With gay teens, doctors remain phobic

By Judah Issa

They're prickly, they're shy and they're defensive. In short, teens make frustrating patients.

The problems they have are also particularly tough for docs to deal with, not least sexual orientation. Few doctors discuss this thorny issue with their teenage patients, according to a recent study on gay, lesbian and bisexual (GLB) youth in the Archives of Pediatric and Adolescent Medicine — and this can spell bad news for their health. "Some teens are ashamed or embarrassed and are waiting for the physician to break the ice," says Dr Garth Meckler, an emergency pediatrician and lead author of the study. "Just make it clear you're willing to listen."

Research has shown that most teens experience social isolation, peer rejection, depression and thoughts of suicide at one point or another. Disturbingly, GLB teens account for two-thirds of teen suicides, the second leading cause of death in this age group. They also have the same STI and contraceptive issues as other teens. So why aren't physicians talking?

IGNORANCE AIN'T BLISS
Coming out to a physician is a major step for GLB teens, and getting there requires a lot of effort and patience on the physician's part. Dr Meckler's study revealed that the strongest predictor of disclosure for GLB teens is a discussion of sex or sexual health of any kind with a doctor. Just telling them about some of the health risks of the sexually active person is a good start.

"Sexual orientation should be part of the normal questionnaire — 'Do you have intercourse with men, women or both?'" adds Dr Marc Steben, a GP at the Quebec Public Health Institute who specializes in STI. "However, the physician has to make it clear that this is a normal question, asked naturally and that it doesn't have any value judgements attached to it."

HIGH SCHOOL CONFIDENTIAL
As with any relationship, trust between a GLB teen and their healthcare provider is of paramount importance. Many teens will be afraid to talk. "It's a question of confidentiality," says Dr Steben. "They feel it will end up on their chart and someone will learn about it, and they fear rejection."

A recent poll of GLB students revealed 90% have been harassed or assaulted. Their social problems leave them at high risk of developing chemical dependency, STIs, depression and eating disorders.

Sue Johanson, an RN and host of TV sexology phone-in show Talk Sex with Sue Johanson recommends a low-key approach. "Ask them questions like 'how are things going at school? Do you have friends at school?' You're looking for clues for violence or harassment, so take the extra time to talk," she adds.

There are also important health risks to look for. Some STIs, such as gonorrhea and chlamydia, are more common in gay men, according to Dr Steben. It's vital for physicians to discuss orientation very early with teens, in order to be able to take preventative measures, he adds.

GREY AREAS
'But how early?' you might be wondering.

"I start to broach the subject at first signs of puberty," says Dr Meckler. "I tackle it indirectly, 'Are your friends starting to date? Do they have boyfriends or girlfriends?'" You should start to normalize sexuality discussions before kids get sexually active, he recommends.

"Ask about their sex education at school," Ms Johanson advises. "Say 'do they cover all the controversial issues like masturbation or homosexuality?' This will open the door for this kind of discussion and let them know that you're willing to talk about it."

Research indicates that teens are becoming sexually active as early as 13-years-old and some already identify themselves as GLB at that age. "Maintaining an open-minded, judgement-free approach is key," says Dr Steben. Dr Meckler agrees. "When beginning to talk to youth, don't assume the gender of the partner. Always include both genders and be cognizant of heterosexist language."

PARENTS NOT ALLOWED
Beginning one-on-one visits with young teenagers is highly recommended. Without their parents around, a GLB teen may feel more inclined to talk. "We believe in the notion of emancipated adolescence," Dr Steben says. "For some teens, it's impossible to broach the issue with their parents. They may have heard their parents say something against gays or they're afraid of their parents," he adds.

Dr Meckler goes even further, revealing that some teens get kicked out of the house and even risk family violence when they come out. The doctor-patient confidentiality rule applies even to young teens. If they're not a danger to themselves or others, doctors are not obliged to disclose the information to the parents, adds Dr Steben.

The process will likely be new to some doctors and uncomfortable to a few, but practice makes perfect. The Gay and Lesbian Medical Association offers guidelines on how to create a welcoming clinical environment for GLB patients as well as suggestions on how to formulate your questions (www.glma.org). "Doctors are human beings and some have their own prejudices," says Dr Meckler. "But practice this sort of conversation with all patients, make it routine and it will get easier," he promises.