The following are a series of mock case scenarios involving LGBTQIA+ patients. Included are excerpts of these hypothetical patients' files. How might the information included in these files impact the ways in which you approach these situations (in terms of patient-provider interactions, diagnosis, and/or treatment)? What might you want to be keeping in mind?
Case Scenario 1: Em
Case Scenario 2: Hannah
Case Scenario 3: Trevor
Case Scenario 4: Javier
Case Scenario 5: Yasmin
Suggested Responses
Em comes in complaining of a stuffy nose and headache. It seems like xe has caught the bad cold that is going around. How would you approach this situation? What are some things you would keep in mind?
| Excerpts from Patient Intake Form |
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General Information Preferred Name: Em Pronouns: xe/hir Birthday: 04/05/95 Primary Language: English Gender Identity: Non-Binary Assigned Sex: Male Name on Insurance: Emilio Rodriguez Sex on Insurance: Male |
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Other Demographics Race/Ethnicity: Native American; Latinx Sexual Orientation: queer; asexual I live in: apartment Veteran?: No Seasonal agricultural worker?: No |
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Medical History Surgeries: wisdom teeth removal (2013)
Have you ever taken hormone replacement?: No Have you ever gotten a period?: No
Are you on birth control?: No Are you interested in discussing birth control methods today?: No
Have you ever had sex with another person?: No Are your interested in discussing sexual health today?: No
Have you ever been non-consensually hit, slapped, kicked, or otherwise physically hurt by an intimate partner or family member?: No Have you ever experienced emotional abuse from an intimate partner or family member?: Yes Do you want to discuss this today?: No Have you ever been forced into sexual activities against their will?: No |
Hannah comes in for an annual physical exam. How would you approach this situation? What are some things you would keep in mind?
| Excerpts from Patient Intake Form |
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General Information Preferred Name: Hannah Pronouns: she/her Birthday: 01/23/62 Primary Language: English Gender Identity: female, intersex Assigned Sex: female Name on Insurance: Hannah Millstone Sex on Insurance: female |
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Other Demographics Race/Ethnicity: African American Sexual Orientation: bisexual I live in: house Veteran?: No Seasonal agricultural worker?: No |
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Medical History Surgeries: removal of testes (1965), cliterodectomy (1962)
Have you ever taken hormone replacement?: Yes If yes, what do you take?: hydrocortisone Have you ever gotten a period?: No
Are you on birth control?: No Are you interested in discussing birth control methods today?: No
Have you ever had sex with another person?: Yes Are your interested in discussing sexual health today?: Yes In your lifetime, your sexual partner(s) have been: cisgender men, transgender men, cisgender women Currently, your sexual partner(s) are: cisgender women, cisgender man Are you practicing safer sex?: Sometimes
Have you ever been non-consensually hit, slapped, kicked, or otherwise physically hurt by an intimate partner or family member?: No Have you ever experienced emotional abuse from an intimate partner or family member?: No Have you ever been forced into sexual activities against their will?: No |
Trevor comes in complaining about severe abdominal pain. How would you approach this situation? What are some things you would keep in mind?
| Excerpts from Patient Intake Form |
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General Information Preferred Name: Trevor Pronouns: he/him Birthday: 01/09/87 Primary Language: English Gender Identity: male Assigned Sex: female Name on Insurance: Tiffany Li Sex on Insurance: female |
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Other Demographics Race/Ethnicity: Asian, White Sexual Orientation: heterosexual I live in: housing instable Veteran?: No Seasonal agricultural worker?: No |
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Medical History Surgeries: none
Have you ever taken hormone replacement?: Yes If yes, what do you take?: testosterone injections Have you ever gotten a period?: Yes How frequently do you get a period?: every 30 days
Are you on birth control?: No Are you interested in discussing birth control methods today?: Yes
Have you ever had sex with another person?: Yes Are your interested in discussing sexual health today?: Yes In your lifetime, your sexual partner(s) have been: cisgender women Currently, your sexual partner(s) are: cisgender women Are you practicing safer sex: No
Have you ever been non-consensually hit, slapped, kicked, or otherwise physically hurt by an intimate partner or family member?: Yes Do you want to discuss this today?: Yes Have you ever experienced emotional abuse from an intimate partner or family member?: Yes Do you want to discuss this today?: Yes Have you ever been forced into sexual activities against their will?: No |
Javier comes in with a rash on his genitalia. He is worried that he has contracted a sexually transmitted infection. How would you approach this situation? What are some things you would keep in mind?
| Excerpts from Patient Intake Form |
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General Information Preferred Name: Javier Pronouns: he/him Birthday: 09/09/91 Primary Language: Spanish Gender Identity: man Assigned Sex: male Name on Insurance: Javier Chavez Sex on Insurance: male |
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Other Demographics Race/Ethnicity: Filipino Sexual Orientation: gay I live in: apartment Veteran?: Yes Seasonal agricultural worker?: No |
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Medical History Surgeries: none
Have you ever taken hormone replacement?: No Have you ever gotten a period?: No
Are you on birth control?: No Are you interested in discussing birth control methods today?: No
Have you ever had sex with another person?: Yes Are your interested in discussing sexual health today?: Yes In your lifetime, your sexual partner(s) have been: cisgender men, transgender men Currently, your sexual partner(s) are: transgender man Are you practicing safer sex: Sometimes
Have you ever been non-consensually hit, slapped, kicked, or otherwise physically hurt by an intimate partner or family member?: No Have you ever experienced emotional abuse from an intimate partner or family member?: No Have you ever been forced into sexual activities against their will?: Yes Do you want to discuss this today?: No |
Yasmin has been feeling anxious and depressed. How would you approach this situation? What are some things you would keep in mind?
| Excerpts from Patient Intake Form |
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General Information Preferred Name: Yasmin Pronouns: they/them Birthday: 05/05/97 Primary Language: Arabic, English Gender Identity: transfeminine Assigned Sex: male Name on Insurance: Rashid El Amin Sex on Insurance: male |
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Other Demographics Race/Ethnicity: Iranian Sexual Orientation: lesbian I live in: dorm Veteran?: No Seasonal agricultural worker?: No |
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Medical History Surgeries: appendectomy (2010)
Have you ever taken hormone replacement?: No Have you ever gotten a period?: No
Are you on birth control?: No Are you interested in discussing birth control methods today?: No
Have you ever had sex with another person?: No Are your interested in discussing sexual health today?: No
Have you ever been non-consensually hit, slapped, kicked, or otherwise physically hurt by an intimate partner or family member?: No Have you ever experienced emotional abuse from an intimate partner or family member?: No Have you ever been forced into sexual activities against their will?: No |
Case Scenario 1: Em
Beyond respecting Em's name and pronouns, information related to hir gender identity and sexual orientation is irrelevant to treatment. Avoid "trans broken arm syndrome," or assuming that all trans people's health concerns are related to their gender identities (For more information, check out this article). A cold is just a cold regardless of the gender identity that a person has!
Case Scenario 2: Hannah
Hannah is an intersex woman, which might have multiple impacts on her general healthcare. It might be important to learn more about Hannah's diagnosis (e.g. what specific difference of sexual development that she has been diagnosed with, if any). In general, when you are asking her for information on her health, keep in mind that many intersex people have had many negative -- often traumatic -- experiences in medical contexts. Establishing trust and respecting patient agency is extremely important. At the same time, be careful not to make assumptions about Hannah's experiences and her relationship to her body. What's most important here is listening and working together with Hannah to provide the best care possible.
Because Hannah was born in the early 60s, there is a good likelihood that she experienced treatment for being intersex under the "concealment-centered model." This might mean that certain information about her health was not disclosed to her, including specific diagnoses, medical procedures that have been performed, etc. (For more information, see LGBTQIA+ Interactions with Providers). Hannah's anatomy might differ from that of a dyadic (not intersex) cisgender woman. For example, she may not have ovaries.
In terms of Hannah's sexual health, remember not to make assumptions about the types of activities that she might be engaging in based on the genders of her partners. Create an open environment to discuss her sexual activity and to provide useful information about things like barrier methods (internal and external condoms, dental dams, lubricants, etc.) and STI testing.
Case Scenario 3: Trevor
Trevor is a trans man. He is on hormone replacement therapy, and he has not had any surgical procedures, including gender affirming surgery. Trevor menstruates every month according to his record (testosterone does not always stop one from menstruating, nor does it necessarily prevent pregnancy in people who have a uterus).
Because Trevor's sexual partners have been cisgender women, he is not pregnant (even though he might have the capacity to become pregnant depending on the anatomy of potential partners). That said, because he is complaining of abdominal pain, you still likely will have to ask questions about things like his menstrual cycle.
Here, it is very important to not gender anatomy. If you are referring to the uterus, do not call the organ something like a "female body part." Trevor is not a woman, so that type of language could produce dysphoria. Just refer to the parts of the body by their names (e.g. uterus, cervix, etc.) or as anatomy in general (not "male anatomy" or "female anatomy"). Be careful with how you talk about the need to do different exams or prodecures. For example, instead of saying "Women should have regular PAP smears for cervical abnormalities," you could say "People who have cervixes should have regular PAP smears for cervical abnormalities." In general, avoid referring to these exams as "gynecological exams" or "well-women exams" at your office. This might deter people who have cervixes from seeking an exam in the first place. Instead, use the language of "pelvic exam."
Not all trans people experience dysphoria about their bodies; however many do. While talking to and examining Trevor, keep this in the back of your mind. Establish trust and respect patient autonomy. This might include asking Trevor how he refers to his different body parts or things like menstruation. For example, instead of saying that he "has a period," Trevor might call this "bleeding" once a month. As a provider, you can respect Trevor's language preferences while still providing him with information about his health.
Case Scenario 4: Javier
In addition to establishing trust with Javier and respecting his agency, remember not to make assumptions about the types of sexual activities that he might be engaging in based on the genders of his partners. Create an open environment to discuss his sexual activity and to provide useful information about things like barrier methods (internal and external condoms, dental dams, lubricants, etc.) and STI testing.
If Javier's partner is a transgender man, you might want to also discuss pregnancy prevention with him. Depending on the sexual activities they are engaging in and the anatomy of he and his partner, there is a chance that his partner could get pregnant. This is true even if his partner is on testosterone, which is a common misconception about HRT.
Case Scenario 5: Yasmin
While being transgender or queer can impact people's experiences of anxiety and depression, be careful to not make assumptions that this is always the case or that experiences of identity are the same for every person who is LGBTQIA+. Also do not make assumptions about Yasmin's experience based on her ethnicity and background. Here, the most important thing to do is to listen to what Yasmin is identifying as stressful or upsetting. You should have resources and advice available to her that are inclusive of LGBTQIA+ folks.
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