#TalkingToTeens101: Let’s Talk About Gender & Sexuality, the #tweetorial
Talking abt gender starts at the beg of the visit. Introduce urself, ur pronouns, then ask patients their name & pronouns.
Ex: “I’m Dr. Fenton & I use she/her pronouns. What name & pronouns do you use?”
1
Talking abt gender starts at the beg of the visit. Introduce urself, ur pronouns, then ask patients their name & pronouns.
Ex: “I’m Dr. Fenton & I use she/her pronouns. What name & pronouns do you use?”
1
If a teen is w a parent, ask more privately. I keep it open-ended: “how do you describe your gender?” For teens looking at me confused, I explain like this: “people can identify as male, female, non-binary, a combination, or no gender at all. How do you identify?”
2
2
Asking for & using a patient’s affirmed name/pronouns is important to do at ALL visits, but asking abt gender identity is not always necessary; it depends on visit reason. For example, it is clutch for well visits, but not for many acute complaints. No need to ask just to know.
3
3
Also my current clinic uses *affirmed* name/pronouns instead of preferred and it is my favorite thing. As a language nerd, preferred suggests that being respectful of a person’s gender is an option. Affirmed gives just the right amount of warm fuzzies and says “I see you”
4
4
Onto sexuality, PLEASE please discard the old school questions: Are you sexually active? (leaves WAY too much room for misunderstandings) & “do you have sex with men, women, or both?” (excludes trans and gender non-confirming partners). Think about what info you actually need
5
5
I stole this question from a preceptor: “do you have a word to describe your sexual orientation?” It allows for all answers, including no. I ask to screen for support: have you told anyone (family, friends, therapists, etc.)? How did they respond? If they haven’t, why not?
6
6
Don’t take for granted that you may be the 1st provider or person period that a teen comes out to. That’s why open-ended questions & respect are key. It’s an invaluable opportunity to reassure LGBTQ+ youth that they are NORMAL, especially in a world that often doesn’t agree
7
7
For sexual practices, “have you ever had sex?” Then assess what parts their partners have. Ex: “do you have sex with partners who have a p***s, v****a, or both?” (Editing so the tweet doesn’t get flagged 😂) I also ask about what parts they are using: mouth, front, and/or back
8
8
Also ask about number of partners (or new partners since last testing.) With the info above, you can assess for STI risk and pregnancy prevention methods (if indicated). “What do you and your partner(s) do to prevent sexually transmitted infections? Pregnancy?”
9
9
Ask about adherence. Ex: “How many times out of 10 do you and your partner use condoms?” or “what grade would you give yourself for remembering to take your birth control pill?” Then, explore what happens when it’s missed and ways to increase use (Motivational interviewing!)
11
11
WATCH OUT:
Sexual assault/rape: I esp screen for physically developed girls w dev delay. Ex q: “has anyone touched you inappropriately or forced u to have sex?”
Reproductive coercion: partners control condom or contraceptive use by withholding or manipulation. This is abuse.
12
Sexual assault/rape: I esp screen for physically developed girls w dev delay. Ex q: “has anyone touched you inappropriately or forced u to have sex?”
Reproductive coercion: partners control condom or contraceptive use by withholding or manipulation. This is abuse.
12
If sexually active, ask about previous pregnancies and the results of them. Assess feelings about birth control and discuss options. Also ask about previous testing for STIs and any hx of positive results. Offer testing for relevant sites: mouth, front, back
13
13
I actually explain recs for testing BEFORE going into sexual practices to limit stigma that only “certain people” should get tested. If you’re having sex, you should be getting tested. PERIOD. I advise patients to get tested at least once a yr, or w new partners, or symptoms.
14
14
No convo about sexual health is complete without thinking about PREP. My fellow Chicago doctor/advocate has said so much about this topic already so check out this thread and her tweets more info:
15
15
Remember, open-ended questions will protect you from cisgender/heteronormative assumptions. Practice respect! Apologize and move on if you say something wrong. Go forth and have productive, honest conversations with teens about gender/sex! Thanks for hanging in until the...
END
END
