Everyone deserves excellent non-biased, non-judgmental, LGBT-affirming care. Seeing practitioners who are part of the LGBT community can heighten the relationship and improve outcomes. We can all maximize our health care by understanding our own personal needs and desires, with constant reevaluation and reassessment.
During the aging -- or should I say, maturing -- process, change recalibrates one's expectations, and without constant analysis, we may never reach our true potential. Here's what you should consider in order to maximize your sexual health consultation and care:
An Open and Honest Doctor-Patient Relationship
First and foremost, it is important to define your doctor-patient relationship. The true understanding of individuals comes through open lines of communication. As patients, we tend to put up so many barriers. But we need safe outlets where we can receive high-quality gender- and sexual-specific care. A true and honest relationship lends itself to the delivery of unsurpassed health care.
That being said, our country is so divisive in the care one receives that responsibilities tend to fall on the patient, demanding a practitioner with a comprehensive understanding of all the sensitivities and concerns that fall within the LGBT community.
All facets of your health -- be it psychological, social, or physical -- should be evaluated at least yearly, if not more, depending upon one's risk. If this is lacking or missing, then find another practitioner who hits the mark. There are many accessible medical leaders, and now with websites -- like Lighthouse LGBT -- highlighting sex-positive professionals, the move is yours to make. Trust me, you will not be disappointed.
Your Sexual History: What the Doc Needs to Know
The cornerstone of the mind, body, and spirit lies within one's sexual history. All the rest of the medical analytics are routine and standard across the profession, with limited standard deviation on the care one receives. Yet, the sexual taboo continues to be in full force in my profession and it is incumbent upon the client to be educated on the appropriate questions one should ask.
This ranges from defining one's sexual interests and desires to functional and risk assessments, all helping to minimize any harm or disease. The Centers for Disease Control and Prevention has developed a simple categorization of sexual history questions to paint an accurate picture of what should be the gold standard of evaluation. It's "The Five P's For Sexual Behavior History Taking." Let's break it down.
PARTNERS These questions are related to who your sexual partners are, how many partners you've had within a specified period of time; whether you're single, monogamous, or open; and whether you've experienced any form of abuse.
PRACTICES AND PROTECTION FROM STIs This includes detailed questions about the kinds of sex and sexual acts you participate in, and safer sex practices, preparation, and exploration.
PRACTICES: SUBSTANCE USE DURING SEX These questions are about substance use and whether alcohol or drugs play a part in your sexual habits.
PAST HISTORY OF STIs This includes detailed questions about STI positivity testing and treatment with a focus on any medical conditions stemming from STIs, along with education, prevention, and discussion of treatments, like the implementation of PrEP.
PREGNANCY PLANS These questions are about pregnancy: education, planning, and prevention, without any LGBT assumptions.
The Yearly Must-Haves
Once the full sexual history is complete and everyone is satisfied that an appropriate understanding with risk assessment has been reached, the next steps fall within the actual physical exam, all to build on prevention or restoring one's assets. The sexual exam is focused on an understanding that people are anal and oral individuals, and those with a vagina are vaginal individuals as well. This is what standardized care should be.
* Human Papilloma Virus (HPV) vaginal (for anyone with a vagina) and anal screening (for anyone who has anal sex) with anal pap smear. And, for high-risk HPV subtypes detected, a new anal chromosomal testing (called Terc-Fish), all for HPV analysis and cancer screening, prevention, or detection. For those with a vagina, a pap smear can be combined to screen for cervical health and HPV.
* Complete high-resolution microscopic external and internal anal canal inspection, allowing for detection of any localized issues (e.g. hemorrhoids, skin tags, warts, pre-cancer changes, or fissures).
* Full anal sphincter evaluation for optimizing and maintaining function or understanding limitations of engagement (pain on entry) or overall increased laxity (decreasing sensations or stimulation).
* Oral HPV sampling and assessment with oropharyngeal cancer screening, prevention, and treatment.
* Complete dermatological evaluation, specifically focusing on sexual contact regions.
* Full STI panel including HIV: blood and urine; swabs of oral, anal, vaginal, and penile orifices.
* Evaluation for vaccinations and administration, if necessary (if negative for high-risk HPV subtypes, one may benefit from being administered the HPV 9 talent vaccine, even if over the age of 26).
Armed with a detailed understanding of a patient's sexual needs and behaviors, as laid out above, a doctor or physician can truly get a sense of their client's needs. From the information obtained, a physician can perform considerable analytics making sure the needs of the client are analyzed, treated, and maximized.
The beautiful thing about PrEP is that it mandates a full HIV evaluation every three months with the intent that the above content is constantly re-assessed and tweaked for optimization. I am a firm believer that the same standard should be held for everyone, regardless of PrEP practice, specifically if one is sexually active within the community.
I'm a huge car guy, so I always say everyone's car is or has already broken down at one point in time, but having the full story and holding practitioners accountable for their lack in sensitivities or limited history and examinations is a must. We, as the LGBT community, must take responsibility for our actions -- and the time is now.
At Bespoke Surgical, we are taking on the new norm for delivering superlative, sex-positive care with data and analytics to substantiate one's practice, all with the intent for long-lived enhanced experiences. Here are three things you can't forget:
* Find a doctor you feel comfortable opening up to.
* Make sure you are honest and detailed about your sexual history and current habits.
* Demand standardized testing, treatment, and care with constant reevaluations.