Being 'OK' with talking to teens about their sexuality

Being a teenager in 2015 can be challenging…being a LGBT (lesbian, gay, bisexual and transgender) teenager in 2015 can be brutal. As I do with all of my teenage patients, I spend time speaking with them alone about personal issues. It was during this time that one of my 15-year- old patients opened up to me.

He is gay. Not only is he bullied in school for being gay, but his own father calls him derogatory names.  Once a competitive athlete, he had to stop abruptly due to a severe concussion. Weight gain resulted from his inactivity. He started restricting his eating to once a day and began vomiting after he ate.  He became severely underweight.  In addition, he began cutting himself.

Being a doctor for teenagers (and a teacher for the next generation of pediatricians) in 2015 requires sensitivity to all of these issues.  One of the first things that I point is "Never ask a girl if she has a boyfriend, and never ask a boy if he has a girlfriend." I encourage the younger pediatricians to be matter-of-fact in their questions and non-judgmental in their responses. If they can't, then it's not okay that they take care of teenagers. For all teens, there must be an opportunity for confidentiality and the environment must be unconditionally accepting. What is said in the exam room must stay in the exam room — unless the teen poses a danger to him or herself or to others or has been abused.

Here's a typical (simplified) conversation I have with a teenage girl:

Me: "I am going to be asking you some personal questions. I hope you are OK with answering them but if you're not let me know.  Let's start with your menstrual periods — can you tell me about them?" 

My patient and I talk about her menstrual periods.

Me: "Here come some even more personal questions, but you don't have to answer if you don't want to."

My patient: "OK."

Me: "Do you know if you 'like' boys, girls or both?"

My patient: "Both."

Me:"OK."

Do you know if you "like" boys, girls or both? Seems like a straightforward question, right?  It's actually quite complicated. Sexual orientation refers to whether a person's emotional and physical arousal is to people of the same or opposite sex. Sexual behavior is not always the same as sexual orientation. The process of determining one's sexual orientation involves neurologic, hormonal and physical changes. Human sexuality is a continuum between being completely heterosexual to being completely homosexual.  An adolescent may feel conflict and self-doubt about his or her sexual identity. Teens may have sex with male and female partners to test their sexual orientation — or to hide it.

"Coming out" may not be OK.  Teens may find it difficult or impossible to disclose their homosexual or bisexual feelings to their families and others because of the negative reactions, such as exclusion, harassment, discrimination and violence it may evoke. Recent studies show the average age for a teenager to "come out" is 16 years old.

Let's continue the conversation:

Me: "Do you know what I mean when I ask someone if they've had sex before?"

My patient (giggling): "Yes!"

Me: "May I ask you that personal question?"

My patient: "OK."

Me: "Have you had sex before?"

My patient: "Yes."

Me: "Was that because you wanted to or were you forced to?"

My patient: "Because I wanted to."

Me: "Have you had sex with boys, girls or both?"

My patient: "Both."

Me: "OK."

Does teenagers' sexual behavior always indicate their sexual orientation?  Adolescents may have had both heterosexual and homosexual attractions and experiences, none of which necessarily determines their sexual orientation. Studies have found that teens that will eventually identify as gay, lesbian or bisexual do not always do so during adolescence, and that sexual identity may change over time.

Why all the "personal questions?" According to the Centers for Disease Control and Prevention compared to their heterosexual peers, LGBT youth are:

Forty percent of LGBT youth are homeless mostly due to family rejection. The LGBT youth population is one of the most vulnerable groups in our community. Nearly 5-7 percent of American youth identify as LGBT, which equals roughly 2.7 million young adults.

My advice:  All teenagers, regardless of their sexual orientation, need loving and responsible adults in their lives — including parents, guardians, teachers, coaches and doctors — so they can be okay with talking about personal matters in a confidential and nonjudgmental environment.

Here are online resources for families  from Child Welfare Information Gateway and teens from Alberti Center for Bullying Abuse Prevention at University at Buffalo.

For immediate help, here are hotlines:

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