What Nurses Need to Know: How to Take a Sex Positive Health History with LGBTQ+ Patients

By: Christopher Payton Stuckey

All too often, a health care provider’s heterosexual bias (explicitly stated or communicated through tone and nonverbal body language) causes LGBTQ+ persons to feel shame during a sexual health history assessment.

Culture—including LGBTQ+ culture—is a social determinant of health.

A provider who is culturally insensitive—who is unaware or uncaring in their implicit heterosexual bias—causes shame and contributes to avoidable poor health outcomes. A patient may not feel safe asking important questions or requesting necessary health services. The provider can inadvertently contribute to the spread of sexually transmitted infection or a patient’s poor mental health, as LGBTQ+ persons have higher rates of depression, anxiety, and violence or victimization. That’s if the provider even sees the patient—29 percent of transgender persons have been refused health care.

Nursing has been ranked as the most trusted profession for nearly 20 years. Let’s build on that. Clinicians can discuss sexual health with patients from a sex-positive perspective—this means with the belief that all consensual sexual activities are natural, healthy, and should be pleasurable. This approach is empowering, strengthens the patient-provider relationship, and reduces patients’ anxiety about sex-related adverse outcomes.

So how do we do it?

The key is to be mindful of why each question is asked, consider what the patient’s action will be based on the provider’s answer, and openly discuss sex to get a complete picture of your patient’s sexual health practices.

Talk to your patient about the 5 P’s: Partners, Practices, Protection, Past history, & Prevention

 Ask about partners

How many partners has your patient had? What gender are your patient’s partner(s) and are they gender-conforming or gender non-binary? What about in the past?

Don’t forget to ask if your patient has experienced sexual trauma or violence—47 percent of transgender persons have at some point during their lifetime.

Ask about practices

Asking about sex practices improves risk assessment, helps patient and provider develop a better safety strategy, and helps the provider decide if they should test for STIs more frequently.

Has your patient had more than one partner in the last 12 months?

Have there been changes in sex practices? Such as if the patient stopped using condoms, if there is a significant increase in the number of partners, or if the patient has started using recreational drugs. Is sex being exchanged for drugs or safety?

Where is your patient having sex? Some cities and areas with a high probability of intercourse (i.e. bathhouses, hotels, parks, etc.) are “hot spots” for STI transmission.

How is your patient being protected from STIs?

Reinforce positive safe-sex practices and, if your patient is engaging in risky sexual behaviors, explore risk reduction techniques.

For example, you could suggest condom use or PrEP (Pre-exposure prophylaxis is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected).

Has your patient contracted an STI in the past?

Has your patient had an STI infection before? Patients who have contracted STIs in the past are at higher risk to contract one in the future.

How is your patient preventing HPV?

Human Papilloma Virus (HPV) awareness and prevention has historically targeted women, but it can cause rectal cancer as well as cervical cancer.

We must talk to men who have sex with men about protecting themselves because anal sex is a significant risk factor for certain strains of HPV. All sexually active patients, regardless of gender or sexual orientation, should be screened and vaccinated against the virus.

We can eliminate stigma in health care. We, as providers, must confront our own discomfort in talking to LGBTQ+ patients about sex so we can provide them with holistic, culturally sensitive care.

Our internal work and nonjudgmental care can encourage LGBTQ+ persons to use necessary health care services more often—and reduce disparities in sexual health and in overall care.

Follow @HopkinsNursing on Instagram! Chris will be posting from the June 30, 2019 New York PRIDE Parade, which marks 50 years since the Stonewall Uprising. 

Read more:

• Taking a Sex-Positive Health History
• Taking PRIDE in Our Communities
• We Need to Talk about Wound Care in Transgender Women Healing From a Vaginoplasty
• The Threeness: A Black, Gay Man in America

What Nurses Need to Know:

• What Nurses Need to Know: Midwifery and Woman-Centered Care
• What Nurses Need to Know: Hypertension Guideline
• What Nurses Need to Know: Tracheostomy Patients at Home

ABOUT THE AUTHOR: CHRISTOPHER STUCKEY

ABOUT THE AUTHOR: SYDNEE LOGAN

Christopher Stuckey is currently a student in the MSN (Entry into Nursing) program, a planning council member of the Greater Baltimore HIV Health Services Planning Council, an executive board member of both Men In Nursing and the HIV Nursing Action Group, and a collaborator on the LGBTQ+ Health Curriculum Initiative with Johns Hopkins University led by Athena D. Ford, PhD (c), BSN, RN. Christopher plans to advance his education by earning a DNP. His interests include HIV/STIs, men’s health, and sexual health, including diversity, equity, and inclusion for LGBTQ+ populations.