Didactics Family Medicine Boardman

LGBT Health – Pearls for Primary Care
https://thecurbsiders.com/curbsiders-podcast/155-lgbt-health

Validate patients for engaging in healthcare and try to create a welcoming environment by providing staff education on gender identity terms. Adding visual welcome signs such as rainbow stickers on badges or pins can signal your practice is welcoming to LGBT patients.

Obtain a sexual history: First ask permission before proceeding then follow the CDC’s “5 P’s” of sexual health.  Ask who are your partners, with what body parts are you sexually active, assess pregnancy risk, ask about past sexually transmitted infections, and finally assess protection used.

Practice using appropriate gender identity terminology by getting in the habit of asking patients “How would you like to be addressed?”.

Mental Health: screen for anxiety, depression, intimate partner violence, and other types of violence. Ask about prior suicide attempts because the prevalence of suicidality is higher in this population.

Approach to cancer screening: “Screen what you have”.  Try to screen in sensitive ways and use gender neutral language as much as possible.

Transgender health tips: To open the conversation for history taking try using phrases such as “What are you hoping for medically?” and “Tell me about who you are?” as starting points. 

Vaccines: Remember 4 additional vaccines – Hep A, Hep B, HPV and meningococcal. For MSM remember – Hepatitis, HPV up to age of 26, and meningococcal in high-risk groups. For WSW, don’t forget to offer the HPV vaccine!

There are higher rates of DVT in trans women who take estrogen therapy (Nota et al, Getahun, et al). Make sure to counsel patients on smoking cessation to decrease their risk of DVT for those initiating or currently on hormone therapy.