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LGBT Patients may be at risk of not getting adequate Obstetrical Care - Articles - Nurses Arena Forum

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LGBT Patients may be at risk of not getting adequate Obstetrical Care by Idowu Olabode : August 22, 2016, 06:38:44 PM
With the increasing societal recognition for same-sex marriage and the LGBTQ population, it is important that nurses be cognizant of the sexual healthcare needs of this community. Literature shows that most health professionals will not assess the sexual history of lesbian, Trans-man or bisexual patients adequately. Subsequently, these patients may be at risk of not getting the adequate obstetrical care and teaching 1, 2.

Lesbian is a term to describe women who have sexual and romantic attraction tendencies to other women. Women who seek romantic and sexually attentions from male and females are referred as bisexual women. Transmen are people born as women. However, they have the male gender identity of a man. Some transmen have sex reassignment surgeries or hormonal transition. Sexual orientation is a permanent guide of romantic and sexual attraction to members of the same, opposite or for both genders. Sexual identity defines how people identify themselves regarding their sexual and romantic preferences 5, 6.

Sexual Behaviors


Lesbians, Bisexual women and Transmen share in a selection of sexual activities with their sex partners that entail the swap of body fluids, possible exposure to blood, and anal and genital stimulation that may place them in danger of acquiring sexually transmitted infections (STIs). The acquisition of sexual diseases and infections stems from infections that are passed from one person to another during sexual contact. Just like their male and heterosexual counterparts, Lesbians, Bisexual women and Transmen are at risk for STDs due to their sexual practices 3.

The cohort tends to have these sexual practices: cunnilingus (oral sex); mutual masturbation; fisting (Putting the whole fist into the vagina); tribadism or "dry-humping" (vulva-to-vulva contact); fingering (using fingers to stimulate the clitoris); anilingus or analingus "rimming" (oral sex involving the anus); and use of sexual toys for oral, anal and vaginal penetration.

Members of this cohort occasionally have sex with heterosexual, homosexual or bisexual men. This act may expose them to the same STDs/STIs as the male homosexual and heterosexual group. Some of their same-sex or opposite-sex partners may have high-risk behaviors such as the use of intravenous drugs or practicing unsafe sex. Also, there is the high probability of exposure to blood from menstrual blood or foreign objects such as dildos and sex toys 1, 8.

Nursing Implications


When these patients seek obstetrical care, it is important that nurses ask the appropriate questions about their sexual behaviors and sexual history. These women are at risk of contracting acute and chronic sexually transmitted diseases (STDs) 3.  Some healthcare professionals are not knowledgeable or uncomfortable asking this cohort about their sexual history.



This paper will discuss some of the obstetrical and sexually transmitted diseases that may affect this group; and nursing implications 1.  Some of the sexually transmitted infections for this include: Bacterial Vaginosis; Scabies; Candida albicans; Vulvovaginitis; Trichomonas vaginalis; Vaginitis; Gonorrhea, Chlamydia, and Syphilis; Herpes; Pubic lice;  Human Papillomavirus (Genital Warts), and Condyloma,  Chancroid, Hepatitis; HIV/AIDS and Pelvic Inflammatory Disease 3,4.

Obstetrical nurses should make every effort to teach and counsel their patients. According to Echezona-Johnson, 2014, before doing any sexual education or providing care for this cohort, obstetrical nurses, and other healthcare providers must satisfy these two important tasks:

a.    Perform a self-reflection about their feelings, judgments, biases and prejudices about this cohort.

b.    Learn more information about the obstetrical needs and the health requirements of this group.

Nursing Diagnoses

•    Sexual dysfunction

•    Infection

•    Risk for Skin integrity; Impaired Skin integrity

•    Risk for Violence, actual and risk for directed at self/others

•   Chronic pain; Acute Pain

•    Swallowing, Impaired

•    Oral mucous membrane, Altered

•    Diarrhea

•    Urinary elimination, altered

•    Ego Integrity Adjustment

•    Impaired Anxiety (mild, moderate, severe, panic)

•    Body image disturbance

•    Defensive coping, individual, ineffective

•    Denial

•    Fear

•    Self-esteem, chronic low Self-esteem disturbance

•    Self-esteem, situational low

•    Spiritual distress (distress of the human spirit)

Patient Education and Rationale
1.  Teach these women the importance of using contraceptive barriers during oral, anal and any vaginal penetrating sex, oral-genital and anal contact, sex toy use, and receptive oral sex. Barrier contraceptives will minimize exposure to the vaginal secretions of women partners. During oral sex, women can use dental dams, the condom cut in half, female condom and plastic wrap. Teach to use condoms with sex toys and dildos. Encourage the use of latex gloves or latex finger cots during vaginal or anal penetration 4, 7.  These practices will protect the patients for acquiring STIs such as HIV. However, the nurse should endeavor to teach the patients that barrier contraceptives will not protect them against scabies and crab infestations. Also, barriers contraceptives are not very effective at protecting against syphilis, herpes, and genital warts. The transmissions of STIs are by contact with skin lesions not covered by the barrier contraceptive 4.

2. Teach patients, especially teenagers or members of the cohort that are not in monogamous relationships, alternative ways of expressing romance and sexuality such as hugging or handholding. Educate the patients that there is no such thing as safe sex. The only way to avoid contracting STD is by abstinence 7.

3.  Since human beings are sexual beings, abstaining entirely from sex may not be practical. Teach patients to avoid sex with partners with visible signs and symptoms of STD. Women should be empowered to ask their partners about partners' STD history. By ascertaining partners' sex history and health, the woman will make decisions about the right contraception and educated decisions about engaging in any sexual activity 4.

4.  Refrain from using any drug or any mind-altering substance during and before having sex. By remaining sober, women will make prudent decisions about engaging in any sexual activity 7. Teach to avoid unsafe sexual contact with a partner who used intravenous drugs or with homosexual or bisexual men. This avoidance will reduce the risk of STD and pregnancy 7.

5.  Avoid direct contact with the partner's vulva or vagina during active infection. Avoiding direct contact with any active lesions on either the lips or the external genitalia will prevent the contamination or infection of some STDs. Inform patients that some STDs can occur in people without any symptoms or visible warts 4. Teach patients that some symptoms of STDs may mimic yeast infection or UTI. Inform patients that people may not test positive for HIV in the initial six months period 7.

6.  Teach patients to brush their teeth before and after cunnilingus and anilingus. This practice prevents the transmission of bacteria that could cause vaginitis such as Bacterial Vaginosis or GI infections. Educate about the importance of proper hand-washing and the sanitizing of sex toys before and after each sexual encounter 4.

7.  Teach the importance of avoiding exposure to blood from genital tract trauma or menstrual blood. This practice reduces exposure to body fluid transmitted STD. Learn to avoid sharing of razors, toothbrushes, towels, undergarments and needles. Sharing of personal effects will predispose these cohorts to blood, crabs, scabies and other STDs 7.

8.  These patients should be advised to take measures to get regular Pap smear screenings. Regular screenings will help to detect abnormal pap smears and other STDs/STIs. Early detection and treatment of STD/STIs can contribute to arrest the growth of chronic health issues such as cervical cancer 7.

9.  Encourage patients to seek medical treatment when they suspect that they have STD. Some untreated STDs like gonorrhea and chlamydia can cause infertility and pelvic inflammatory disease. Syphilis can cause nerve damage, blindness, paralysis, and damage to many different organ systems even death. Hepatitis B may be latent for years with eventual scarring of the liver (cirrhosis), and liver cancer can develop. Also, STDs can cause premature labor in pregnant women. Some STDs are detrimental to the baby either during pregnancy or childbirth 7.

10.  Explain to patients that there is no immunity to some STDs. There is a possibility that subsequent exposures to STDs can trigger new STD infection again. Some STDs like Hepatitis have the vaccine. However, most STD treatments do not offer protection from future STD development 7.

Chinazo Echezona-Johnson is director of Nursing/Women and Children Nursing Education at Metropolitan Hospital Center in New York, NY.

References

1. Brennan, A. M. W., Barnsteiner, J., de Leon Siantz, M. L., Cotter, V. T., & Everett, J. (2012). Lesbian, gay, bisexual, transgendered, or intersexed content for nursing curricula. Journal of Professional Nursing, 28(2), 96-104.

2. Echezona-Johnson, C. (2014). Equitable Obstetrical Care for the Lesbian, Gay, Bisexual, and Transgender Community (Doctoral dissertation, WALDEN UNIVERSITY).

3. Marrazzo, J.M., & Gorgos, L.M., (2012). "Emerging sexual health issues among women who have sex with women." Current infectious disease reports 14.2: 204-211.

4.  Reisner, S. L., Mimiaga, M., Case, P., Grasso, C., O'Brien, C. T., Harigopal, P., Skeer, M., & Mayer, K. H. (2010). Sexually transmitted disease (STD) diagnoses and mental health disparities among women who have sex with women screened at an urban community health center, Boston, Massachusetts, 2007. Sexually transmitted diseases, 37(1), 5.

5. Thomas, S. R. (2013). Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. In J. Sandoval (Ed.), Crisis counseling, intervention and prevention in the schools (pp. 264-289). New York, NY: Routledge.

6. Tong, R. L., Lane, J., McCleskey, P., Montenegro, B., & Mansalis, K. (2013). A pilot study describing knowledge and practices in the health care of men who have sex with men by US Air Force primary care providers. Military Medicine, 178(2), E248-E254.

7.  Xu, F., Sternberg, M. R., & Markowitz, L. E. (2010). Women who have sex with women in the United States: Prevalence, sexual behavior and prevalence of herpes simplex virus type 2 infection-Results from National Health and Nutrition Examination Survey 2001-2006. Sexually transmitted diseases, 37(7), 407-413.

8. Zenilman, J., Shahmanesh, M., (2011). Sexually Transmitted Infections: Diagnosis, Management, and Treatment. Jones & Bartlett Publishers. pp. 329-330. ISBN 0495812943. Retrieved November 4, 2012.

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