Would you come out to your doctor?

Coming out is a major issue for almost all people who are lesbian, gay, bisexual or transgender. But have you come out to your doctor?

Every one has his or her own saga. Some are horrific, some warm, some supportive, some funny, some violent. Many people spend months, or even years, thinking about how to handle coming out to those close to them. They see how others they know have handled it, read about other people coming out, ask questions on the Internet and use other methods to get some ideas of what to do and what to expect. Often there is a lot of planning, fear and worry involved. Then the time comes, the news is broken, things in the relationships change – or not. Then the event is over. And the next time the person needs to come out, the past experiences may make it easier.

But in spite of all the planning, some people don’t come out to their doctors. This can be for any one of several reasons. And not coming out to the doctor can be a mistake, sometimes a very serious one.

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Why don’t LGBTQ patients come out to their doctors?

There may be a number of reasons. I’ve heard several different ones from patients who finally did come out to me or to other doctors. Some reasons are:

1. I didn’t think a straight doctor would understand.

Not understand what? That you’re attracted to and having sex with people of the same sex?  I think what mean is that they feared their doctor wouldn’t approve.

2. It’s personal, and I didn’t want to tell you.

Hmmm, but you’re willing to discuss your bowel habits in great detail, your irregular menstrual cycles, and let me insert a finger into your intimate areas.  Trust me, telling me you’re gay is hardly the most intimate thing we’ve done in my office.

3. I didn’t think you’d like me if you knew that I was LGBTQ.

This takes us back to fear #1. I don’t have to like you to take good care of you as a patient. And, do you really think that I’m so shallow that I’d change my opinion of you just because of that?  Though granted, some people are shallow. But hopefully after you’ve established a good rapport with your doctor, you can trust that it should work out fine. Then again, there’s a good argument for coming out early to your doctor – if the doctor is going to have an issue with it, it’s better to know early on, and find another doctor.

There are other reasons given, but often it comes down to the fact that many LGBTQ people are used to being closeted, and keeping information about their sexuality private. They’re afraid of alienating the doctor and experiencing another rejection.

I wish I could say that that never happens. But that isn’t the case. I’ve seen it happen to patients and I’ve had it happen to me. When it did happen to me, I felt angry and hurt. But a few minutes later, I felt relieved. Relieved that I hadn’t continued to see that doctor, built a professional relationship with him and then found out a few years later that he was “uncomfortable” with gays. Then I’d have had to move on. Instead, I found out during the first exam and just left and got a new doctor.

Regardless, it is important to let your doctor know that you are LGBTQ. You should have told him about all of your other past medical history so that he has a baseline to work from. Don’t keep him in the dark about your sexuality. Not telling him can have repercussions.

Why does my doctor need to know?

Many reasons. First of all, LGBTQ patients may have some diseases that aren’t seen as commonly in the remaining 90-95% of the population. Not just HIV/AIDS, but other diseases as well.

LGBTQs often suffer from depression. Many have seriously considered or attempted suicide. They may have a higher instance of eating disorders, perhaps use or used street drugs or may drink more alcohol. They may have a higher rate of sexually transmitted diseases. Some may have suffered physical or psychological abuse, spent time homeless or in community shelters, may have become prostitutes just to survive. These are all issues that the doctor may need to consider when examining a patient.

Additionally, there are some things that need to be done as part of preventive medicine. It used to be thought that lesbians had a much lower incidence of forms of cancers of the genital tract because they didn’t have sex with men, and often had fewer STDs than their straight counterparts. On that basis, some lesbians weren’t offered Pap, smears or were only offered them sporadically.

Anal cancer is something that needs to be considered in gay male patients who are receptive to anal intercourse.

Then there was the recent outbreak of meningitis that was seen primarily in just some gay men in New York City.

Bisexuals and transgendered patients also have their own issues – some in common with gay males and lesbians, and some quite different.

And HPV, and the various cancers it’s associated with, are a concern for everyone.

Not letting your doctor know about your sexuality can cause him to not consider you as the whole patient, with your individual, specific and potential problems as an LGBTQ patient.

Should I talk about my sexual health with my doctor?

Yes.

Ideally, you and your doctor should form a partnership and cooperate so that you get the best health care available.

You should feel free to ask questions, get advice and have open discussions. In fact, it may be important that you initiate these conversations yourself. There have been a number of studies and surveys that have shown that some doctors are uncomfortable discussing patients’ sexual issues, problems and diseases. These doctors might never ask about STDs, erectile dysfunction, female orgasm, menopause or other things of that nature. They operate on the assumption that, if there’s something wrong or if the patient has a question, the patient will bring it up. Of course, that’s not how it should be, but sometimes that’s the way it is.

So, make sure that if your doctor doesn’t mention things like Pap smears, STDs and other sexual health issues, that you do when necessary. If you do bring up questions on sexual health, and your doctor avoids them or gives incomplete information, you might want to consider seeing another doctor. In larger cities, there are LGBTQ practices, you might be more comfortable seeing a doctor in one of those practices, or finding a solo LGBTQ practitioner. There are online resources that you can use to locate practitioners who are either LGBTQ or LGBTQ-friendly. But note that these sites do not screen the doctors who are listed there or verify their credentials – you’ll need to do that. If you can’t find an LGBTQ doctor near you, ask your friends what doctors they go to and if they’d recommend them.

What do I do if my doctor doesn’t react well when I tell him I’m LGBTQ?

Ideally, this shouldn’t be an issue. Your doctor should be professional enough so that this shouldn’t make any difference to him. But, if he reacts negatively or you begin to feel uncomfortable with him, you might want to consider seeing someone else. But consider that his reaction may be to the fact that you haven’t given him all of the information that he asked for in your initial visit. He might be upset that you didn’t trust him enough to tell him the full story. In that case, his reaction may be temporary, and it may not be a reaction to you. Ultimately, though, you may need to make a decision about continuing or terminating the doctor-patient relationship.

Bottom line: You need to be open and honest with your doctor. It’s in your own best interests, and his.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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