is something bothering her, she says she has recently come out to herself and to her parents.


Possible outcomes of coming out
Possible Outcomes of “Coming Out” resources for GLBTQ youth?

  • Family discord and rejection

  • Religious condemnation

  • School and peer problems

  • Physical violence

  • Social stigma

  • Isolation

  • Homelessness


Glbtq youth and mental health difficulties
GLBTQ Youth and Mental Health Difficulties resources for GLBTQ youth?



Case lola2
Case: Lola resources for GLBTQ youth?

  • As a coping mechanism, Lola has started to drink with increasing frequency.

  • Do GLBTQ youth face disproportionate risk of substance abuse?


Glbtq youth and substance abuse
GLBTQ Youth and Substance Abuse resources for GLBTQ youth?


Responding to lola
Responding to Lola resources for GLBTQ youth?


Case lola3
Case: Lola resources for GLBTQ youth?

  • During your sexual history, you discover that Lola has been in a monogamous relationship with another female for 2 months.

  • She has never had sex with a male.

  • Do you perform a Pap smear?


Indications for vaginal exam
Indications for Vaginal Exam resources for GLBTQ youth?

  • No. Lola is asymptomatic and has never had sex with a male

    • Recommendations: Pap smear warranted 3 yrs after sexual debut or at 21 yrs old

  • Do you perform a pelvic exam?

    • Depends – ask patient about past risk behaviors and know population prevalence of STIs


Cdc 2006 sti screening recommendations for wsw
CDC 2006 STI Screening Recommendations for WSW resources for GLBTQ youth?

  • Trichomonas

  • Bacterial Vaginosis

  • HSV


Trichomonas diagnosis
Trichomonas resources for GLBTQ youth? Diagnosis

Available Test: Affirm™ VP III

Available test: OSOM Rapid Test


Bacterial vaginosis diagnosis
Bacterial resources for GLBTQ youth?Vaginosis Diagnosis

Amsel’s Criteria

Requires the presence of at least 3 of the following 4 criteria:


Hsv diagnosis
HSV Diagnosis resources for GLBTQ youth?

Culture requires a new lesion and high viral load

Most HSV-1 is not sexually transmitted

Sensitivity decreases as lesion heals


Lola and sti risk
Lola and STI Risk resources for GLBTQ youth?

  • If Lola had reported past sexual history with a man or had shared sex toys with a female, tests to consider:

    • Chlamydia

    • Gonorrhea


Chlamydia diagnosis
Chlamydia Diagnosis resources for GLBTQ youth?

Preferred


Gonorrhea diagnosis
Gonorrhea Diagnosis resources for GLBTQ youth?

90% sensitive in symptomatic male; only 50% sensitive in females and in asymptomatic males.

Preferred


Case lola4
Case: Lola resources for GLBTQ youth?

  • After ordering the tests, how do you close the visit with Lola?

  • Advise her of the community resources that exist to help GLBTQ youth.

  • Make a follow-up appointment.


Case david
Case: David resources for GLBTQ youth?

  • David is 17 years old. He does not identify as gay but he has sex with males (MSM). He presents for care but has not been in the office for a year.

  • He wants to be tested to ensure that he does not have any STIs.

    • What tests would you run?


Cdc 2006 guidelines for msm

HIV resources for GLBTQ youth?

Syphilis

Test for:

Urethral test with N. gonorrhoeae and C. trachomatis

Rectal infection with N. gonorrhoeae and C. trachomatis

Pharyngeal infection with N. gonorrhoeae

CDC 2006 Guidelines for MSM:


Hiv testing technology
HIV Testing Technology resources for GLBTQ youth?


Syphilis diagnosis
Syphilis Diagnosis resources for GLBTQ youth?


Rectal pharyngeal chlamydia and gonorrhea
Rectal/Pharyngeal Chlamydia and Gonorrhea resources for GLBTQ youth?


Emerging areas msm

HPV vaccine resources for GLBTQ youth?

Anal cytology

Anal/oral/pharyngeal HPV

HSV Screening

Emerging Areas: MSM


Case david1
Case: David resources for GLBTQ youth?

  • After discussing the tests that you will run, you ask David about condom use.

  • He reports that he uses condoms most of the time.


Msms and condom use
MSMs and Condom Use resources for GLBTQ youth?

  • Among young men who have sex with men (YMSM)

    • 27-48% have engaged in unprotected anal sex <6 months before


Counseling about condom use
Counseling About Condom Use resources for GLBTQ youth?

  • Withhold judgment

  • Respect concerns

    • Listen to concerns of discomfort or sizing issues

    • Offer a wide range of condoms including larger sizes and different colors


David case synopsis
David: Case Synopsis resources for GLBTQ youth?

  • Follow 2006 CDC Screening Guidelines when considering tests for STIs and MSM

  • Counsel regarding condom use


Review of objectives
Review of Objectives resources for GLBTQ youth?

  • Can you:

    • Identify 3 risk factors faced by GLBTQ youth

    • Discuss the ways that homophobia contributes to GLBTQ health outcomes

    • List 3 elements of GLBTQ competent healthcare delivery

    • Describe resources for GLBTQ youth


Please complete evaluations now
Please Complete Evaluations Now resources for GLBTQ youth?


Provider resources
Provider Resources resources for GLBTQ youth?

Resources:

  • www.prch.org- Physicians for Reproductive Choice and Health

  • www.aap.org - The American Academy of Pediatrics

  • www.acog.org - The American College of Obstetricians and Gynecologists

  • www.adolescenthealth.org- The Society for Adolescent Medicine

  • http://www.aclu.org/reproductiverights/- The Reproductive Freedom Project of the American Civil Liberties Union

  • www.advocatesforyouth.org – Advocates for Youth

  • www.guttmacher.org – Guttmacher Institute

  • www.cahl.org/ - Center for Adolescent Health and the Law

  • www.gynob.emory.edu - The Jane Fonda Center of Emory University

  • www.siecus.org - The Sexuality Information and Education Council of the United States

  • www.arhp.org - The Association of Reproductive Health Professionals


Provider resources1
Provider Resources resources for GLBTQ youth?

  • The Gay and Lesbian Medical Association: www.glma.org

  • Mazzoni Health Center: http://www.mazzonicenter.org/

  • Callen-Lorde Health Center: http://www.callen-lorde.org/

  • Callen-Lorde Transgender Protocol Request Form: http://www.callenlorde.org/documents/TG_Protocol_Request_Form2.pdf

  • Teenwire.com: http://www.teenwire.com

  • Sex, Etc: http://www.sexetc.org/

  • QueerAmerica Database: http://www.queeramerica.com/