When providing contraceptive counseling to lesbian, gay, bisexual and transgender patients, providers should take care to establish rapport and use patients’ preferred name and gender pronoun. Especially for transgender patients, ask the patient how they would prefer to refer to their body parts, and use that language.

Reproductive health care should focus on behavior rather than identity. Specific sexual behaviors may result in unplanned pregnancy, with no regard for categories/groups. For example, transgender men and transmasculine patients may be able to conceive, even while taking testosterone. The copper IUD or other non-hormonal methods would be good contraceptive options for patients who are on testosterone.

Adolescents who have sex with both sexes have higher rates of unplanned pregnancy than peers who have sex only with the opposite sex. Teens who have sex with same-sex partners may not identify as gay/lesbian. The discordance between identity and behavior declines somewhat with age. Providers should avoid making assumptions based on identity and instead, focus on patients’ specific needs, as determined by their behavior.

Sources

Saewyc E, Bearinger L, et al. Sexual Intercourse, Abuse and Pregnancy Among Adolescent Women: Does Sexual Orientation Make a Difference? Family Planning Perspectives. 1999; 31(3)

Bradford J, Cahill S, et al. Why Gather Data on Sexual Orientation and Gender Identity in Clinical Settings. The Fenway Institute.

Resources

Taking Routine Histories of Sexual Health: A System-Wide Approach for Health Centers. National Association for Community Health Centers. Bethesda, MD, Aug. 2014.

The National LGBT Health Education Center at The Fenway Institute

Mazzoni Center

UCSF Center of Excellence for Transgender Health

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.