To help LGBTQIA+ individuals feel more welcome, I introduce myself with the pronouns I use. This seems to invite them to do the same.
For each new patient, I start with the same introduction: “Hi, my name is Dr. Fenton. I use she/her pronouns. What name do you like to go by and what pronouns do you use?” If someone accompanied them to the visit, I add, “Who’s here with you today?”
As our society (belatedly) recognizes and acknowledges an increasing diversity of gender identities, we must unlearn the biased assumptions about gender that pervade our culture. The above introduction helps me to make sure that I’m keeping the patient at the center of their care. Yet, their care experiences start long before we meet each other. The scheduling process, the art hanging in the waiting room, the check-in experience, and many other factors, help patients determine if they feel safe or affirmed in a space. These aspects of their care must be addressed.
Here are some tips I’ve learned for practicing LGBTQIA+-affirming care:
If your workplace does not include required training about gender and sexuality, create it utilizing existing programs, ideally led by those the training affects.
2. Make the clinic office and waiting room welcoming to all.
Make the office more affirming by better representation in displayed literature as well as office procedure development.
3. Do not make assumptions.
Some of us have been socialized to believe sex assigned at birth = gender expression = gender identity = sexual orientation. These factors are all independent. Do not ask presumptive questions or make biased decisions. An example of a presumptive question is, “Why aren’t you using birth control?” to a cisgender woman who has birth-assigned female partners.
4. Share your own pronouns when you introduce yourself.
This lets the patient know that this is a standard question and not an assumption about their gender.
5. Remember that names and pronouns are not really “preferred.”
They are required to demonstrate respect and safety. Deadnaming (calling someone by their unaffirming, legal name), or misgendering (referring to a person by incorrect pronouns or gendered terms), is harmful and can have significant consequences. Some refer to names and pronouns as “affirmed” to reflect this difference.
6. Practice cultural humility by using the language the patient states.
People may use pronouns, gender identities, or other terms you’ve never heard of before. If clinically relevant, ask, “What does that term mean to you? It will help me understand how to better care for you.” Never impose an identity on a patient; it invalidates their autonomy.
7. Focus only on necessary information.
The above practices and languages should be standardized across all patient interactions, but not every question below is necessary for every visit type. Patients’ identities are personal and clinicians should never ask unnecessary questions out of curiosity or for their own education.
The questions below are suggestions for affirming language for all patients when an in-depth gender and sexual history is indicated.
1. How would you describe your gender identity?
2. Do you have a word to describe your sexual orientation?
3. For young patients, instead of, “Are you sexually active?” I ask, “Have you ever had sex?”
4. “Do you have sex with partners who have a penis, a vagina, or both?”
5. “During sex, are you using your mouth, vagina (or penis), and/or bottom?” Ask gender diverse patients about their terms for genitalia and use the same affirming language.
6. “How many partners have you had?” For a follow-up visit, ask, “Any new partners since the last time you had testing for sexually transmitted infections?”
7. “What do you and your partner(s) do to prevent sexually transmitted infections? Pregnancy?” (Ask about pregnancy only if indicated.)
8. Ask about previous pregnancies and outcomes as well as assess thoughts about contraception. If they’re interested, discuss contraception options.
9. Ask about a previous history of STI testing and diagnoses. Offer appropriate testing.
10. Talk about PrEP, either for the patient and/or a peer’s benefit
11. Assess adherence to barrier and contraceptive methods and help patient brainstorm ways to improve.
12. Screen for experiences of sexual assault or trauma, including reproductive coercion (partners controlling condom or contraceptive use by withholding or manipulation) and provide desired resources.
These questions are based on the “5 P’s”, which are recommended for sexual health histories. The National Coalition for Sexual Health includes a sixth P for “plus” to include pleasure, problems, and pride. Example questions can be found in their resources.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.