A Guide to LGBTQ+ Sexual Health
By Dr. Justin
Most of us don’t learn everything we need to know about sexual health through sex education courses, but this is especially true for LGBTQ+ folks. In fact, a recent report found that, among LGBTQ+ students who had received school-based sex ed, just 8.2% said that it was LGBTQ+ inclusive.
In other words, less than 1 in 10 sexual and gender minorities said that they received sex ed that even spoke to them. Unfortunately, this means that most LGBTQ+ persons need to educate themselves; however, finding accurate and reliable educational sources can be challenging. So let’s discuss some of the key things you need to know when it comes to being LGBTQ+ and managing your sexual health.
Search for Providers Who are LGBTQ+ Affirming
When LGBTQ+ folks encounter bias and discrimination in the healthcare system, it can lead patients to avoid or delay seeking care when they need it and/or to have their sexual healthcare needs be inadequately addressed. For these reasons, it’s important to find knowledgeable healthcare providers who won’t shame or judge you for who you are.
Whether you’re looking for a doctor or therapist, here are some tips for finding an affirming provider:
- Ask LGBTQ+ friends for their recommendations. Some of them will have been through this process before and may be able to help you pinpoint who to see and who to avoid.
- If you’re not comfortable asking for recommendations or you don’t discover any helpful leads, search online databases that can help you to identify trusted providers. For example, if you’re looking for medical providers, the GLMA has a helpful search tool for finding LGBTQ-friendly specialists in your local area. Likewise, WPATH’s search tool can be valuable if you’re looking for transgender health specialists specifically.
- Need a sex therapist? Use the search tool on the AASECT website to find providers who are certified in sex therapy by an organization that values and respects sexual and gender diversity.
- Local clinics (such as Planned Parenthood), as well as local LGBTQ centers, may also have helpful resources available.
Unfortunately, you may not always be able to see your provider of choice due to insurance restrictions. However, if you wind up in a situation where you do not feel comfortable, look around and try other providers to identify the best possible fit.
Take Charge of Your Sexual Health
In an ideal world, doctors would routinely ask patients about their sexual health needs. Unfortunately, however, many doctors don’t do this, often because they’re worried about offending their patients. So if your provider doesn’t bring it up, initiate the conversation so that it doesn’t go unaddressed.
Come prepared with your questions and what it is that you want to discuss. Rehearse them ahead of time if it’s helpful. And if you see a nurse before your doctor, you might let them know so that the doctor will be sure to bring up the subject.
Keep in mind, too, that if you aren’t out to your provider, they can’t necessarily provide you with optimal care. It’s therefore important to be open and direct.
Talk About Safer Sex and Make STI Screenings Part of Your Routine Care
Many LGBTQ+ groups are disproportionately burdened by sexually transmitted infections (STIs), so it’s important to make safer sex and STIs part of the conversation.
There are a great many things your doctor can help you with when it comes to lowering your STI risk. These include:
- Getting vaccinated for the human papillomavirus (HPV), a virus spread via skin-to-skin contact that can potentially cause genital warts and a number of cancers, including cancers of the cervix, anus, and throat. Research has found this vaccine to be safe and effective, so if you haven’t had it yet, discuss with your provider whether it’s right for you.
- Getting vaccinated for hepatitis A (which can be spread through oral-anal contact) and B (which can be spread through vaginal and anal intercourse, as well as oral sex), both of which can damage the liver. Again, talk to your doctor about whether this vaccine is right for you.
- Getting a prescription for Pre-Exposure Prophylaxis (PrEP) for HIV prevention. PrEP is a daily medication that some studies have shown to be 99% effective at preventing transmission of HIV. HIV is a virus that is primarily spread through vaginal and anal intercourse, so depending on your sexual practices, it may be a very helpful tool for lowering your risk. However, keep in mind that PrEP only provides protection against HIV, so it’s not a substitute for condoms when it comes to protection against other infections.
- In addition to PrEP, some doctors may prescribe antibiotics to be taken after unprotected sex in order to reduce the risk of chlamydia and gonorrhea infection. Studies have shown that antibiotics taken with 24-72 hours of condomless sex can significantly reduce infection rates for certain bacterial STIs. This is not currently a widespread treatment approach but is increasingly used for those at high risk.
- Depending on your sexual health history and needs, your doctor may have other recommendations. For example, you may need to discuss contraceptive needs with your doctor, if applicable, given that the most effective contraceptives are currently available by prescription only (e.g. pills, patches, IUDs).
As you can see, safe sex isn’t just about condoms—there are many other preventative measures you can take to maintain your sexual health, and you can obtain the most possible protection by combining multiple methods.
Once you’ve taken care of the safer-sex side of things, figure out a routine for STI testing. Different frequencies may work better for different people, however. For example, if you’re sexually active with just one partner, once per year might be fine. Alternatively, if you have more than one partner and you’re not a consistent condom user, it might be every three months.
Discuss Sexual Problem Areas
Some research has found that rates of sexual difficulties are higher in certain LGBTQ+ groups. For example, emerging evidence suggests that gay men are more likely to experience erectile dysfunction compared to heterosexual men.
No matter the difficulty, many people find it uncomfortable to bring this up in the doctor’s office because they feel embarrassed or ashamed; however, if you don’t let your provider know, they can’t help. By opening the door to talking about things like STIs, though, can make it easier to discuss other aspects of sexual health, including sexual difficulties, whenever they emerge.
Your healthcare provider is best equipped to help you determine the cause of any sexual problems because they can have many potential roots. For example, difficulties can be tied to broader health issues (such as chronic illnesses and hormonal imbalances), stress and anxiety, as well as relationship conflict. Identifying the cause is crucial to identifying the most appropriate treatment.
Don’t Neglect Your Mental Health, Because Mental Health Can Impact Sexual Health
The LGBTQ+ community is disproportionately burdened by mental health issues, including depression and anxiety. Research suggests that this stems, at least in part, from frequent experiences with prejudice and discrimination.
This mental health impact can affect sexual health in many ways, such as by increasing the odds of certain sexual difficulties. For example, depression and anxiety can often make it more difficult to become and stay aroused. In addition, for some individuals, depression can lead to riskier sexual behavior as a coping mechanism.
At the same time, however, sexual health issues (such as STIs and sexual difficulties) can contribute to or create mental health problems. Taking care of your sexual health, then, involves taking care of both body and mind.
Takeaways
Few LGBTQ+ persons are taught what they need to know in order to optimize their sexual health. To be sexually healthy, it is essential to find providers who are affirming and equipped to manage your needs, to take charge of your sexual health during office visits and communicate openly, and to adopt sexual safety practices that are right for your sex life.
References:
Barbonetti, A., D’Andrea, S., Cavallo, F., Martorella, A., Francavilla, S., & Francavilla, F. (2019). Erectile dysfunction and premature ejaculation in homosexual and heterosexual men: a systematic review and meta-analysis of comparative studies. The journal of sexual medicine, 16(5), 624-632.
Bostwick, W. B., Boyd, C. J., Hughes, T. L., West, B. T., & McCabe, S. E. (2014). Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. American Journal of Orthopsychiatry, 84(1), 35.
Grant, R. M., Anderson, P. L., McMahan, V., Liu, A., Amico, K. R., Mehrotra, M., … & iPrEx Study Team. (2014). Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. The Lancet infectious diseases, 14(9), 820-829.
Lehmiller, J. J. (2017). The Psychology of Human Sexuality (2nd ed.). Oxford, UK: Wiley-Blackwell.
Markowitz, L. E., Hariri, S., Lin, C., Dunne, E. F., Steinau, M., McQuillan, G., & Unger, E. R. (2013). Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010. The Journal of infectious diseases, 208(3), 385-393.
Molina, J. M., Charreau, I., Chidiac, C., Pialoux, G., Cua, E., Delaugerre, C., … & Lorente, N. (2018). Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial. The Lancet Infectious Diseases, 18(3), 308-317.
