Screening Questions
GLBT people are sometimes reluctant to come out to their health care providers. Regardless of the reasons for this reluctance, it is incumbent on health care providers to make it possible for their GLBT patients to reveal their sexual orientation and gender identity, without fear of discrimination or reprisal.
Sexual orientation is a vital piece of any person’s health history as part of getting to know who they are as an individual. It is also important to ask for a comprehensive sexual history. Without knowing anything about a person’s sexual history, health care providers don’t necessarily ask the right questions, order the right tests, or interpret unexpected symptoms correctly. For example, without asking direct questions about sexual behaviors and risks, a doctor might not realize that a male patient is bisexual and should be screened for HPV (with an anal Pap smear and rectal exam). Without knowing that a woman is a lesbian, a doctor might mistakenly attribute symptoms of anxiety and depression to PMS, rather than to harassment, stigma, or isolation related to the woman’s sexual identity.
Language has power. Words do matter. Using words that people find offensive implies a lack of respect—that much is obvious. Yet using only words that don’t apply to a segment of your patient population—GLBT people or otherwise—means that you exclude them from the conversation. Even when it is unintentional, it still has the effect of marginalizing that group.
One way to create an inclusive environment is to include questions about sexual orientation/gender identity when you are taking the patient’s health history. What’s more, simply changing the way these questions are framed signifies that your practice is GLBT-friendly and that you want to count GLBT people among your patients.
The Gay and Lesbian Medical Association has developed a list of screening questions that you may want to add to your standard patient intake and health history forms. They are listed below for your convenience. Be sure to use these questions while you are taking an oral patient history, too.
Legal name
Name I prefer to be called (if different)
Preferred pronoun?
She
He
Gender (Check as many as are appropriate)
(An alternative is to leave a blank line next to “Gender,” to be completed by the patient as desired.)
Female
Male
Transgender
Female to Male
Male to Female
Other
Other (leave space for patient to fill in)
Are you sexually active?
Are your current sexual partners men, women, or both?
In the past, have your sexual partners been men, women, or both?
Different sex acts have different health risks associated with them. What types of sexual acts do you participate in (ex: oral-genital, oral-anal, vaginal, anal receptive/insertive)?
What is your current relationship status? Do you have a significant other? (An alternative is to leave a blank line next to “current relationship status” so that the patient can fill it in as desired.)
Single
Married
Domestic Partnership/Civil Union
Partnered
Involved with multiple partners
Separated from spouse/partner
Divorced/permanently separated from spouse/partner
Other (Leave space for patient to fill in)
Living situation
Live alone
Live with spouse or partner
Live with roommate(s)
Live with parents or other family members
Other (Leave space for patient to fill in)
Children in home
No children in home
My own children live with me/us
My spouse or partner’s children live with me/us
Shared custody with ex-spouse or partner
How do you self-identify?
Bisexual
Gay
Heterosexual/Straight
Lesbian
Queer
Other (State “please feel free to explain” and leave space for patient to fill in)
Not Sure
Don’t Know
What safer sex methods do you use, if any?
Do you need any information about safer-sex techniques? If yes, with:
Men
Women
Both
Are you currently experiencing any sexual problems?
Do you want to start a family?
Are there any questions you have or information you would like with respect to starting a family?
Do you have any concerns related to your gender identity/expression or your sex of assignment?
Do you currently use or have you used hormones (e.g., testosterone, estrogen, etc.)?
Do you need any information about hormone therapy?
Have you been tested for HIV?
Yes
Most recent test (Space for date)
No
Are you HIV-positive?
Yes
When did you test positive? (Space for date)
No
Unknown
Have you ever had any sexually transmitted infections?
Bacterial Vaginosis
Chlamydia
Gonorrhea
Herpes
HPV/human papilloma virus (causes genital warts and abnormal Pap smear)
Syphilis
None
Have you ever been diagnosed with or treated for hepatitis A, B, and/or C?
Hepatitis A
Hepatitis B
Hepatitis C
Have you ever been told that you have chronic hepatitis B or C, or are a “hepatitis B or C carrier?”
If yes, which and when?
Have you ever been vaccinated against hepatitis A or B?
Vaccinated against hepatitis A
Vaccinated against hepatitis B
Below is a list of risk factors for hepatitis A, B, and C. Check any that apply to you.
Sexual activity that draws blood or fluid
Multiple sex partners
Oral-fecal contact
Sexual activity during menstrual period
Travel extensively
Dine out extensively
Tattooing, piercing
Use intravenous or snorted drugs
Ever been diagnosed with or treated for an STD
Close contact with someone who has chronic hepatitis B or C
None apply
Not sure if any apply
Source:
Gay and Lesbian Medical Association, “Guidelines for Care of Lesbian, Gay, Bisexual, and Transgender Patients,” January 2006.