Sex Talks With Doctors Vary by Patients' Sexual Orientation

— Findings highlight need to normalize sexual health discussions among all patients, expert says


Male patients who identified as gay or bisexual were more likely to have discussions with their clinicians about sex compared with patients who identified as straight, a researcher reported.

Healthcare providers asked a higher proportion of patients who identified as bisexual or homosexual, compared with those who identified as heterosexual, about how many sexual partners they had, about sexual orientation and activity, and about condom use, reported Jenna Reich, a medical student at NYU Grossman School of Medicine in New York City, and colleagues.

Patients who were homosexual were also more likely to be tested, diagnosed, or treated for a sexually transmitted infection (STI) within the last year, Reich said in a presentation at the .

"Contrary to previous literature, men who identified as homosexual/gay or bisexual reported a higher likelihood of being asked questions about sexual health practices," Reich said, adding that further studies are necessary to better understand what drives higher rates of discussion among these populations.

Amy Pearlman, MD, of the University of Iowa Healthcare in Iowa City, who was not involved with the study, told app that while it's interesting to see that people who identify as gay or homosexual are asked more about sex, she was not surprised.

"I think this means that we have to do better with our heterosexual men. We as providers have to feel more comfortable asking about sexual health," she said.

Pearlman added that clinicians' discussions with patients about sex should not be limited only to questions about whether patients are sexually active. Normalizing the conversation around how patients have sex, who they have sex with, and whether or not they want to be tested for STIs should all be routine, she said. "It's really important to ask for those specifics."

She noted that there have been few studies about patient-provider discussions involving sex -- especially from the patient perspective.

Reich said the analysis by her team is the first to evaluate how sexual orientation impacts patient-provider conversations about sex in a national cohort.

The researchers used data from the CDC's , which evaluates sexual health, contraception use, and family planning throughout the U.S.

Respondents were categorized based on their self-reported sexual orientation: homosexual, heterosexual, or bisexual. Answers to questions about health services and discussions with providers were compared among the three groups.

The researchers analyzed nearly 14,000 survey participants. More than 90% of the men identified as straight, about 2% as gay, and 2% as bisexual. Race and ethnicity did not differ significantly between the three groups, and most respondents were white. Men who identified as bisexual were 24 years old on average, while those who identified as gay or straight averaged about 29.

Approximately one-third of men who identified as gay said they'd been asked by providers about how many sex partners they had, compared with 13% of straight men and 20% of bisexual men. Some 40% of homosexual men, 26% of bisexual men, and 15% of straight men had been asked about their condom use.

About 45% of homosexual patients were asked if they had STI tests within the past year, compared with 24% of bisexual men and 14% of heterosexual men. About 12% of patients who identified as gay were asked about STI treatment, compared with 5% in the bisexual cohort and 2% in the heterosexual group.

Study limitations, the researchers said, included that while the survey had a large sample size, there was a small subset of patients who identified as homosexual or bisexual. Additionally, the analysis did not control for actual sexual behaviors.

  • Amanda D'Ambrosio is a reporter on app’s enterprise & investigative team. She covers obstetrics-gynecology and other clinical news, and writes features about the U.S. healthcare system.


Reich and co-authors did not report any relevant relationships with the industry.

Pearlman did not disclose any conflicts related to her comments.

Primary Source

Sexual Medicine Society of North America

Reich J, et al "How Sexual Orientation Effects Sexual Health Discussions and Care with Providers: A Study Using the National Survey for Family Growth 2011-2017" SMSNA 2020; Abstract 010.