What LGBTQ+ Sexual Health Should Look Like

This Pride month there is so much to celebrate: More Americans than ever before identify as LGBTQ+ and this is especially true of the younger generation: More than 15% of Generation Z have a sexual or gender identity other than cis-hetero. The binaries of “straight”/gay and male/female are less rigid than before, with more people identifying as bi or pan, trans or nonbinary. The growing size, diversity and power of the LGBTQ+ community deserves to be celebrated by all people, straight ones too, because gay rights are human rights and when people have more freedom to be their most authentic selves we all benefit.

But while Americans and especially young people keep progressing toward a less defined, more expansive vision of gender and sexuality, sexual health information and education needs to keep up. The sex acts an individual enjoys, the type of people they enjoy partnering with, and the body parts, toys and accessories they like to have in the mix are in no way predetermined by that individual’s body, expressed gender or sex assigned at birth. But much of sex education and sexual healthcare remains almost entirely focused on penis-in-vagina intercourse.

When people focus on such a limited definition of sex, or think that people who look or act a certain way have certain types of sex, health is at risk. What do I mean by this? Here are just a few examples:

• If men who have sex with men (sometimes or all the time) don’t have access to nonjudgmental, informed care they are very much at risk for HIV and other STIs.  
• If lesbians aren’t provided with sexual healthcare simply because pregnancy prevention isn’t a concern, so much of the rest of their health gets neglected. If trans people with cervixes aren’t offered affirming care they may miss essential screenings.
• If we assume people with vaginas only need pregnancy prevention, they’re at risk of sexually transmitted infections. Hormonal birth control doesn’t protect against STIs, so anybody on birth control should understand that they should also be using condoms, or be taking PrEP, unless they are completely confident in their partner’s status. 
• If you assume the vaginas are only at risk for chlamydia infection then you are missing their risk for other STIs including HIV. One STI puts you at risk for others. I have had to deliver news of a positive HIV diagnosis to women who just thought they had a bad infection from chlamydia. It never occurred to them that this was a possibility. 
• If people of every gender and sexual orientation don’t get tested for oral and rectal STIs then testing is incomplete. The assumption that a woman won’t have gonorrhea in her throat is doing her a disservice. Remember, if you can have one STI you can have them all. 

Advice for Healthcare Providers 

We need to stop making assumptions about what people are or should be doing sexually based on their bodies or how they look or act. Stop locking people into old expectations and roles. Don’t make assumptions about who people prefer to play with. We need to approach each individual as a human who deserves the best information and care. When providing sexual health we need to drop the assumptions. When you categorize then you may be missing important information and education for your patient. 

Many patients are afraid to disclose the things that they enjoy for fear of judgment/stigma. It is up to healthcare providers and sex educators to create a space where freedom of expression happens in the relationship between the health care provider and patient. Sexual health is more than just testing and treating STIs — it is creating a safe space so people feel free to ask for what they need and what they desire. It is a relationship of mutual respect that allows for thriving health. 

Advice for Anybody Who Has Sex

Tell your healthcare providers about your sex life and make sure you get the care you need — whether that’s STI testing, PrEP, birth control or anything that helps make sex more joyful and pleasurable. If your medical provider won’t listen to you or approaches sex conversations with shame, stigma or fear-mongering, try to find another provider or turn to telehealth resources like Nurx. Sexual health isn’t separate from overall physical or mental health. Sexual health is health, and no matter your sexual orientation or gender identity, you need and deserve affirming, comprehensive sexual health care. 

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