For LGBTQ+ people there can be an extra worry when going to see their GP, a sexual health clinic or another healthcare practitioner: should I tell them about my sexuality or gender identity?
'Coming out', or telling people about your sexuality or gender identity, is a very personal decision and each person's experience is different. For some, it's not a big deal, whereas it can be life changing for others. Some people don't feel the need to come out at all. One place it can be tricky to decide whether or not to disclose this personal information is in a health setting.
The LGBT in Britain - Health Report from LGBT charity Stonewall found that one in five LGBTQ+ (lesbian, gay, bisexual, transgender and queer) people aren't out to anyone in healthcare about their sexuality. And the same proportion of trans people aren't out to anyone about their gender when seeking medical care. LGBTQ+ people from ethnic minorities are even less likely to have told a healthcare practitioner. One in four aren't out to anyone about their sexual orientation.
For some, the reason for not telling their doctor was it didn't seem like necessary information to disclose - which was particularly common among bisexual people. Others didn't tell a healthcare professional for fear of discrimination. One in seven LGBTQ+ people and around a third of trans and non-binary people have avoided treatment for this reason.
Do I really need to tell my doctor?
"Someone's sexual orientation or gender identity may have an impact on their health needs, so as long as a person feels safe to do so, it's a good idea to share this with a doctor or healthcare professional. However, many LGBT people do not feel comfortable sharing this with healthcare staff, and coming out is not something that anyone should ever feel pressured or forced into doing," explains Laura Russell, Director of Campaigns, Policy and Research at Stonewall.
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, agrees. "A patient's sexuality or gender identity can potentially have an impact of some aspects of their healthcare, so it's certainly useful for a GP to be aware of this when we are making a diagnosis or advising on treatment, but it should always be the patient's choice whether they disclose this information. GPs and our teams are highly trained to have non-judgmental conversations about all sorts of issues that might be affecting a person's health and well-being, so we would encourage our patients to tell us anything that they think might be relevant."
There are certain health risks which are more prevalent in the LGBTQ+ community, including mental illness, alcohol and drug misuse, and smoking. Gay and bisexual men are at a higher risk of HIV and certain other sexually transmitted infections. Bisexual women and transgender people experience domestic violence at a much higher rate than the general population and LGBTQ+ people make up a disproportionate amount of the homeless population.
Many of us will see a healthcare professional at some point about our sexual health. For LGBTQ+ people who have sex with people of the same sex, pregnancy prevention is not a concern. But you may be at risk of certain sexual health problems. Your doctor or healthcare professional can make a more accurate diagnosis of your problem if they know that you have a same-sex partner and can offer you tailored sexual health advice.
Coming out to your doctor can also help them to make your visit more comfortable. For transgender and non-binary patients, it may be necessary to disclose gender identity and birth sex as many health conditions have different symptoms depending on sex. You may also still have your name and gender given to you at birth on your medical records and need to make your healthcare professional aware of your preferred pronouns and name. Additionally, you will need to tell your doctor if you do not identify with the gender you were assigned at birth and you are seeking treatment for gender dysphoria.
How do I come out to a healthcare professional?
If you choose to disclose your sexual orientation or gender identity to a healthcare professional, there are ways to make it less stressful.
Treat it as a matter of fact. Doctors and healthcare professionals see many people from all backgrounds every day and are used to professionally handling personal and sensitive information. Finding the right doctor can make coming out easier.
Bring someone with you
You might feel more comfortable if someone you trust can attend the appointment with you for support. This might be a friend, family member or partner. If you are attending an appointment with your partner, you may find that a healthcare professional assumes that you are siblings or friends. Introducing them as your partner is a way to 'come out' which doesn't involve disclosing your sexuality. You can also use your partner's pronouns when referring to them if they are not there.
Consider pronoun tools
Some trans and non-binary people use tools like pronoun badges (which say 'she/her' or 'they/them', for example) to indicate their preferred pronouns and gender to others. Telling your doctor, "Please could you refer to me using he or him" or "I identify as non-binary" can also open a conversation about your gender identity.
Bring a list of questions
You might prefer to write down a list of relevant questions to give to your doctor so that you don't forget anything. For example, "I am interested in HIV prevention and PrEP. Could you tell me more about it?"
Find an inclusive service
Some health services (especially mental health and sexual health) can offer LGBTQ+ specialised appointments which are more equipped to deal with specific needs. Asking other LGBTQ+ people in your area which services or practices they use can help you to find out which services are the most inclusive. If you are booking over the phone you can ask whether the healthcare professional has experience dealing with LGBTQ+ patients.
The LGBT Foundation has created a Pride in Practice accreditation award to help patients and providers be reassured they are offering inclusive care. The scheme offers support, training and resources to primary care services such as GPs and pharmacies. Practices are assessed and may be given a bronze, silver or gold plaque to tell service users that it is an LGBTQ+ inclusive service.
If you are worried about your safety or concerned that information about your sexuality or gender identity might make it back to friends or family through your doctor, you can make the healthcare professional or receptionist aware of your concerns beforehand. They have a duty of care which covers patient confidentiality. You don't necessarily have to see your family GP if you would feel more comfortable talking to someone else.
"Patients can be reassured that general practice is a safe space and anything they tell their GP is completely confidential," says Stokes-Lampard. Healthcare professionals themselves are from a wide range of backgrounds and may be able to relate to your experience, she explains. "The Royal College of GPs is a diverse and inclusive College and we are very proud of our strong LGBT+ community of doctors, patients and staff."
All LGBTQ+ people are protected from discrimination by law. The Equality Act 2010 protects everyone from discrimination based on sexual orientation or gender identity. If you are discriminated against or mistreated, you can file a complaint. You can also switch doctors if you feel uncomfortable or disrespected.
Don't allow negative experiences to get in the way of your healthcare or accessing screenings. Find a GP or healthcare professional you feel comfortable speaking to about your sexuality or gender identity so that you can get the treatment that you need.