Office-Based Care for Sexual Minority Youth

August 6, 2013

Office-Based Care for Sexual Minority Youth

  1. Alain Joffe, MD, MPH, FAAP

Most sexual minority youth grow up to be healthy adults but they are at risk for adverse health outcomes.

  1. Alain Joffe, MD, MPH, FAAP

Sponsoring Organization: The American Academy of Pediatrics (AAP)

Target Population: Primary Care Pediatricians

Purpose and Objective: Although most sexual minority youth — lesbian, gay, bisexual, transgender, and questioning (LGBTQ) — grow into healthy adults, they are at greater risk than their heterosexual peers for adverse health outcomes. Homophobia and heterosexism lead to LGTBQ youth being ostracized, stigmatized, and victimized. This technical report updates the AAP 2004 statement on providing office-based care for sexual minority youth.

Key Points

—Adolescents may not view themselves as LGBTQ, even though they are having sex with same-sex partners.

—LGBTQ youth are at risk for homelessness, substance abuse, sexually transmitted infections (STIs), HIV infection, mental health problems, physical and sexual abuse, and pregnancy.

—Factors fostering healthy outcomes include family connectedness, caring adults, religious involvement, and a supportive school environment (e.g., zero or low tolerance for teasing and bullying, access to gay-straight alliances).

—Make the office LGBTQ-friendly.

Table 1: Selected Resources for Sexual Minority Youth and Families
Table 1: Selected Resources for Sexual Minority Youth and Families
  • All office staff must be welcoming and nonjudgmental; confidentiality is critical.

  • Intake forms and questionnaires should not suggest that all adolescents and parents are heterosexual.

  • Reflect the diversity of adolescents in waiting rooms, offices, exam rooms, and Web site materials. Display gay-oriented magazines, rainbow decals, posters with same- and opposite-gender couples, and provide educational pamphlets on sexual orientation and information about support groups (Table 1).

—Collect information about sexuality and sexual behaviors.

Avoid questions suggesting that heterosexual relationships are the norm. It can take several visits before a LGBTQ youth feels comfortable disclosing his or her sexual orientation. Appropriate questions include:

  • Are you attracted to males, females, or both?

  • Are you dating anyone? Tell me about your partner.

  • Are you in a sexual relationship or having sex? Is that person (your partner) male or female?

  • Do you have sex with men, women, or both?

Ask about specific sexual behaviors; explain that the information is needed to make recommendations about STI testing and prevention.

  • Have you ever had oral sex? Has someone ever “gone down” on you or have you “gone down” on someone else?

  • Have you ever had vaginal or penile vaginal sex?

  • Have you ever had anal sex?

  • Do you use condoms (for oral or anal sex involving the penis) or dental dams/other barrier methods (for oral-vaginal or oral-anal sex)?

—STI testing and prevention:

Table 2: STI Screening for Men Who Have Sex with Men
Table 2: STI Screening for Men Who Have Sex with Men
  • Reinforce abstinence as normal behavior.

  • For adolescents in low-risk relationships (monogamous, 100% consistent and correct condom use, no substance abuse), test for STIs annually. Otherwise, frequency depends on risk behaviors.

  • Men who have sex with men (MSM) should be tested for STIs (Table 2).

  • Lesbians can acquire bacterial, viral, and protozoan infections from current and previous partners (including men). Digital-vaginal and digital-anal contact (especially shared devices) can transmit cervical-vaginal secretions. Skin-to-skin and skin-to-mucosa contact can transmit HPV infection. Hence, testing for chlamydia (all sexually active women ≤25) should be performed annually.

  • Testing for HIV, gonorrhea, syphilis, and bacterial vaginosis should follow current CDC guidelines for all adolescents.

  • Promote use of condoms (including with sex toys) and dental dams (during oral-genital and oral-anal contact).

  • Males and females should be vaccinated against HPV; MSM should receive hepatitis A and B vaccines if not previously vaccinated (and hepatitis B antigen/antibody testing is negative); and any adolescent with history of injection drug use, or who is HIV positive, should be tested for hepatitis C.


Many parents have difficulty accepting the coming out of their son or daughter. Pediatricians should acknowledge parental feelings but also support the adolescent. As parental reactions may change over time, follow up with parents regularly. The Endocrine Society provides an excellent resource for treating transgender youth (J Clin Endocrinol Metab 2009; 94:3132).

  • Disclosures for Alain Joffe, MD, MPH, FAAP at time of publication Editorial boards Adolescent Medicine: State of the Art Reviews; JAMA Pediatrics


Reader Comments (2)

ANNE-MARIE LANNOY Other Healthcare Professional, Preventive Medicine, independent

I think adolescents are afraid their parents won't accept if they are lesbian or gay, but parents react better than they think

DAVID PRICE Physician, Pediatrics/Adolescent Medicine

Not sure how this got published. Nothing new. Summary - don't assume and if you don't know, ask. Shouldn't we treat all patients this way.

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