Health Issues for Gay Teens
A small percentage of the teenage population is homosexual. Aside from the normal stresses of adolescence, gay teens also have distinct health and psychosocial needs. Not all parents suspect or know that their son or daughter is gay, but those who do have a special responsibility for providing support and care. Parents, teachers, and doctors are all links in the chain that can provide support and encouragement for gay teenagers.
A gay 15-year-old was hospitalized for an appendectomy . The young man kept his sexual orientation a secret from almost everybody, although he did have a few gay friends.
When a young intern on a post-op chore came around, the teen complained of pain in his anal canal. But the intern's bedside manner was less than warm. "What is this?" said the intern, shocked at his findings. "You have herpes. How could this happen? You're not homosexual, are you?"
The teenager, thinking fast, said he did have male-male sex just once because an older man had forced him. The by-now thoroughly uptight intern muttered a cryptic "uh-huh" and scribbled some notes in the chart. In the doorway, the intern passed three openly gay teens arriving to visit their friend.
The next day, the teenager's mother visited. When the doctor thoughtlessly and bluntly blurted out that her son is gay, the mother dissolved in tears. Then the young man had yet another major woe on his hands.
Medical Care That Is "User-Friendly"
If medical care is not user-friendly, gay teens just may do without.
"One of the biggest concerns about healthcare in the minds of gay or lesbian teens is how they are going to be treated," says Bret Rudy, MD, assistant professor of pediatrics at the University of Pennsylvania School of Medicine and director of the adolescent HIV program there.
"Gay teens want to know they are in a friendly environment," Dr. Rudy says. "Often, a doctor just assumes a gay teen has a heterosexual orientation."
While many gay or lesbian teens struggle with their sexual identities, they still have the same healthcare concerns as other teenagers. For gay young men, the risk of getting HIV is far higher than that for most other teens. The risk adds significantly to the health "worry" burden that teenagers normally face.
Lack of empathy or harsh bedside manner potentially turns teens off not just to the doctor, but away from healthcare altogether.
"Gay and lesbian teens want to sense their doctor is concerned with them regardless of their sexual orientation," Dr. Rudy says. Gay teens need to feel relaxed because sexual information must be very specific so the doctor can learn if the teenager is at risk. Moreover, the physician must also be very specific in telling a young man or woman about the skills needed to protect one's self.
"Healthcare providers should have some understanding of sexual behavior to approach gay and lesbian teens and treat them appropriately," Dr. Rudy says.
For example, young lesbian women may deny need for birth control despite occasional sexual encounters with men. Sexual identities remain fluid during adolescence, and only frank discussion between a teen and her doctor can identify important concerns and risks.
"A physician needs to take a very sensitive and complete medical and sexual history to be able to treat those kids appropriately," Dr. Rudy says.
Often, gay-and-lesbian friendly posters and brochures in a waiting room can be enough to put a teen at ease. Because many youths are still questioning and exploring their sexual identities, they may be ill at ease with the terms "lesbian" and "gay." However, still other teens are farther along in their quest for sexual identity and may be comfortable using those terms to describe themselves. Most doctors avoid labeling and simply ask, "If you have (or fantasize about) sex, is it with men, women, or both?"
Increased Physical and Emotional Health Risks
Sexually transmitted infections are an important risk for all teens, gay or straight. Gay teens are particularly at risk for HIV because this infection is still common among older gay men. Condoms can prevent transmission of HIV, but inexperienced teens may not know how to ensure that they are used. When a teen gets HIV, symptoms may not appear for many years. Counseling and testing can protect teens and help them to get proper treatment.
"Healthcare concerns for gay and lesbian teens are very hard to separate from psychosocial concerns," says Dr. Rudy. "Usually, teens go through stages where they just feel different from other kids. Then they go through stages of confusion about their emotional and physical attractions to people of the same sex where they're not at all sure what their actual orientation is."
All of this confusion can lead to emotional distress, anxiety, depression , and even suicide. One-third of gay and lesbian teens have attempted suicide at least once, while a third of that number have attempted suicide three or more times, according to Donna Futterman, MD, associate professor of pediatrics at Albert Einstein College of Medicine in New York City.
Gay teens are also very concerned about bashing and emotional abuse at home and school in the years after "coming out."
"Not all gay teens want to disclose their sexual orientation to a doctor on the first visit," says Dr. Futterman, "but a physician should let it be known he or she is very comfortable with the topic and ready to discuss it when the teen is." According to Dr. Futterman, "It's important to get kids talking frankly about their lives, because, from where I sit, the number one health issue facing gay and lesbian teens is the risk of HIV infection."
Importance of Support and Resources
"One of the best ways to help gay teens is to support them," Dr. Rudy says. "Have resources so they can talk about sexuality and offer an environment where physical or psychological abuse based on any kind of differences, whether it be gender, religious, or sexual, is not tolerated."
As the parent of a gay teen, you can help most by remaining open-minded and supportive. Love and warmth from supportive parents can work wonders as children face the challenge of growing up gay or lesbian in a straight world. Work with your son or daughter to find groups and associations where they can interact positively with people who understand their orientation.
According to Dr. Futterman, "One of the more important connections for gay and lesbian teens are gay-straight alliances. Gay kids need to know that not only other gay people care for them. They also need to know that straight people care for them and want to see them healthy."
Gay, Lesbian, and Straight Education Network
Gay Teens Resources
Teen Health Website
Alan R. Acquired immunodeficiency syndrome and human immunodeficiency virus. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Updated December 2007. Accessed July 7, 2008.
BL Frankowski and the Committee on Adolescence. Sexual orientation and adolescents. Pediatrics 2004; 113:1827-1832.
Knowing the facts on sexual infections. Gay Teens.org website. Available at: http://www.gayteens.org/714/Sections-article24-p1.html. Accessed July 8, 200.
Last reviewed June 2008 by Kari Kassir, MD
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