? re: how to document, how to ask about sexual activity - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 12 Old 12-14-2003, 11:57 PM - Thread Starter
 
lorijds's Avatar
 
Join Date: Jun 2002
Posts: 2,945
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Hey there, I am a nurse at a women's health clinic and birthing center. I have kind of a funky question. This has come up a couple of times where I work, and I just wanted to know how lesbian moms/women would prefer to have their doctor/health care practitioner handle their line of questioning as well as the documentation in their charts.

Whenever a woman comes in for an appointment (usually for an annual exam), we have a set list of things that we ask. First day of last menstrual period, medications, herbals and vitamins taken, whether you smoke. We also ask about birth control use. If a woman says that she does not use any sort of birth control, we ask if she is sexually active. If she says yes, then we always ask if pregnancy is not a concern. If she says, no pregnancy is not a concern, we usually explore that further...they are trying to conceive, partner has a vasectomy, they have never used birth control and have never gotten pregnant, etc. Occasionally a woman will say, because I'm gay, or because my partner is a woman.

Okay, no problem there. But one of my questions is, how to document this? Normally I simply put: No BC used, positive sexual activity, partner is female. I hesitate to put lesbian; first of all because I don't know that. Maybe sometimes a woman has male partners, sometimes female. Somehow, too, it doesn't sit well with me to put that down, I'm not sure why. Do any of you gay/bi mamas have any way you would prefer that your health care professional documents your sexual orientation?

A few of our gay patients I now recognize, since I"ve been there a while, so I just ask them if they are with the same partner as last year. Also if I see in their chart that it is previously charted that they have a female sexual partner, I again just ask if they are with the same partner as last year. But for the ones that I don't recognize, or who are new to our practice, I always feel a little uncomfortable after the fact when I have asked my questions. I feel like I have assumed they are straight (which I have, usually), but I'm not sure how to reword my questions for a more inclusive format.

So my other question is, if you were sitting in our exam room, and
I was asking you the questions that I listed, would the line of questioning or the way I worded them make you feel uncomfortable or unwelcome? Is there any other way the questions might be worded to make you feel better and more open and honest? I imagine for many gay women, especially those who are out and have been a long time, it isn't a big deal. The women I am particularly worried about alienating or making uncomfortable are the young women (high school or college) who are not yet comfortable with their sexuality, or who have not yet told anyone. I can imagine if your parents and relatives think you are straight, and you live your lifestyle rather secretly, it would be disconcerting to have to say the words "I'm gay." Or is it not that big of a deal?

Sorry, when I type this out, it all seems rather silly. But we are located in a pretty conservative town, home of Fred Phelps, and I feel like gays and lesbians have a hard enough time here as it is. I'm just trying to be sensitive about it all, and since it came up the other day again at the office, with a new patient, who blushed when she told me she was gay, I wondered if maybe there is another way of asking that might be more, oh I don't know, supportive? Nonjudgemental? Because I, and none of us where I work, give a hoot about someone's sexual orientation. I just felt bad when the woman blushed and looked away. I didn't want to make a bigger deal about it, so I just touched her hand, smiled, and said, "That's totally okay, you know." and went on with my questions.

Anyhow, some guidance in how to make office routines, questions, and documentation more accepting and supportive would be appreciated.

Thanks!

Lori
lorijds is offline  
#2 of 12 Old 12-15-2003, 04:27 AM
 
birdwomyn's Avatar
 
Join Date: Nov 2002
Location: Oklahoma, USA
Posts: 268
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I spent the last couple of years doing HIV Testing and Counseling at Planned Parenthood -- most of my clients were family planning patients.... the vast majority of them were straight women, but certainly not all were.....

What I found most helpful was to ask EVERYONE the same thing:

Are you sexually active? How many different partners have you had in the past year, etc... Are your past or present partner(s) male or female? Asking this way lots of straight folks are caught off guard -- but I just matter of a factly say that I ask everyone the same thing, I am not making ANY assumptions. Asked this way, the women with female partners seemed to have a MUCH easier time talking about it with me.

Asking any other way does assume heterosexuality and by choosing to NOT assume heterosexuality, you are not only avoiding embarrassment for the sexual minority patients you have but you are actively acknowledging that diversity is present -- even where Fred Phelps lives and breathes..... ( I have had many encounters over the years with Mr Phelps and his band of followers).

It also helped that I had a picture of my family on my desk for all to see -- me, my female partner and our two children....

One thing to thing about: you might ask the client how she wants you to document in the chart... if she is really freaked about being out, most women I know just lie to their doctors offices... if you gave the option of charting without indicating sex of partner, but indicating that you talked about appropriate birth control options and STI risks, it might be "safer" for your patients. Medical records (even with HIPPA) are VERY PUBLIC and many sexual minorities DO NOT want this aspect of their lives "documented". I think it was easier for me because the work I did was anonymous testing -- but I did have conversations regarding documentation with the family planning staff who were sensitive to these issues.

WHAT NOT TO DO: I was treated for endometriosis with 6 months of Lupron this time of year two years ago -- and every time I went to the doctor for the shot and for every procedure (HSG, etc...) they wanted to do a pregnancy test -- it drove me nuts and EVERY time I reminded them that my partner is female, THERE IS NO WAY I AM PREGNANT BY ACCIDENT!!! If I remember correctly, they finally quit insisting on the pregnancy tests after the third shot and the zillionth pregnancy test. I know they had liability issues to deal with, but it was still very frustrating because I was as OUT as you can get -- and those tests cost $$$$ to do over and over again. It also was very frustrating to be forced to "comply" to a standard that simply did not apply to my situation -- and was heterosexist .... grrrrrr....

It is wonderful that you are even thinking about these issues in your office. I hope you all advertise in the local gay/lesbian publications because sensitive health care is difficult to come by, especially in the midwest!

kathy
birdwomyn is offline  
#3 of 12 Old 12-15-2003, 05:16 AM
 
kama'aina mama's Avatar
 
Join Date: Nov 2001
Location: Watching Top Chef, eating Top Ramen
Posts: 21,139
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
What a great solution! That is very smart.

I feel you about the required pregnancy tests... hard to say if they are hetero-sexist or just plain sexist or both. I can remember being forced to submit urine for a PG test when I was a virgin (in every possible way!) and being really offended.
kama'aina mama is offline  
#4 of 12 Old 12-15-2003, 11:23 AM - Thread Starter
 
lorijds's Avatar
 
Join Date: Jun 2002
Posts: 2,945
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Thanks for your input. I really appreciate it.

We kind of dance around this issue, because sometimes alternatives to the mainstream medical make strange bedfellows. Many gay women/moms, single moms, very young moms, etc, come to us. Many of the Phelps clan come to us. Many members of the ultra conservative/traditional religious groups in the area come to us. Respecting everyone's feelings while making everyone feel welcome is certainly an intricate chess game!

Sometimes you can tell someone's feelings on this just by how they dress (for example, the conservative religious set generally dress similarly to traditional Mennonites).

I've been thinking about it, and I know I can word things more openly. If a woman says that pregnancy is not an option, asking something like "Is pregnancy not a concern because you are *wanting* to become pregnant, or is it not a concern because you are in a same sex relationship, or is there some other reason?" Hmmm, it all still sounds awkward. Maybe just a simple "Why is pregnancy not a concern for you?" would suffice. I'm working on it!

Again, thanks for your input. Keep it coming!

Lori
lorijds is offline  
#5 of 12 Old 12-16-2003, 01:32 AM
 
Angiemama's Avatar
 
Join Date: Nov 2001
Location: Vermont
Posts: 179
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I think that havving a question about theor sexual preference or such is appropriate for a gyn exam. If someone asks you why you can explain "If yu have a female partner we can go ahead and skip all the birth control questions" which is a little funny and may lighten thins up a bit.
I am bi an am a bit offended that most of our society assumes that everyone is straight (look at advertising!) I would be much happier with someone asking me a question like that rather then just assuming I ws straight.
Angiemama is offline  
#6 of 12 Old 12-16-2003, 12:40 PM - Thread Starter
 
lorijds's Avatar
 
Join Date: Jun 2002
Posts: 2,945
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Angie, that's a great idea. Something like "If your partner is female, we can skip the talk about birth control and pregnancy; otherwise I am curious as to why pregnancy is not a concern. " Does that seem too flippant? Or does it sound good?

It came up AGAIN yesterday....I think women are just being more honest, either with themselves or with us. Either way, it's good for them.

I agree, Angie, it *is* appropriate for a gynecological exam. It also dictates treatment, to a degree. Treatment for bacterial vaginosis and yeast can be different for women who have female partners instead of male partners.

Again, I appreciate everyone's input, since I don't have any lesbian or bi friends of whom I can ask this sort of thing. And I wanted a completely honest answer; I knew I could get it here!

Thanks for all the input; if anyone has any other thoughts or input, please share them.

Lori
lorijds is offline  
#7 of 12 Old 12-16-2003, 06:44 PM
 
grltalk's Avatar
 
Join Date: Dec 2003
Posts: 6
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Thanks for asking!

I changed GYNs a couple of years ago. She does the "interview" questions with her new patients. So, she had my records and knew that I had two kids. She asked the birth control question and I said, "No." She asked the sexually active question and I said...."Well, I'm gay." She said, "OK. And are you sexually active?" I said, "Yes, with my partner only." She said, "Then birth control isn't an issue." After being out for several years, that was the first time I had come out to a doctor. It was very comfortable. As others said, I think it's pertinent information for that kind of doctor. Sounds like you're going about it just fine.
grltalk is offline  
#8 of 12 Old 12-24-2003, 04:29 PM
 
JuliaP's Avatar
 
Join Date: Dec 2003
Posts: 2
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Hi Lori,

I think its great that your clinic is asking these questions and thinking about how to be more respectful and sensitive.

I just wanted to let you know that the Gay & Lesbian Medical Association has printed a guide book to these sorts of issues. I saw it a couple years ago when working in a Community Health Clinic--I'm sure that if you contacted them they would know the name of this document and maybe be able to email it to you. It is quite good and well worth the effort to track down.

The other thing is that I really think that by naming the possibilty that a woman's partner could be female, or that she could identify as LGBT opens up the space for her to tell you about it. I don't think an open ended Q signals your openness and that it will be safe for the woman to share her sexuality with you in the same way as a specific question does.

Also, I do not think it is impossible that a woman who is a Mennonite or member other such religious group could be a lesbian. She may not be acting on her sexuality, but if you open the door to talk about it, you could be doing an amazing and liberating thing. You could be the only person in the world that ever lets her know that it is OK to talk about it, and the only place in the world where she feels safe talking her sexuality! I just wanted to add my two cents on this issue...I don't think you should "edit" your script if you think "there is no way she could be gay." Religion or culture doesn't exempt you from being LGBT.

Keep up the excellent work!

Julia
JuliaP is offline  
#9 of 12 Old 12-26-2003, 02:14 AM
 
JuliaP's Avatar
 
Join Date: Dec 2003
Posts: 2
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Hi Lori.

Well I'm still thinking about this issue (good thread BTW!). Here's the GLMA link: www.glma.org

the publication I was talking about is: CREATING A SAFE CLINICAL ENVIRONMENT FOR LESBIAN, GAY, BISEXUAL, TRANSGENDER, AND INTERSEX (LGBTI) PATIENTS

You can find it under the "Clinical Issues " (or was it "Clinical Publications?")

Happy holidays!

Julia
JuliaP is offline  
#10 of 12 Old 12-26-2003, 11:59 AM - Thread Starter
 
lorijds's Avatar
 
Join Date: Jun 2002
Posts: 2,945
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
That is great!

Thank you so much for the link and the input!



>>>>>Also, I do not think it is impossible that a woman who is a Mennonite or member other such religious group could be a lesbian. She may not be acting on her sexuality, but if you open the door to talk about it, you could be doing an amazing and liberating thing. You could be the only person in the world that ever lets her know that it is OK to talk about it, and the only place in the world where she feels safe talking her sexuality! I just wanted to add my two cents on this issue...I don't think you should "edit" your script if you think "there is no way she could be gay." Religion or culture doesn't exempt you from being LGBT.<<<<<

You are so right. Thanks for the perspective. I like to think of myself as open minded, but I still obviously have my own stereotypes and preconceived notions. Thanks for reminding me of that! It is important to remember that, that people are amazing and surprising, and that they don't fit into the cubbie holes that we often make for them.

I didn't even know there was a Gay and Lesbian Medical Association. What a great resource!

Thanks again!

Lori
lorijds is offline  
#11 of 12 Old 12-29-2003, 04:38 PM
 
A&L+1's Avatar
 
Join Date: Dec 2003
Posts: 664
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Lori,
I have actually been offended or at the very least amused at the expense of a past doctor who asked me the "why is pregnancy not a concern?" question - especially when it was asked in such as way as to imply that I was being irresponsible for not using birth control (as a very young woman). Often the reponse to me saying I am a lesbian has been tense and I imagine that the doctor was trying to think back to the part of medical school that taught how to handle "gay" medical issues...saying something like "uh, yes, well, that, uh, makes sense" while trying to come up with something to say next. It always seemed to stop the interview in it's tracks since the doctor then had to scan down the list of questions to figure out what could be skipped. This silence was pretty strange and I did feel a bit "othered."

I like the idea of asking "are your past or present partners male or female?" I think that this would be a great way to be open to the possiblity in the questioning.

Since I am pregnant right now, my partner and my doctor have seen each other several times and there are no more questions. I think that the main issue we have run into is that every single form asks for Father/Husband info and we have to cross things out to have it make sense for us and our family.
A&L+1 is offline  
#12 of 12 Old 01-09-2004, 11:13 PM
 
LylasMom's Avatar
 
Join Date: Aug 2003
Posts: 280
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I apologize in advance if I've repeated what others have said, since I haven't read through all the replies. Just wanted to say that I also used to be an HIV Counselor/Tester. After attending some Gender Identity workshops related to my work, I realized that the best way to ask my clients about sexual activity was to find out what the risk was associated to HIV transmission. The questions that were on our intake form asked about specific types of sexual activity rather than ask if their partners were male or female. So, I would ask: do you have oral/anal/vaginal sex and if they were receiving or giving the above.

We cannot assume someone's SEX or GENDER and it's almost irrelevant what sex or gender someone identifies as so knowing this (or about partners sex/gender) doesn't necessarily give you answers about risk. In the context of STD or HIV testing, it's best to assess the risk of how they might have been exposed.

Does that make sense?
LylasMom is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off