Paeds · adolescent-and-young-adult-medicine
Sexual orientation, identity and inclusive care
Also known as Inclusive care for sexual minority youth · LGBTQ+ adolescent care · Affirming paediatric care · Sexual orientation history-taking in adolescents · Minority stress in young people · SOGI data collection in paediatrics · Affirming clinical environment
Fellowship-level approach to sexual orientation, identity and inclusive care for adolescents: distinguishing sexual orientation from gender identity, expression and sex assigned at birth; the three components of orientation (attraction, behaviour, identity); the minority-stress model and why sexual minority youth carry excess depression, anxiety, suicidality and substance-use burden; affirming history-taking (HEEADSSS sexuality module), SOGI data collection and documentation; building an affirming environment and confidentiality; acute risk management (suicidality, family rejection, disclosure crisis); family acceptance; the harms of sexual orientation and gender identity change efforts; and care for Aboriginal and Torres Strait Islander, Maori, culturally diverse, rural, out-of-home-care and neurodiverse sexual minority youth.
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Red flags
- A young person who discloses a sexual minority identity and is then met with silence or curiosity rather than explicit affirmation — the encounter becomes a stressor, not a protection
- Suicidal ideation, self-harm or a sudden withdrawal in a sexual minority youth, especially after bullying, family conflict, being outed, or exposure to change efforts
- A clinician disclosing a young person's sexual orientation to parents or others without the young person's consent — involuntary outing can precipitate a crisis
- Sexual-health advice (contraception, STI screening) withheld or misdirected because orientation was assumed from a partner's gender
- Pressure on a young person to undergo, or remain in, sexual orientation and gender identity change efforts ('conversion practices') — these are harmful and never appropriate
- A sexual minority youth whose family has rejected them now avoiding care or presenting with housing instability
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Adolescent Medicine
- Professionalism and Ethics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 19: Ethics and professional behaviour
- Renewed curriculum for first-year trainees from 2027 — Learning goal 9: Diversity, equity and inclusion; cultural safety
- Long Cases
- Communication
- Ethics and Professional Practice
- 1. Professional values and behaviours (equity, diversity and inclusion)
- 2. Professional skills and knowledge: communication with children, young people and families
- 9. Safeguarding: recognising and managing risk and vulnerability
- General Paediatrics: Adolescent health
- Foundation of Practice (FOP) — Professional and ethical practice; safeguarding
- Applied Knowledge in Practice (AKP) — Adolescent health and communication
- History taking and management planning
- Child and adolescent mental health
- General Pediatrics Content Outline — Domain 1: Professional Conduct; diversity and inclusion
- General Pediatrics Content Outline — Universal Task 5: Communication; adolescent interview
- General Pediatrics Content Outline — Adolescent medicine and mental health
- Interpersonal and Communication Skills 1: Patient-, family-, and team-centered communication
- Professionalism 1: Professional conduct and accountability; equity and inclusion
- Patient Care: adolescent-centred and confidential psychosocial care
- Communicator
- Professional (equity, diversity and inclusion)
- Health Advocate
- Pediatrics: Adolescent medicine and mental health
Overview & Definition
A fifteen-year-old sits in your consulting room with her mother for a "check-up." The mother does most of the talking. Once you ask the mother to wait outside, the young person tells you she has a girlfriend, that she has been called slurs at school for months, and that she has thought about killing herself. What you do in the next twenty minutes — what you ask, how you ask it, what you keep private, and what you connect her to — is the whole of this topic. An affirming clinician in that moment is not being polite. They are delivering a protective intervention. [1] [8]
Sexual orientation is a person's pattern of emotional, romantic and sexual attraction to others. Inclusive care is care that actively welcomes and affirms sexual diversity and works to dismantle the health disparities that stigma creates. The two ideas belong together, because the disparities faced by sexual minority youth are not caused by who they are attracted to — they are caused by how they are treated for it. Grasp that single point and the rest of the topic falls into place. [1] [3]
The clinician's job is not to diagnose or "confirm" an orientation. It is to build an environment safe enough that a young person can disclose what is relevant, to screen for the consequences of stigma, to treat what you find, to protect confidentiality, and to broker acceptance and connection. Nothing here changes who the young person is. Everything here changes how much harm stigma is allowed to do to them. [8] [9]
References10ShowHide
- [1]Meyer IH Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 2003.PMID 12956539
- [2]Bradford J, Mustanski B Health disparities among sexual minority youth: the value of population data. American Journal of Public Health, 2014.PMID 24328630
- [3]Baams L, Grossman AH, Russell ST Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Developmental Psychology, 2015.PMID 25751098
- [4]Cahill S, Singal R, Grasso C, King D, Mayer K, Baker K, Makadon H Do ask, do tell: high levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American community health centers. PLoS One, 2014.PMID 25198577
- [5]Fenaughty J, Tan K, Ker A, et al. Sexual Orientation and Gender Identity Change Efforts for Young People in New Zealand: Demographics, Types of Suggesters, and Associations with Mental Health. Journal of Youth and Adolescence, 2023.PMID 36301377
- [6]Luk JW, Goldstein RB, Yu J, et al. Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior. Pediatrics, 2021.PMID 34580171
- [7]Lea T, de Wit J, Reynolds R Minority stress in lesbian, gay, and bisexual young adults in Australia: associations with psychological distress, suicidality, and substance use. Archives of Sexual Behavior, 2014.PMID 24573397
- [8]Diana P, Esposito S LGBTQ+ Youth Health: An Unmet Need in Pediatrics. Children, 2022.PMID 35884011
- [9]Ream GL Minority Stress and Intersectionality in LGBTQIA+ Youth Mental Health Disparities. American Journal of Public Health, 2024.PMID 38662974
- [10]Yu L, Dalke K, Eckstrand K An Interview Tool for Identifying Sexual Orientation or Gender Identity and Expression Change Efforts in Queer Youth. Journal of the American Academy of Child and Adolescent Psychiatry, 2025.PMID 40912505