Caring for LGBTQ+ Patients

Disclaimer: This article contains mentions of sensitive medical topics that may affect the LGBTQ+ community, including mental illness, substance abuse, eating disorders, body dysphoria, and suicide. If you or anyone you know is in need of crisis intervention, please call the Suicide & Crisis Lifeline number at 988.

Written by Savannah Munholland

Understanding LGBTQ+ Healthcare

Every person deserves fair and comprehensive healthcare, but different communities have different healthcare needs. For example, members of the LGBTQ+ community will have unique challenges and needs that healthcare professionals should be aware of when treating LGBTQ+ patients. Regarding LGBTQ healthcare, it's crucial that nurses and other healthcare professionals create a safe space for the patient and doctor to discuss their health and needs. For nurses and other healthcare professionals to offer the best quality of care, they must first strive to understand those differences and challenges that the LGBTQ+ community may face when seeking healthcare and create a safe space of respect and duty of care.

Healthcare Accessibility for LGBTQ+ Individuals

The first major problem facing the LGBTQ+ community is access to healthcare. More than one in eight members of the LGBTQ+ community live in states where doctors and healthcare professionals are allowed to deny them healthcare because of their sexual orientation. In a recent KFF study, about 36% of LGBTQ+ Americans reported having negative experiences with accessing healthcare, compared to 22% of non-LGBTQ+ Americans. Some of these negative experiences include doctor's not believing the patients, suggesting the patient was to blame for the healthcare issue, dismissing the concern, or making assumptions that weren't true.

Over a third of America's LGBTQ+ population has had negative experiences accessing healthcare. With statistics like these, many LGBTQ+ individuals may hesitate to seek healthcare for fear of discrimination. When going to the doctor, an LGBTQ+ person doesn't know if they'll be denied care or have assumptions made about them. This fear makes going to the doctor an anxiety-riddled task. That's why quality and respectful nursing healthcare for LGBTQ+ patients is so important. Respectful and empathetic healthcare professionals can ensure LGBTQ+ individuals aren't afraid to seek care when needed.

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LGBTQ+ Issues in Healthcare

Many healthcare issues impact the LGBTQ+ community disproportionately to the rest of the population. Some LGBTQ healthcare issues include mental health issues, such as:

  • Depression
  • Anxiety
  • Suicide
  • Substance abuse.

These mental health issues are typically caused by social pressures, bullying, and fear of acceptance. LGBTQ+ individuals also have specific reproductive health needs that can involve safe-sex practices, fertility, and paths to parenthood.

Some of these issues stem from mistrust of the healthcare system due to past and current discrimination. By striving to understand LGBTQ+ issues in healthcare, nurses and other medical professionals can start to rebuild that trust. But first, medical professionals need to understand the challenges facing members of the LGBTQ+ community. The following list is not exhaustive but is based on common issues found in existing research. Not every person is the same, so it's important to approach every individual with empathy and respect to understand their needs, healthcare issues, and situation.

Healthcare for Lesbians and Bisexual Women

Lesbian and bisexual women have unique reproductive health needs that nurses and doctors, especially gynecologists, should know. For example, many misconceptions exist that women cannot get STIs from other women. However, this isn't true, but the misconception can lead lesbian and bisexual women to neglect safe sex practices. Doctors should be aware of this misconception and be able to educate women on safe sex practices in same-sex relationships with two women. This can include practices such as:

  • Using protection like dental dams
  • Washing their hands
  • Thoroughly clean any toys used every time

Lesbian and bisexual women are also less likely to go to routine exams and screenings. This means they are at an increased risk of breast and reproductive diseases and cancers. To combat this, lesbian and bisexual women need to be able to go to the doctors without fear of discrimination. Healthcare providers can help by not making assumptions and treating each patient respectfully.

Healthcare for Gay and Bisexual Men

Gay and bisexual men having intercourse with other men should be aware of the risk of STDs and the importance of using protection. Many gay and bisexual men mistrust the medical system, especially regarding reproductive health. This is due to the AIDS crisis when gay and bisexual men were unfairly blamed for the spread of AIDs, though it is just as easily spread through intercourse between a man and woman.

Studies also show that gay and bisexual men are more likely to suffer from an eating disorder than heterosexual men. Men who are part of the LGBTQ+ community are more likely to partake in unhealthy dieting and purging. These unhealthy habits are typically caused by the feeling that their body shape is not what others will find attractive. Gay and bisexual men are already at an increased risk for mental health issues, such as anxiety and depression, and these feelings can extrapolate to body image issues.

Medical professionals should be aware of these risks and nuances to provide helpful and professional care. For example, professionals should know how to advise on safe sex between gay men and STI screening practices. But they should also be aware of the higher risk for disordered eating, so they can intervene if necessary.

Healthcare for Transgender Individuals

All members of the LGBTQ+ community are at a greater risk of experiencing mental health issues such as anxiety and depression. But within the community, transgender and non-binary individuals are at a particularly high-risk for mental health issues due to emotional abuse, bullying, gender dysphoria, and more. There are many nuances to transgender healthcare, such as hormone replacement therapy and gender-affirming surgeries. These treatments help transgender individuals' bodies match their gender identity, but they do have risks. For example, hormone treatment therapy can:

  • Increase the chances of blood clots and high blood pressure
  • Lead to infertility
  • Reduce sperm production

In addition, not all transgender individuals fully understand their unique healthcare needs and risks, so healthcare professionals must be able to explain them in an informative and respectful way.

It's vital to understand the importance of gender-affirming healthcare for transgender individuals. Still, medical professionals should also know that not every healthcare issue a transgender person experiences is caused by their gender identity. Too often, medical professionals over-emphasize transgender or non-binary patients' gender identity when treating unrelated health issues. This is referred to as the transgender broken arm syndrome. For example, if a transgender patient is coming in for treatment of a common cold or broken arm, focusing on their gender identity is unnecessary, unprofessional, and leads to a negative experience for the patient.

Caring for LGBTQ+ Patients: Creating an Inclusive Environment

To create positive medical experiences for members of the LGBTQ+ community, nurses, doctors, and other healthcare professionals should ensure everyone feels welcome as they walk through the door and throughout their visit. Many members of the LGBTQ+ community mistrust doctors, so it's crucial to create a respectful and welcoming experience when caring for LGBTQ patients.

There are some everyday things healthcare professionals can introduce into their practice and routine to ensure every patient is treated kindly. For example, nurses and doctors should stay up-to-date on the common terms and problems facing the LGBTQ+ community. Correct and respectful language is always developing as society learns more and becomes welcoming. This language will help ensure doctors and nurses are treating every patient with respect. And staying updated on common issues in the community allows healthcare professionals to empathize with their patients and provide accurate care.

By creating a safe space, using inclusive language, and avoiding stereotypes and assumptions, doctors and nurses can help create positive healthcare experiences for LGBTQ+ individuals.

Visual Indicators of a Safe Space

A patient who is a member of the LGBTQ+ community has likely had a negative experience while seeking healthcare. Past bad experiences can make them on edge and less likely to speak openly and honestly about their healthcare needs. To provide the best and most accurate care, healthcare professionals need their patients to be comfortable talking to them.

The best way to set members of the LGBTQ+ community at ease is to set cues that they are welcome as soon as they walk in the door of the clinic or practice. Something as simple as placing a rainbow pride flag and a transgender pride flag in a pencil holder can indicate that they will be treated with respect and not discriminated against because of their gender identity or sexual orientation.

To take it a step further, it may be a thoughtful idea to place pronouns on name tags. This can show that providing pronouns is a normal practice in the clinic and will show any transgender or non-binary patient that the staff accepts and understand their gender identities. Many retailers sell pride decor, such as wall hangings, stickers, flags, etc., that can indicate that the practice is an ally to the community and welcoming of LGBTQ+ patients.

Using Inclusive and Gender-Neutral Language

Using inclusive and gender-neutral language will help keep LGBTQ+ patients at ease throughout the visit. It's an accommodating approach to start by asking patients what their preferred names and pronouns are since their medical history might not reflect their identity. And transgender and non-binary people may be more willing to tell their doctors and nurses their preferred name and personal pronouns if asked instead of having to volunteer the information. Asking indicates a dedication to creating an inclusive environment and that they are in a safe space.

It's also important to recognize that sex is not the same as gender. So, for example, a woman is not always a person who is born with female reproductive organs. In addition, some women may not have a uterus, and some men might. Therefore, it's crucial to avoid language like "menstruating woman" or "pregnant woman." Taking away gendered language so that these phrases are "menstruating person" and "pregnant person" can be more inclusive of a wider range of patients.

This kind of language should be used in conversation with the patient and on intake forms and questionnaires. For example, ask for gender identity and sex assigned at birth and ensure there are options beyond man and woman. Healthcare professionals can also mirror their patient's language and describe them as they do.

Avoiding Assumptions

When treating any patient, healthcare professionals should not make assumptions about their identity, situation, or desires. They especially should not make assumptions about a person based on their appearance. This can be as simple as asking a person if they have a partner(s) instead of asking about a boyfriend or girlfriend.

Even if the patient's gender identity and sexual orientation are known, healthcare professionals shouldn't make assumptions about the care they might want. It's important to understand the unique healthcare challenges that different members of the community might face, but also to know that not every person is the same. For example, gender-affirming care will look different for every transgender person, and not every patient who can carry a child will want to.

When in doubt, don't make an assumption. Ask patients what kind of care they want and need. Healthcare providers want to strive to provide the best care possible, and that requires building a trusting relationship with a patient. Making assumptions can lead to a negative experience for the patient and damage the trust between the patient and the healthcare provider

Healthcare for LGBTQ+ Parents

Plenty of members of the LGBTQ+ community want to have a family. However, parenthood and reproductive healthcare can alienate LGBTQ+ individuals and couples. Too many healthcare providers make assumptions about how a couple may want to become parents.

When providing care to any prospective parent, especially members of the LGBTQ+ community, doctors and nurses should listen to the patient to understand their situation and desires. Healthcare providers can then explain the options available to them without bias and with respect for the patient.

If a couple wants to become parents, fear of speaking to a reproductive specialist or other healthcare providers should not be the obstacle that stops them. LGBTQ+ health, especially when it comes to parenthood, has unique nuances. Healthcare providers should remember that every individual and couple is different, so they should not make assumptions or pass judgment on a couple's path to parenthood.

Gay, Lesbian, and Bisexual Parents

There are many ways that gay, lesbian, and bisexual individuals can become parents. The options include fostering or adopting a child, using a sperm donor for artificial insemination, or using a surrogate. Women in same-sex relationships can purchase sperm from a donor. They can then either inject the sperm into the parent who is carrying, or they can use in-vitro fertilization (IVF), which is when an egg is extracted, and sperm is used to inseminate it in a laboratory. Then, a viable embryo is implanted in the cervix of the parent or surrogate who is carrying.

Men in same-sex relationships may choose to use a surrogate to carry their child. Surrogates can be friends or family members who agree, or they can be hired through a reproductive healthcare facility. One of the parents can provide sperm, which is then used to inseminate a donor's egg. Viable embryos are then inserted into the cervix of the surrogate. If this process results in pregnancy, the surrogate will carry the baby and give birth to the parent's child.

In addition to understanding the paths LGBTQ+ couples might take to parenthood, healthcare providers should also know how to treat LGBTQ+ couples. Both members of the couple are full parents of the child. It does not matter who carried the child or is genetically related. Always refer to both parents as parents and treat them as such.

Transgender Parents

Transgender reproductive health is not commonly discussed, and healthcare providers should know how to talk to transgender and non-binary individuals about paths to parenthood and how to treat transgender parents. For example, transgender men and non-binary individuals who were assigned female at birth can get pregnant from intercourse with an individual assigned male at birth, even if they are undergoing hormone treatment therapy. In addition, a common misconception is that taking testosterone prevents pregnancies, but that is not true due to studies conducted on the subject. However, according to Family Equality, there has been very little research into the effects of hormone treatment on fertility. Each individual should talk with their doctor about reproductive health.

Transgender individuals may also experience postpartum depression after giving birth, especially given the increased rate of mental illness in transgender and non-binary people. Healthcare providers should also recognize that transgender men and non-binary individuals who give birth may not feel comfortable or be able to chest feed.

It's important to use gender-neutral language and respect pronouns when providing care to transgender and non-binary individuals before and after they become parents. For example, use the term "chestfeeding" instead of "breastfeeding." Always refer to both parties as parents, and never call a pregnant transgender man the "mother" or a transgender woman "the father." Refer to patients in the same language they describe themselves with to ensure the practice is a safe space. And never assume to know how a transgender patient wants to become a parent. Instead, let each individual describe what they want and are open to, and tell them about their options from there.

Frequently Asked Questions

  • How nurses can help the Lgbtq+ community?

    Nurses can help the LGBTQ+ community by providing appropriate care, not making assumptions, and using respectful and gender-neutral language. Giving LGBTQ+ community members a positive medical experience will help restore trust in healthcare.

  • What are three ways to make Lgbtq+ peers feel safer?

    Avoiding assumptions, using appropriate and gender-neutral language, and creating an openly safe space by adding visual cues such as a pride flag will help LGBTQ+ individuals feel at ease.

  • What are some LGBTQ+ health disparities?

    LGBTQ+ individuals are at an increased risk of mental illnesses such as anxiety, depression, and eating disorders. There are also nuances to LGBTQ+ reproductive health, including paths to parenthood and avoiding STDs.

  • What causes LGBTQ+ health disparities?

    Some LGBTQ+ health disparities are caused by negative experiences with healthcare preventing LGBTQ+ individuals from seeking regular care. Creating a safe space and understanding LGBTQ+ healthcare needs can help.