Photo Caption: Dr. Sarah Pickle (left) and Malia Schram (right). Photos provided by UC Health

A message from The Center for Closing the Health Gap

By Dr. Sarah Pickle, Malia Schram

Editors: Pam Gruber, Carol O’Hare

Sarah Pickle, MD is a UC Health family medicine physician and associate professor in the Department of Family and Community Medicine at the University of Cincinnati College of Medicine. Malia Schram is a fourth-year medical student at the University of Cincinnati College of Medicine.

Lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ+) persons often face higher rates of stigma and discrimination in the healthcare system and poorer access to care. This leads to differences in health outcomes, including higher rates of some cancers, like cervical cancer, and higher risk of sexually transmitted infections, like the human immunodeficiency virus (HIV).

Below we will discuss some of the misconceptions related to sexual and reproductive health in LGBTQ+ persons. We recognize that there are a variety of terms that people can use to describe the areas of their bodies related to sexual health. We will use inclusive terms and describe specific organs that exist independent of an individual’s gender and sexual identities.

Myth: I identify as LGBTQ+; do I have to come out to my doctor?

Fact: You can share whatever information you feel comfortable disclosing if you feel safe to do so. Sometimes, doctors and medical offices can support individuals by connecting patients with community resources, creating an affirming experience or providing medical care specific to their identities, like gender affirming hormones.

Myth: Condoms or other barrier methods are the only way to prevent transmission of HIV from sex.

Fact: Internal and external condoms and dental dams provide important protection against multiple sexually transmitted infections (STIs). Another strategy for prevention of HIV transmission from sex is a medication called pre-exposure prophylaxis, or PrEP. When taken as prescribed, PrEP is highly effective at preventing HIV transmission from multiple types of sex and can be used by people of all genders. PrEP only prevents the spread of HIV, not other STIs. Many people who have sex are good candidates for PrEP, so talk to your doctor if PrEP is the right choice for you.

Myth: If I am over the age of 26, I am not eligible for the human papillomavirus (HPV) vaccine.

Fact: Human papillomavirus (HPV) can cause cancers of the genitals (such as anal, cervical, vaginal, vulvar, and penile cancers), cancers of the oral cavity (such as tongue, mouth and throat cancers), and genital warts. The HPV vaccine helps protect against 90% of cancers caused by HPV and prevents 90% of genital warts. Initially approved for people through age 26, it is now approved for all persons of all genders through age 45. Because there are multiple types of HPV, the vaccine is recommended even if you have tested positive for HPV in the past. HPV can be spread by the hands, genitals and mouth, so any person engaging in any form of sexual contact with another person is at risk of contracting HPV.

Myth: If I am on gender-affirming hormones, I cannot become pregnant or get someone else pregnant.

Fact: It may be possible to become pregnant or get someone else pregnant even while taking gender-affirming hormones, like testosterone or estradiol. Gender-affirming hormones may change one’s ability to get pregnant or get someone else pregnant (i.e., fertility), but taking hormones does not always prevent pregnancy.

For people who produce sperm, the number and quality of sperm may decrease over time while taking gender-affirming hormones, however, sperm could still be produced.

For people who release eggs, testosterone may stop bleeding, but it does not always prevent egg release and pregnancy could still occur. If you are using your body in a way that could result in pregnancy and you would like to prevent pregnancy, talk with your doctor about forms of birth control that are right for you. 

If you are taking gender-affirming hormones and are interested in pregnancy, talk with your doctor about ways to preserve fertility and pregnancy options.

Learn more about LGBTQ+ care at UC Health For more information, call 513-475-8000.

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