Intro: This is BayCare HealthChat, another podcast from BayCare Health System.

Caitlin Whyte (Host): Welcome to BayCare HealthChat. I'm Caitlin Whyte. And today we are discussing LGBTQ wellness exams. Overall, it's pretty similar to the wellness exam for everyone else with some specific differences. Because of previous discrimination and negative interactions, many people put off preventative visits.

Patients often feel they have to teach their provider, which could be incredibly frustrating. Having a baseline knowledge and treating everyone with respect will go a long way with patient rapport. Joining us for this important conversation is Dr. Alexandra Lawson, a Family Medicine Physician at BayCare

So Dr. Lawson, let's start out this conversation with some terminology. What does LGBTQIA mean?

Alexandra Lawson, MD, MPH (Guest): That is a great question. And sometimes it can seem like an alphabet soup, but there are points to all of these terms. So, people generally know the first few, lesbian, gay, bisexual, T for transgender or transsexual. You may hear that term as well, Q for questioning. You may also hear the term queer and that has somewhat come in and out of fashion. Some people felt queer was a discriminatory term, but now it is being used a bit more. Generally I can typically mean intersex, which is not spoken about as much, A can be asexual or ally.

You may also hear pansexual. So while there's not one overall term, but you know, again, it's kind of an alphabet soup. Really the most important thing is asking the patient, what is the term, if they have a term that they use for themselves.

Host: So, we mentioned stigma in the intro, keeping a lot of people in these populations from wanting to come into the doctor. What are some ways that you and your team work to make every patient experience inclusive?

Dr. Lawson: That is absolutely so important. And actually, if you look at the youth mental health survey that was performed by the Trevor Project back in 2019, only about 30% of patients said they disclosed their sexual orientation and 29% disclosed their gender identity.

So, it's important for providers to know the difference between those terms and to normalize asking those questions. So, first it's important to know that sexual orientation is emotional, romantic or sexual attraction to other people. Whereas gender identity means does your external features, your body, match with the internal features of your gender?

So, typically if you are female sex assigned at birth, does that mean that your body is feminine and matching with that? So with CIS gender, usually your gender matches with the sex assigned at birth. If you're transgender or non-binary, that means you do not identify with the sex assigned at birth. So, one of the ways that we, as providers can really help improve this process is one, asking what is their name and pronoun. For people who are transgender or non-binary, they may not use the pronouns that are associated with the sex assigned at birth. We also often hear the term preferred name or preferred pronoun, but we like to steer away from that because saying preferred may imply that being transgender is a choice.

Host: So, what is the annual physical and why is it important not to put it off?

Dr. Lawson: That is an excellent question, because I feel like a lot of people don't completely understand what the point of the annual physical is. So, it really is time set aside for you and your doctor to discuss all the things to keep you happy and healthy. So, this is going to include, you know, what kind of foods do you eat? What's your typical diet? Do you exercise and how much, talk about all the preventative screenings, vaccines and what are your habits?

Our goal as doctors is really to prevent illness as much as possible. And if you should develop an illness or disease, our goal is to help you manage it so you can live your best life possible. Now, this can be somewhat uncomfortable, especially talking about some of the preventative screenings. So, if you're feeling anxious or uneasy, let your doctor know so they can plan accordingly, you know, most of the time we'll let you bring a support person, even with COVID restrictions.

Host: When we get to this appointment, what information is important to share up front with your physician?

Dr. Lawson: We really want you to tell us your name and pronouns. You'd be surprised that you know, most LGBTQ providers are friendly, but may not be knowledgeable. And it's definitely a push in the medical community to increase the importance of LGBTQ instruction, but it has not become standardized. But we really do want to treat you with respect and make you as comfortable as possible.

Host: And what are some ideas of questions we can ask our doctors to help streamline the process?

Dr. Lawson: Absolutely. So, for CIS gender people, you're going to basically follow the same guidelines. For transgender and non-binary people, it really does depend on your anatomy and hormones. So, to give you an example, a transgender woman who has had a vaginoplasty, or as it's more commonly known as bottom surgery; you may no longer have testicles, but you still have a prostate. So, it's very important for us to discuss what anatomy you do have

and what are the screenings that are appropriate for you? That being said, if you use different terms for your anatomy, please tell your doctor what terms you use, because we do want to be respectful. I realize sometimes for transgender men, the term vagina may be triggering. And so if you use the term third hole, for example, we want to make sure we're using the vocabulary you use.

But most preventative health screenings focus on cancer prevention and early detection, which again is why these appointments are so important. If you do develop an unfortunate disease, the chances of survival are greatly dependent on when something is diagnosed, the earlier the better. Furthermore, sexual health screenings can be an uncomfortable topic, but it's so important to be screened appropriately and discuss safe sex practices.

Unfortunately, we know that the sexually transmitted infections are higher in the LGBTQ community than the general population. And there are absolutely ways to prevent spread and protect yourself. I'm talking about more than condoms and birth control. Florida was the number one state in 2019 for new HIV cases. And there are medications like pre-exposure prophylaxis that you can take to protect yourself against HIV. So, when you're talking to your doctor about this, let them know, are your partners, men, women, or both, and what types of sex you have, whether vaginal, oral or anal. And if you use contraceptive, what type and how often you use it.

Something that most people don't consider is that men who have sex with men should actually get anal pap smears because of the concern of risk of HPV and getting the same kind of cancer that women get for cervical cancer. It's called a type of squamous cell cancer. Furthermore, for transgender men, just because you're not having periods, you still ovulate and you can get pregnant. So, it's really important to discuss contraceptives, to help prevent pregnancy, but there's even contraceptives like IUDs that can help stop menstrual bleeding. Lastly, you really want to talk to your doctor about what steps you can take to have a healthier life.

So, really keeping a balanced nutrition and making sure you exercise, which is not only important for your physical health, but also your mental and emotional. Things like the HPV vaccine are approved for all men and women up to age 45. And it's recommended for everyone at least to age 26. And of course discuss any alcohol, tobacco or drug use with your doctor, especially if you feel like it's becoming a problem because your doctor can refer you to helpful resources.

Host: Do you have any tips for navigating the health care system and finding the right doctor for you?

Dr. Lawson: So that can be a difficult process to navigate, but I do hope that it's getting simpler. Of course you can always ask your friends for doctors that they recommend. Look online at clinician bios. You know, many physicians are starting to list if they're part of the LGBTQ community, or if they're an LGBTQ friendly provider. There are some specialty clinics for the LGBTQ population as well.

If you're having a difficult time discussing this with your doctor, you are definitely not alone. And so I do want to mention a resource, there's many out there, but this one, I particularly like. I want to state that I'm not financially supported by them in any way, but something called the Q card. So, this is a simple card that folds up to be the size of a business card.

And when you open it up, it actually has blanks for my name is blank. My pronouns are blank. My sexual orientation is blank, and then it has a spot where you can put specific questions for your doctor as well. So, if you feel like telling your doctor about your sexual orientation or gender identity is very difficult for you, you can fill out this card and hand it to your doctor so that they're aware.

Host: Well, thank you so much for joining us, Dr. Lawson, and for doing the work to keep healthcare as inclusive as possible. And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information, and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast as well as all the other BayCare podcasts.

For more information, health tips, and updates, follow us on your social channels. This has been another episode of BayCare HealthChat. I'm Caitlin Whyte. Stay well.