Institute of Medicine Says Your Medical Records Should Be As Gay As You Are

It’s possible that, when going to a new doctor or medical provider for the first time, you have had them awkwardly ask if you’re sexually active and if so, is it with girls or boys? If so, you probably answered meekly, and then some executive decisions were made regarding when you needed a PAP test next. It’s also very possible that you’ve never had this conversation with your doctor ever, even though it informs large parts of your physical and mental health. Now a new report from the Institute of Medicine says that not only should this be information that your doctor cares about, but it should stay in your health record permanently. They also recommend that federally funded studies track sexual identity and orientation – something that might actually work towards solving the endless repetition of “Unfortunately we don’t have enough research on [gay issue or problem] to take action.”

As it stands, there are very little data out there on the health needs of LGBT patients, the paper’s authors point out. There is even less information about adolescent and elderly LGBT people than there is for LGBT adults, and comparatively less for transgender and bisexual people than there is for gay and lesbian patients.

A hypothetical requirement to include your sexual orientation in your medical records would be scary for some people, which the study recognizes – “the study’s authors point out that this bit of information will probably be perceived as “more sensitive” than others.” But given the particular health challenges associated with being queer, it could be worth the risk.

These include that LGBT youth may have an elevated risk for attempted suicide and depression, and sexual minority youth may have higher rates of substance use than heterosexual youth; that one of the barriers to accessing quality health care for LGBT adults is a lack of providers who are knowledgeable about LGBT health needs as well as a fear of discrimination in health care settings; and that LGBT elders are more likely to rely on friends and others as caregivers rather than biological family members, at least in part because they are less likely to have children.

As an example, a study has recently found that older gay and lesbian adults in California are more likely to have physical and mental health problems than their straight counterparts, “based on data from the California Health Interview Survey, the nation’s largest state health survey, gathered in 2003, 2005 and 2007 by the Center for Health Policy Research at the University of California, Los Angeles.” Is this trend true nationwide? What about the finding that older lesbian and bisexual women are more likely to report physical disability? Because the California Health Interview Survey is unique in gathering data on sexual orientation and gender identity, it’s hard to know.

The researcher’s summary recognizes that this could help researchers make long-awaited progress towards important findings on gay people and “gender minorities” in America, and the Institute of Medicine concludes:

Lesbian, gay, bisexual, and transgender individuals have unique health experiences and needs, but as a nation, we do not know exactly what these experiences and needs are. To advance understanding of the health needs of all LGBT individuals, researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. Building a more solid evidence base for LGBT health concerns will not only benefit LGBT individuals, but also add to the repository of health information we have that pertains to all people.

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Originally from Boston, MA, Rachel now lives in the Midwest. Topics dear to her heart include bisexuality, The X-Files and tacos. Her favorite Ciara video is probably "Ride," but if you're only going to watch one, she recommends "Like A Boy." You can follow her on twitter and instagram.

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  1. i don’t even understand “sexually active” because apparently this phrase indicates a time period in which you are actively sexual but i don’t even-

    anyway this sounds fun and good, i hope this happens

    • yup…you are so right…I’m in med school, and a good doctor would never use that phrase. It’s just the safest, non-confrontational way to ask if you have ever had sex…Doctors these days…

    • I’ve always wondered if, after a certain amount of time, a person sexually deactivates.

  2. Just yesterday I was on the phone with Kaiser about a discharge problem. The appointment representative asked if STDs were a concern. I said, sure, that’s something to check out. She asked if I had had unprotected sex. I said, “Define sex.” PAUSE. “…What do you mean?”

    No, lady, what do YOU mean? PIV hetero sex? Shared toys? Oral-genital (receiving)? Oral-genital (performing)? Fingers? It’s all sex, it can all be done with or without barriers, and I’ve done some things and not others. Please tell me what you need to know about.

    And then at the actual appointment this A.M., the gyno asked what method of birth control I use. I said, “I’m gay, that keeps it pretty much under control.” He laughed awkwardly and said yes, it certainly does, but didn’t ask any follow-up questions about barriers or anything. Which, you know, surely might be relevant if I’m having some problems? Was the question really only meant to assess how I’m preventing pregnancy, or also how I’m protecting against diseases?

    Anyway this is all kind of a tangent, but I think my point is: yes, please, it would be great to have sexual identification on medical records for the purposes of gathering data, but it would also be really effing great if healthcare professionals were, I dunno, educated on the existence and habits of gay people. Maybe the one will help the other, I guess.

  3. Had to go to ER. Was too ERed to fill out papers so gf did.
    It actually went smoothly, but on the follow-up, the business office asked our relationship, then didn’t have a drop-down for “girlfriend”, and then a nurse asked if we were sisters.
    Really a let-down after the first time.

    If they want our information, they need to be prepared for our answers. To say nothing of actual health coverage…

    On a lighter note, let’s just assume everyone’s gay!

    • I totally wish people would just assume everybody is gay until told otherwise. Then maybe strangers on the bus wouldn’t bad mouth the gay couple a few seats ahead of us because the person he is speaking to is obviously one of teh gayz, because everybody is gay.

      • I also agree with this idea, and think it should be placed inside “Teh Gay Agenda”.

  4. As a health care provider I think that it is important to collect this information. However you have to rely on people telling the truth. Some people are so in the closet that they would never even tell their physician they were gay.

    • Yeah, really. My family’s GP asked my tween-aged stepsisters some questions about how they felt about boys and girls, etc. during a back-to-school checkup, and my parents were so enraged that they stormed out of the office and changed to a new practice. This was a doctor my family had been seeing for over 20 years.

  5. I was really lucky when we lived in Texas that I had a FABULOUS MD who knew I was gay, handled it with aplomb and answered all our questions and treated my partner and I as a normal couple and not as “one of those…*whisper, whisper* gay couples”. It was awesome.
    I hope I can find someone as awesome here in AZ!
    I, too, agree that our gayness should be a part of our records! Maybe then they wouldn’t bombard me with pregnancy tests if I’m a day late for my depo appointment! *sigh*

  6. OHH – because, you can’t EVER use bc as anything BUT as bc you know! I use it for period control – but I still get bombarded when I go in for my depo! *sigh again*

  7. Wait, your doctors actually *ask* you who you’re having sex with?

    I remember one time I called an on-call nurse because I was having severe nausea. She asked me if I was sexually active, then she asked me if I was using birth control. Before I could fit the “but” in after “no” to the second question, she snapped, “Well, one and one make two, don’t they?” She felt pretty dumb when I told her my partner was female…

  8. I tend to see a lot of doctors, and having this conversation over and over and over is really frustrating. This would be great to have in my record, just like the fact that I have asthma. Sheesh.

  9. I live in an extremely liberal city (don’t hate me), and got a new regular MD. When I told her I was gay, she was shocked. SHOCKED. All the blood drained from her face and she stared at me for the longest pause of all time.

  10. I have Kaiser and i recently went to get a PAP less than a month ago. I had a good glimpse of the screen as she was running through routine questions. this was the first time i wasn’t asked what method of birth control i used, but rather she asked “and you are currently sexually active with women, right?” it took me aback but i saw on her screen that the “women” box had been checked off from a previous PAP test. so that was nice.

    the only good PAP experience was my first. I had amazing doctor, she was young and so nice. She made the whole thing less terrible. When she asked what method of birth control, i don’t use any, she was surprised and asked why in concern if i was sexually active. i told her i was gay and she sighed in relief, but quickly came back with proper cleaning of toys, using condoms on dildos, and dental dams/gloves.

    The bad thing is, i don’t remember her name and I looked up every doctor in the directory at that facility and i’m pretty sure she moved somewhere else. :(

    • Whoah, that’s really awesome that you had a health professional who not only was cool about the whole gay thing, but also knew enough about girl on girl safer sex to recommend gloves and dams! That’s really impressive!

  11. When doctors ask me if I’m sexually active, I always say no because I assume they are asking me if I’m banging dudes, which I most certainly am not.

    My primary doctor also asked me whether I was “interested in men, women or both” at our first appointment where she got my medical history. She promptly forgot because still asks me if I might be pregnant. At one appointment I brought my mom and she asked if I might be pregnant and then asked me if I was sure, and my mom laughed and said to the doctor, “You better check her chart.”

    Also, because I don’t sleep with men I don’t think I need to go to the gyno, which probably isn’t true.

    Being a gay a lady is treacherous water at the doctors. (I have no idea if anything I said is directly related to this article, but I think gay lady doctor experiences are interesting._

  12. On this topic, I went to my gyno and accidentally saw the screen with all my information on it. It had “sexual orientation” and said “Heterosexual.” I have never been asked what my sexual orientation was. I’m really annoyed that they assume you’re straight if you haven’t said anything.

  13. I’ve had the hardest time finding a “gay-friendly” ObGyn in Arizona. I really wish that more doctors were not only sensitive of the issue, but also informed.

    My internal med specialist had the “sexual orientation” question on her medical form, which I appreciated, but she was so judgmental about my caffeine, alcohol, nicotine, and diet habits, I’d hardly feel comfortable talking to her about my sexual habits.

    The most open-minded (and awkwardly enthusiastic) staff I’ve encountered was at Planned Parenthood, but they informed me that their branch got their funding based mostly on the “family planning” aspect, so it was a good thing I’d experimented with a boy or two as a teenager because that’s what they’d be playing up for their statistics. Obviously, and unfortunately, there’s a whole lot more to worry about regarding their funding now.

  14. Two stories:
    1. I was filling out an internet survey and they were asking about birth control. It was the most complete list of possible forms of birth control I’ve ever seen, including every form of hormone, physical barrier, and even the “rhythm method.” And yet, Teh Gay was not on the list. I had to choose “Other.” Which was lame.
    2. Someone I knew in college went to health services to get the morning after pill, and they said they had to test to see if she was already pregnant (b/c you can’t take the pill if it’s more than a couple days in to a pregnancy). She said there was no chance of that. They wanted to insist. She finally said to the (totally gay herself) nurse that she had not had sex with a biomale for years until the night before. The nurse said “well what the hell were you doing last night then?” Which she found pretty funny.

  15. OMG this happens to me all the time, i have kidney problems so have A LOT of infections, i also happen to be on the pill coz of iregular periods but EVERY TIME i go to the doctors they “inform me” that the pill wont work when im on anti biotics, *no shit, as if i dont know that by now* i tell them i dont take it for contracetive perpouses, but they just dont get it, maybe i should employ someone to hold a neon sign over my head that says lesbian, im sure it would cut my appointment times in half.

    Recantly one doc was very persistant about it and i snappped coz i was sitting there feeling like crap and listing to the same spiel for the 100th time so i told her “i have never had a penis inside me and never will, i am on the pill for iregular periods now can i please leave and go and get my prescription?”

    there was a pause then she said, “oh” … “ok”… “you can go then”

    you know how theres a pop up box that appears on their screen to check if you still smoke? i wish there was one to remind them that not everyone is straight, they shouldnt assume anything, they should ask

  16. I have been with the same doctor for years now, but still, when I try talking with her about certain female problems, she says “since your not interacting with a male- you’ll be fine!” very aggravating!!

  17. Well, I went for the first time to an ObGyn a few weeks ago after 10 mins of her rambling about safety and birth control (while I was brain-humming)she finally asks
    -have you had sex?
    – yes
    – did you used birth control?
    – no… I’m a lesbian, it was with a female partner
    – Are you sure?
    – That I’m a lesbian or that she was female?
    she starts laughing so hard

    I swear I wasn’t trying to be funny, is just that her question was really dumb…

    As for the topic I wish all the world would do that…

  18. I haven’t had to deal with this issue yet, but then again I’m trans so there is a completely different set of concerns and challenges related to that. This sounds like a good idea, but like any other kind of idea, it can very easily be abused.

  19. My healthcare provider asked if I was sexually active, then “With men, women, or both?” When I said women, she raised an eyebrow and marked it down and proceeded to give me a full mental health and DV screening. I checked later, and it’s not SOP. I won’t be seeing her again.

    I see the point of having this in the record, but if it’s going to mean that my doctor acts less professionally, leave it out.

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