You are in: eMedicine Specialties > Pediatrics: Developmental and Behavioral > MEDICAL TOPICS Sexuality: Sexual OrientationArticle Last Updated: Jun 12, 2006AUTHOR AND EDITOR INFORMATIONSection 1 of 9
  Author: David S Reitman, MD, Department of Adolescent and Young Adult Medicine, Instructor in Pediatrics, Children's National Medical Center David S Reitman is a member of the following medical societies: American Academy of Pediatrics Editors: Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School; Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine Author and Editor Disclosure Synonyms and related keywords: sexual orientation, homosexual, homosexuality, gay, gayness, bisexual, bisexuality, lesbian, lesbianism, GLB INTRODUCTIONSection 2 of 9
  Teenagers who are gay, lesbian, or bisexual (GLB) face a variety of challenges during their adolescent years and are at greater risk for substance abuse, depression, suicide, and sexually transmitted diseases (STDs) than their peers who are heterosexual. The first contact with a professional in the medical field for the teenager who is GLB is often the pediatrician, family practitioner, or internist. Many healthcare professionals provide medical care to teenagers who are GLB far more often then they realize. The practitioner's knowledge and sensitivity regarding sexuality issues strongly influences the patient's comfort level in seeking optimal health care in the future. In the 1950s, Kinsey conducted the first modern sexuality studies. He concluded that by the time an individual is aged 20 years, nearly 28% of young men and 17% of young women had at least 1 homosexual experience. Approximately 10% of those polled considered themselves to be predominantly homosexual. In 1993, Diamond and colleagues performed a review of studies conducted with various populations and concluded that the prevalence of predominant homosexual attraction was lower than Kinsey had predicted. Diamond concluded that 5-6% males and 2-3% females considered themselves to be GLB. In 1990, Ramafedi et al conducted the Demography of Sexual Orientation in Adolescents study. Using the Minnesota Adolescent Health Survey, they polled 34,706 middle and high school students from diverse socioeconomic and cultural groups in Minnesota. Researchers included 5 items concerning sexual fantasies, behaviors, attractions, behavioral intent, and labeling of sexual orientation. Data revealed that the percentage of teenagers reporting primarily GLB attractions increased with age (6.4% when aged 18 y), and uncertainty of sexual orientation decreased with age (8.9% when aged 18 y). Fewer than 33% of subjects with predominantly homosexual fantasies, attractions, or behaviors actually identified themselves as homosexual or bisexual. This figure suggests that most adolescents who might be experiencing same-sex attractions are reluctant to label themselves as GLB. Today, most studies regarding the prevalence of homosexuality involve adult subjects (5-10%), but these figures also appear to be consistent with the available data concerning adolescents. THEORIES ABOUT GAY, LESBIAN, AND BISEXUAL SEXUALITYSection 3 of 9
No specific biological or psychosocial factors have been identified that determine why some individuals develop sexual attraction toward members of the same sex. For decades, researchers have asked the question of whether biological or social factors play the greater role in development of sexual attraction, without reaching a consensus. Freud's theory attributes homosexual development in males to a family unit in which the adolescent has a strong relationship with his mother and a conflicted hostile relationship with a domineering father. According to this theory, the outcome of this classic unit is failure by the adolescent to resolve critical psychosexual issues, leading to the development of homosexual attractions and identity. No data exist to document the validity of the above theory of gay, lesbian, or bisexual (GLB) sexuality made many years ago. Biological theories regarding GLB sexuality attempt to link sexual orientation with DNA markers on the X chromosome or to demonstrate that in utero maternal hormones have an effect on sexual orientation. Other theories attempt to show that the brain of the male who is GLB is anatomically different from that of the male who is heterosexual. Studies show a concordance of sexual orientation in male twins who are raised apart, lending support to the idea that biological factors contribute greatly to the development of sexual orientation. Likewise, Bell and colleagues conducted a study of 1500 individuals identified as gay and lesbian through detailed interviews involving various aspects of their childhood environment, including parental relationships. They concluded that adults who are GLB and adults who are heterosexual had almost identical familial and sociological upbringing. To date, research studies suggest that aspects of homosexuality likely are linked to genetic factors. DEVELOPMENTAL STAGES OF GAY, LESBIAN, AND BISEXUAL ADOLESCENTSSection 4 of 9
Teenagers who are gay, lesbian, or bisexual (GLB) are overwhelmingly similar to their peers who are heterosexual in overcoming the regular struggles of adolescence. However, they may face additional challenges from parents, religious leaders, and friends who do not accept homosexuality. Trying to keep their sexuality hidden from close friends and family members can lead to a profound sense of isolation. Unfortunately, some teenagers have little access to positive information regarding their homosexuality, and other teenagers are unwilling to obtain information for fear of being discovered. In 1988, Troiden published a framework for understanding the developmental processes experienced by adolescents who are GLB. These milestones are not age specific, but they constitute a general guide to comprehending the experiences of teenagers who are GLB as they become aware of their sexual inclinations. Stage 1 - Sensitization Many persons who are GLB recall feelings of being different from their peers of the same sex during early and middle childhood. Such feelings were nonspecific and nonsexual in nature. Stage 2 - Identity confusion During early and later adolescence, sexual attraction toward members of the same sex begins, often occurring with the absence of attraction toward the opposite sex. Some teenagers who are GLB start sexual experimentation. Over the past 10 years, the Internet has emerged as a significant resource for these adolescents, as they can enter chat rooms to network and share concerns with other teenagers who are GLB without having to disclose their identity. Although the teen may view anonymity as a benefit, the use of these Internet chat rooms can lead to risky sexual practices or even to sexual exploitation by adult predators. Teenagers in this developmental phase may try to deny or change their homosexual feelings; some may display outward hostility toward persons who are GLB, sometimes to the point of harassment or violence. This distancing from the acceptance of sexual orientation is termed dissociation, and acting "macho" to the level of antisocial behavior is termed signification. Obviously, these actions are used as a way of hiding an individual's own feelings. Teenagers who have identified themselves as homosexual, or having same-sex attraction, are at higher risk for depression, substance abuse, and suicide attempts. Teenagers who deny their homosexuality or bisexuality to the outside world (ie, "in the closet") expend tremendous amounts of energy hiding and denying their sexual inclinations; some may channel much of their energies into excelling in academics, athletics, or other endeavors. Stage 3 - Identity assumption This stage, in which teenagers begin to define themselves as GLB, occurs during late adolescence (aged 18-21 y). Adolescents may disclose their sexual orientation to their friends, or they may have several discrete sets of friends, including a set that is aware of their orientation and another set that is not aware. Occasionally, the teen may cultivate an extensive network of online friends, who consist of other teenagers who are GLB who communicate almost exclusively through Internet chat rooms. Whether they disclose their sexuality (ie, "come out") voluntarily or are discovered, teenagers who are GLB are at risk of rejection from peers and family members, which makes them more likely to run away from home. Adolescents who are exposed to harassment and physical abuse in school are most likely to drop out of school. In some instances, teenagers who are GLB may be expelled from their homes, placing them at higher risk of prostitution and substance abuse. Resourceful teenagers may begin to associate with other persons who are GLB in support groups or social settings. Stage 4 - Commitment As teenagers who are GLB reach young adulthood, many realize acceptance of self and identify more with the community of individuals who are gay. Disclosure to family members usually occurs during this period. Once a young adult has accepted his or her sexual orientation, relationships with true intimacy become a more likely possibility. ROLE OF THE PEDIATRICIAN IN CARING FOR GAY, LESBIAN, AND BISEXUAL PATIENTSSection 5 of 9
The role of the pediatrician is to provide a safe and confidential environment in which adolescents feel free to discuss issues of sexuality, mental health, and substance abuse. Clinicians must develop a comfortable manner when asking adolescents about sexuality, phrasing questions in a nonjudgmental and open-ended fashion. For example, asking, "Are you dating anyone?" is preferable to asking, "Do you have a girlfriend?" If a pediatrician feels reluctant or unable to ask questions and support adolescents who are gay, lesbian, or bisexual (GLB), he or she is obliged to make a referral to a colleague or another professional who has personal comfort and experience in this area. Conversely, physicians who are comfortable caring for teenagers who are GLB should be sure to refer subspecialty physicians who are likewise comfortable working with these patients, when indicated. Disclosure of a teenager's homosexuality by a health professional to his or her parents without the teenager's permission is a violation of confidentiality. Such disclosures may lead to catastrophic consequences in the teenager's life, including depression and suicide, physical and emotional abuse, and homelessness. A provider who is unable to offer confidential care to a patient who is GLB must refer the patient to another provider without informing the parent of the sexual orientation of the teenager. The American Academy of Pediatrics Statement on Homosexuality recommends that pediatricians who care for teenagers understand the unique medical and psychosocial issues facing youth who are GLB. A working knowledge of the terms describing the sexuality of an individual is also important. Below are a number of definitions that may be used to help clarify various aspects of sexuality.
CLINICALSection 6 of 9
History
Physical
WORKUPSection 7 of 9
Laboratory evaluations
MISCELLANEOUSSection 8 of 9
Medical/legal pitfalls
Patient education
REFERENCESSection 9 of 9
Sexuality: Sexual Orientation excerpt Article Last Updated: Jun 12, 2006 |
