ABC of sexual health: Homosexual men and women

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Abstract
Avoiding prejudice Presumptions—When counselling gay people about sex, it is important not to have preconceived ideas about their sexual repertoire. Perhaps as many as a third of gay men choose not to practise penetrative anal sex on a regular basis,1 and the traditional division of gay men into “active” and “passive” is not born out by experience—most gay men who do have anal sex will play either role. The assumption that the passive partner is somehow less “male” or less “aggressive” is also largely a myth. Similarly, in lesbian sex either partner can be psychologically “active” regardless of whether sex play includes penetration with a dildo. Counselling gay men and women Be honest with yourself; if you are uncomfortable with gay people refer the patient to someone else If an adolescent is confused about his or her sexuality try to help the patient to adjust Do not have preconceived ideas Take the opportunity to discuss safe sex with gay men A married man or woman might benefit from couples counselling Sexual orientation is not always fixed. Some people change their mind Disapproval—The days when physicians would try to impose their own moral standards on their patients should be long past. If individual clinicians are aware that they are uncomfortable with the issues of gay sex and relationships then they should refer the patient on to somebody else. It is difficult to focus on the relevant clinical issues if you are having to concentrate on your own discomfort and trying not to express it. View larger version: In this window In a new window Lesbians may choose to be a “penetrator” in lovemaking by using a dildo and harness or other sex toys Inaccurate advice—It is unwise to advise patients on subjects that they may know more about than you do, and if anal sex is not something that you know much about it is better to admit this rather than offer inaccurate or misleading advice. Local genitourinary medicine clinics should be aware of what services are available locally and which are considered as “gay friendly” and can be used as a source of reference. Patients' reticence—Even if a doctor is comfortable with homosexual patients it does not follow that such patients are comfortable with the doctor. Gay men face practical problems, such as a future application for life insurance, which mean that some patients will not wish to disclose their sexual orientation to their general practitioner, no matter how sympathetic and confidential.

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