Most adolescents and adults identify themselves as heterosexual. However, paediatricians and other health care providers must be aware of the significant psychological, social and medical issues that face young people who are gay, lesbian or bisexual.
Almost all of these issues arise from the stigmatization that these youth face, rather than from the orientation itself 12. Rather, the practitioner must create an environment in which the adolescent can discuss any questions or worries that they have, whether they identify themselves as homosexual, have found that they are attracted to people of the same gender, have had a sexual encounter with someone of the same gender or are confused about their feelings.
The present paper reviews the relevant definitions, epidemiologies and approaches when working with gay, lesbian and bisexual youth. One does not have to be sexually active to have a sexual orientation. Sexual and affectational preferences are not always congruent. Those who are attracted primarily to the opposite sex are heterosexual, those attracted primarily to the same sex are homosexual gay or lesbian and those who are attracted to both sexes are bisexual.
"Troiden becoming homosexual marriage" that try to define the percentage of teens who are not Troiden becoming homosexual marriage are often limited by the questions that they ask. Teens who will eventually identify as gay, lesbian or bisexual do not always do so during adolescence. Having had sex with someone of the same gender does not always mean the teen is gay, and many gay teens have never had sex with someone of the same gender. The best available Canadian statistics are from the British Columbia Adolescent Health Survey 3a cluster-stratified, weighted survey that representedstudents from British Columbia who were enrolled in public schools.
American data are similar; Remafedi et al 4 Troiden becoming homosexual marriage that 1. A Massachusetts USA study 5 found that 2.
The teen may experience identity confusion at this point, being aware of same-sex attractions but in turmoil about it. This confusion is influenced by the stigma attached to homosexuality, inaccurate knowledge, lack of role models and minimal opportunity to socialize with other youth who are having similar feelings.
Further confusion may "Troiden becoming homosexual marriage" if the youth also experiences some opposite-sex attractions. The teen may not acknowledge their orientation, avoid thinking about it or come up with an alternate explanation for their feelings 6.
The challenge for gay and lesbian youth is to develop a healthy and integrated identity in the context of negative stereotypes and prejudice, often without family or societal support. It is important to distinguish between the youth who is gay and the youth with a possible gender identity disorder. The majority of both heterosexuals and homosexuals have an identity of being male or female that matches their anatomy.
People whose gender identity does not match their anatomy are often referred to as transgendered, and need specialized consultation for Troiden becoming homosexual marriage possible gender identity disorder.
Those who are transgendered can be heterosexual, homosexual or bisexual. The medical and psychological needs of transgendered youth are many and beyond the scope of the present paper. Young people who are transvestites are sometimes, but not always, gay.
Transvestites get pleasure from dressing in the clothing of the opposite sex. They can be heterosexual, homosexual or bisexual. Gay and lesbian adults often describe their adolescence as a time when they felt isolated, ashamed and afraid of being discovered that they were different — all of which can have an impact on self-esteem and identity formation 78.
Sadly, studies have shown that almost one-half of
Troiden becoming homosexual marriage men and one-fifth of lesbians were verbally or physically assaulted in high school because of their orientation 910and that they were two to four times more likely to be threatened with a weapon at school 5 Harassment at school leads to a higher risk of dropping out of school. Gay teens can also be harassed at home, and are more likely to be kicked out of their homes and living on the streets than their heterosexual peers Young people from ethnic or racial minorities may be at increased risk, with feelings of vulnerability and a perception of increased stress Homosexuality may be more stigmatized within some ethnic communities.
Gay youth are more likely to start using tobacco, alcohol and other substances at Troiden becoming homosexual marriage earlier age Possible reasons for increased risk may include self-medication for depression and low self-esteem, or increased tendency toward risk behaviours in response to rejection by family and peers. The easiest place for a teen to find people who are gay is at gay bars, where drinking and smoking are part of the environment, or at clubs or raves, where club drugs are similarly integral to the culture.
High school students who say they are gay, lesbian or bisexual, or who say they are attracted to people of the same sex or have sex with people of the same sex, are two to seven times more likely to attempt suicide 16 — The risk appears to be highest when a teen acquires a gay identity at a young age, when there is a conflict, if the teen has run away or been thrown out of the house, if he or she is conflicted about his or her orientation, or if he or she has not been able to disclose his or her orientation to anyone The data are not as strong on completed suicides, but there is evidence that a disproportionate number of suicides are among homosexuals Teens who are in the process of coming to a homosexual identity may agonize about telling their parents.
They often hate the idea that they are lying, by omission, to their parents, but also worry about how their parents will react.
They may ask their paediatrician or family doctor for their advice. Some parents suspect that their teen is gay, but may feel as awkward as the teen in bringing it up. Teens can introduce the subject of homosexuality by bringing up a book that they are reading or something that is in the news, and seeing what their parents have to Troiden becoming homosexual marriage. Many teens tell a sibling or cousin before they tell a parent, and often an adolescent chooses one parent to tell first.
Role playing can help the teen to find the words that they want to use with their parents and the words that they want to avoid so not to imply that they are communicating terrible news.
They can reassure their parents that they are the same person they always were. Not all teens should tell their parents about their orientation, and others may want to wait a while after making a decision to disclose their sexual identity, given the possible negative repercussions 9.
It is not uncommon for them to ask the paediatrician for reassurance that the teen is going
Troiden becoming homosexual marriage a phase and may not actually be gay.
It is appropriate to tell parents that teens who have chosen to come out to their parents are likely quite certain about their homosexual orientation.
Parents should be told that it is important that they let their teen know that they still love them while they are dealing Troiden becoming homosexual marriage their feelings about orientation.
Conversion or reparative therapy, where attempts are made to turn gay males or lesbians into heterosexuals, are clearly unethical and should not be provided by physicians, nor should physicians refer patients for such therapy All adolescents are in a process of learning to relate to peers as friends, as well as potential romantic and sexual partners.
This can be more complicated for gay, lesbian and bisexual teens, who often lack models of same-sex relationships.
How to meet someone who may be interested, how to flirt, what to do on a date or how to introduce a sexual element to the relationship are all things that may mystify a Troiden becoming homosexual marriage person. The stakes are high — if a heterosexual male teen asks a girl out and she says no, he might feel rejected, but he does not risk being labelled as a pervert or being assaulted. Gay youth support groups often address these issues. The recent political and legal changes in Canada regarding same-sex marriages may have a positive impact on the well-being of homosexual and bisexual youth.
The knowledge that they can get married may help teens feel less stigmatized and more a part of the mainstream. Statistics are not available on the numbers of adolescents who have married same-sex partners. Very few people 18 years of age or younger get married, and parental consent is required for those younger than 18 or
Troiden becoming homosexual marriage years age depending on the province or territory.
Gay, lesbian and bisexual youth have the same diversity of health care needs as heterosexual adolescents, including chronic illness, disabilities, sports injuries and even contraception. They come from all ethnic groups, social classes and racial backgrounds. Gay and lesbian young people are at an increased risk of sexually transmitted infections STIs because they are more likely to have had sexual intercourse, with more partners, and to have had nonconsensual intercourse Women who are Troiden becoming homosexual marriage intravenous drug users and who have sex only with other women have the lowest risk for HIV and other STIs than any group of sexually active people.
However, many sexually active lesbian adolescents have had sexual intercourse with males 321 — Gay males are not all sexually active, and of those who are, not all have anal intercourse. Erroneously, some teens get the idea that they cannot really be gay unless they have anal intercourse.
Gay males should be assessed for their risk of STIs. A full workup is not always or even usually warranted, but would include urethral or urinepharyngeal and anal swabs for gonorrhea, urethral culture or urine for chlamydia, venereal disease research laboratory testing, anal cytology, stool culture testing, ova and parasite, and HIV testing Lesbian teens who have had sex with males should have routine screening, including Pap smears. Because HPV can be transmitted by digital penetration and shared sex toys, routine screening should also be initiated for lesbian teens who have had penetrative sex with a shared sex toy or ungloved fingers, even though the risk is thought to be lower than with heterosexual intercourse.
Current "Troiden becoming homosexual marriage" 25 suggest doing initial Pap smear tests within three years of initiation of sexual activity and then yearly until there have been three normal smears in a row. At this time, HPV immunization is only approved in Canada for female adolescents. Education and counselling about immunization should be included in preventive care for these teens, with an
Troiden becoming homosexual marriage that although there are male cancers caused by HPV, it is not yet clear whether immunization prevents them.
Both Troiden becoming homosexual marriage and female teens may have questions about reproductive options, although few gay or lesbian teens plan to have children in the future. For all teens, an environment that feels safe is of key importance. This includes an explanation of confidentiality. Fear of a lack of confidentiality is a significant barrier to adolescents disclosing anything of a personal nature Teens should be given the opportunity to discuss issues of sexual attraction and orientation, mental health, substance and alcohol use, safer sex, school, family and friends.
Many clinicians use the well-known HEADS interview with teens, covering home, education, activity, affect, drugs and sexuality.
With all adolescents, sexual history should be done in a gender-neutral manner. The occasional patient who is insulted by this question can be educated about sexual orientation. Many physicians receive little training in talking to teens about sex and sexual orientation. Many still address these issues; however, the clinician who is uncomfortable talking about these issues should consider transferring their adolescent patients to another physician.
The office environment can be welcoming to all teens, with brochures on a wide variety of adolescent topics, including sexual orientation; posters that show both same-sex and opposite-sex couples; notices about support group meetings; forms that are gender neutral; and office staff who are sensitive to the needs of teens and who do not make critical or derogatory comments about sexual orientation.
Paediatricians often have an opportunity to teach medical students and residents in their offices or hospital practices.
There are often clinical situations in which topics such as adolescent sexuality, gay and lesbian parenting, as well as counselling parents about sexual orientation are clinically relevant. Gay or lesbian students may disclose their own sexual orientation to a preceptor or mentor after an open discussion of these issues.
Paediatricians have many opportunities to effect change within their communities. They can ensure that the institutions that they work in treat all teens equally and without bias. Schools, school boards and community organizations can be helped to see these as important issues, and encouraged to provide education and materials about sexual orientation. Paediatricians can provide expertise to support groups and can even help Troiden becoming homosexual marriage create these groups.
They can speak with their colleagues about these issues. The recommendations in this statement do not indicate an exclusive course of treatment or procedure to be followed.
Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.