Table Of ContentCARING FOR LESBIAN AND GAY PEOPLE:
A CLINICAL GUIDE
Allan D. Peterkin, MD, and Cathy Risdon, MD
What should you say if your patient is struggling with her sexuality? How do
you respond to your married patient when he discloses to you his same-sex
sexual history? To which medical studies do you turn when you need to know
more about club drugs? As physicians and health professionals, you want to
provide the best possible care for your patients, but medical schools and other
health care teaching institutions do not generally provide comprehensive infor-
mation on how to approach caring for sexual-minority patients++++arin+g
Lesbian and Gay People++the first medical guide to offer busy clinicians practi-
cal, accessible, and evidence-based information to help in the care of lesbian
and gay patients.
Allan D. Peterkin and Cathy Risdon begin with an overview of the history of
medical relations with lesbian and gay patients, providing advice and guide-
lines for strengthening the doctor-patient relationship and raising the standard
of care for all patients. The book then delves into a range of specific clinical
issues, such as risk profiles for particular illnesses, screening for and managing
sexually transmitted infections, and HIV treatment in the primary care setting.
Subsequent chapters cover a wide range of topics such as mental health care
and the effect of homophobia on relationships, same-sex parenting, the role
that body image plays in health, and unique populations, such as lesbian and
gay ethnoracial minorities, the transgendered, rural lesbian and gay people,
and elders. Each chapter includes practical tips (advice on inclusive language,
for example) and summaries, along with references of written and online
resources. Comprehensive and detailed, this work covers physical and mental
health throughout the life cycle, with equal emphasis on women's and men's
health.
Based on more than twenty years of patient care and contributions to medi-
cal education and community development, this indispensable resource will
greatly heighten the quality of care that clinicians, health care practitioners, and
educators can provide to their patients, and will in turn provide patients and
consumers with the means to take an active role in their own health care.
ALLAN D. PETERKIN, MD, is an assistant professor in the Department of Psychia
try and the Department of Community and Family Medicine at the University
of Toronto.
CATHY RISDON, MD, is an associate professor and the David Braley and Nanc
Gordon Chair in Family Medicine at McMaster University.
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Caring for
Lesbian and Gay People
A Clinical Guide
Allan Peterkin, MD, and Cathy Risdon, MD
UNIVERSITY OF TORONTO PRESS
Toronto Buffalo London
www.utppublishing.com
©+U++n+iv+e+r+si+ty+ +o+f +T+o+ro+n+t+o+ P+re+s+s+ I+n+c+o+rp+o+r+at+e+d+ 2+0+0+3
Toronto Buffalo London
Printed in Canada
ISBN 0-8020-4857-9 (cloth)
ISBN 0-8020-8379-X (paper)
(oSo)
Printed on acid-free paper
National Library of Canada Cataloguing in Publication
Peterkin, Allan D.
Caring for lesbian and gay people : a clinical guide / Allan
Peterkin, Cathy Risdon.
Includes bibliographical references and index.
ISBN 0-8020-4857-9 (bound) ISBN 0-8020-8379-X (pbk.)
1. Gays-Medical care. 2. Lesbians - Medical care. 3. Gays -
Health and hygiene. 4. Lesbians - Health and hygiene. I. Risdon,
Cathy. II. Title.
RA564.9.H65P48 2003 362.1'086'64 C2002-905194-0
University of Toronto Press acknowledges the financial assistance to
its publishing program of the Canada Council for the Arts and the
Ontario Arts Council.
University of Toronto Press acknowledges the financial support for
its publishing activities of the Government of Canada through the
Book Publishing Industry Development Program (BPIDP).
For Robert.
In memorium, Dr Ron Afanasiev and Dr Kelly McGinnis
-A.P.
For Lori, Gusto, Newton, and (in memorium) Alex.
Also to Pat Kimura, Lynn Andrews, and Dave Davis for being there
during the crucial turning points. My profound thanks for the depth
of your generosity and inspiration to me.
-C.R.
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+++++++
Foreword++ix
Introduction++xi
Acknowledgment+++iii
1 Why a Clinical Guide on Lesbian and Gay Health? 3
2 Improving the Doctor-Patient / Provider-Client Relationship 13
3 Lesbians' Physical and Sexual Health 25
4 Gay Men's Physical and Sexual Health 44
5 Gay, Lesbian, and Bisexual Adolescent Physical and Mental
Health 80
6 Diagnosing and Treating Sexually Transmitted Diseases 110
7 HIV Issues 124
8 The Mental Health of Gays, Lesbians, and Bisexuals 156
9 Substance Abuse 185
10 The Body 209
11 Relationships 236
12 Special Populations 260
13 Professional and Training Issues 291
14 Legal Issues 309
viii Contents
Appendix A: Factors that May Indicate an Increase in Risk for Specific
Diseases++323
Appendix B: Sample Legal Contracts++325
References+++335
Index++367
Online resources indexed at www.glbcare.com.
Foreword
The health of a nation, physically and emotionally, can only be as good
as the health of its most vulnerable and stigmatized citizens. While
culture, class, and religion are known to affect how illness may appear
and be understood, sexual orientation has been less well researched or
understood as a mediator of health and illness. Yet, as every gay,
lesbian, or bisexual (GLB) person knows, developing a relationship
with a medical or mental health provider that truly addresses the entire
well-being of the person requires the provider not only to be tolerant
but also knowledgeable about sexual orientation and its impact on
psychological and physical health. Unfortunately, very little formal
education or training in professional schools or clinical placements
prepares clinicians with the knowledge and attitudes necessary to pro-
vide competent and compassionate care to lesbian, gay, or bisexual
people.
Being open about one's sexuality to a medical provider is especially
difficult if the patient perceives that sexuality in general, and same-sex
orientation in particular, appears to make the provider uncomfortable.
Even well-meaning providers can unwittingly create an atmosphere of
discomfort for GLB people by assuming the patient is heterosexual and
thereby forgoing the opportunity to ask the patient in a nonjudgmental
way about his or her sexual orientation. Coming out as gay, lesbian, or
bisexual over and over again in health care settings can be anxiety-
provoking and difficult even for those people who have negotiated this
process in other aspects of their lives. For young people particularly,
health care providers can provide much-needed support for integrating
sexual orientation into a positive self-image. Adolescence is an espe-
cially difficult time for GLB people, and finding a health care environ-
