Preference or orientation?

[Apollyon]

First, I am an ally. Second, mine is a sincere question. For background, I am an EM doc (but I'm done with clinical medicine). I am cisgender male married to a cis female, with no children. Also, I am still licensed in Hawai'i, and lived there 2009-2012.

In these hearings about Judge Barrett, Senator Mazie Hirono grilled her about the use of the term "sexual preference". However, that is how I was taught. People are up in arms about "it's sexual orientation" and "sexual identity". I was taught not to ask "are you homosexual". If I ask, "how do you identify?", that is about gender identity, not sexual orientation. It's still not clear if I ask, "how do you sexually identify?" That just makes me shudder.

So, it could be crude, and specify what one does (sorry, no), or, "preference" isn't a preference, but it's a genteel way of asking (like "do you prefer a paper citation right now, or one in the mail?" - you're still getting a ticket).

But, I don't know that I could inoffensively ask a pt "what is your sexual orientation?" That actually seems more rude to me, because it's tantamount to "are you gay" or "are you straight", which, for a goodly number of people, isn't digital, but analog, and, as such, not delicate. (As to why it is relevant, it can direct the workup; if you want examples, I can outline them by PM.)

So, help me out here - I just don't want to step on toes. I went to military college for undergrad, so, I have heard my life's worth plus more of homophobic jokes and statements, which, in historical perspective, were overcorrections of personal fears. I winced then, and wince now. I'm happy that one person can find another in a situation where both (or more) are happy, and equal. I don't care who you kiss at night, as long as you do your job as best as you can.

---

Members don't see this ad.

 

[deleted480308]

First, I am an ally. Second, mine is a sincere question. For background, I am an EM doc (but I'm done with clinical medicine). I am cisgender male married to a cis female, with no children. Also, I am still licensed in Hawai'i, and lived there 2009-2012.

In these hearings about Judge Barrett, Senator Mazie Hirono grilled her about the use of the term "sexual preference". However, that is how I was taught. People are up in arms about "it's sexual orientation" and "sexual identity". I was taught not to ask "are you homosexual". If I ask, "how do you identify?", that is about gender identity, not sexual orientation. It's still not clear if I ask, "how do you sexually identify?" That just makes me shudder.

So, it could be crude, and specify what one does (sorry, no), or, "preference" isn't a preference, but it's a genteel way of asking (like "do you prefer a paper citation right now, or one in the mail?" - you're still getting a ticket).

But, I don't know that I could inoffensively ask a pt "what is your sexual orientation?" That actually seems more rude to me, because it's tantamount to "are you gay" or "are you straight", which, for a goodly number of people, isn't digital, but analog, and, as such, not delicate. (As to why it is relevant, it can direct the workup; if you want examples, I can outline them by PM.)

So, help me out here - I just don't want to step on toes. I went to military college for undergrad, so, I have heard my life's worth plus more of homophobic jokes and statements, which, in historical perspective, were overcorrections of personal fears. I winced then, and wince now. I'm happy that one person can find another in a situation where both (or more) are happy, and equal. I don't care who you kiss at night, as long as you do your job as best as you can.

I never ask orientation or preference, it’s irrelevant. I ask “do you have sex? If so, with men/women/both?”

 

[Apollyon]

I never ask orientation or preference, it’s irrelevant. I ask “do you have sex? If so, with men/women/both?”

Yeah, that's indelicate. I was taught in residency that that could/would lead to complaints. But, thanks for the response.

Edit: And, I'm mostly wondering about the general. Individually, I could ask pts like you say, but, in general, how is it described?

 

[deleted480308]

Yeah, that's indelicate. I was taught in residency that that could/would lead to complaints. But, thanks for the response.

Edit: And, I'm mostly wondering about the general. Individually, I could ask pts like you say, but, in general, how is it described?

Times might have changed, that is the phrasing taught in my school and residency (or my training was indelicate)

I’ve heard both preference and orientation. I find the way you treat the person far more important than stressing over lingo that changes every few years

 

[Apollyon]

I don't know what is your field (and not asking). In the ED, it is quite different than in, for example, outpatient psych.

 

[culturekweenXx]

I don't see why you need the label of gay, straight, bisexual, etc. Unless the patient volunteers a particular identity, shouldn't it be enough to describe them by their sex and the sex of their partners? If you really need to ask, use "how would you describe your sexual orientation/sexual identity?". Don't use the word preference. Any discomfort that comes from asking about sexual orientation is due to the personal nature of the subject and not the phrase itself.

 

[FutureInternist]

I think “preference” implies choice.

So my orientation is straight, but my preference is long dark haired women.

 

[Crayola227]

The way I rattle of "men women or both I ask everyone this" has never failed me. In my experience people are used to very blunt questions from doctors and as long as you make it seem matter-of-fact and just part of the job, nothing personal, I've never had issues.

I think it was Kinsey which had the scale that the idea of orientation and preference were separate concepts. Or maybe it was orientation/preference vs behavior.

For example, there are a lot of cases of people with a heterosexual orientation engaging in homosexual behavior, often against their orientation or preference when options are limited. Eg jail.

Also, I've seen sexual orientation used to ascertain if there is a sex/gender preference for most sex acts, and sexual preferences used to describe specific behaviors (ie I'm heterosexual and fellatio and cunnilingus are some of my sexual preferences)

 

[SF-NYC]

According to organizations such as Gay & Lesbian Alliance Against Defamation (GLAAD), the preferred term is sexual orientation.

GLAAD has published "An Ally's Guide to Terminology" that is really helpful: (https://www.glaad.org/sites/default/files/allys-guide-to-terminology_1.pdf)

It's important to note that people may self-describe to be of a specific sexual orientation, say a cis-man may identify as "straight," yet still have sex with people with penises. So it is important to ask directly (as mentioned in this post) to assess STI risk and contraceptive methods.

However, asking about a sexual orientation or gender identity is also important because of the discrimination faced by LGBTQ+ folk in our society - and a good place to offer support or connect a patient with community resources.

Thank you for asking!

 

[Mad Jack]

First, I am an ally. Second, mine is a sincere question. For background, I am an EM doc (but I'm done with clinical medicine). I am cisgender male married to a cis female, with no children. Also, I am still licensed in Hawai'i, and lived there 2009-2012.

In these hearings about Judge Barrett, Senator Mazie Hirono grilled her about the use of the term "sexual preference". However, that is how I was taught. People are up in arms about "it's sexual orientation" and "sexual identity". I was taught not to ask "are you homosexual". If I ask, "how do you identify?", that is about gender identity, not sexual orientation. It's still not clear if I ask, "how do you sexually identify?" That just makes me shudder.

So, it could be crude, and specify what one does (sorry, no), or, "preference" isn't a preference, but it's a genteel way of asking (like "do you prefer a paper citation right now, or one in the mail?" - you're still getting a ticket).

But, I don't know that I could inoffensively ask a pt "what is your sexual orientation?" That actually seems more rude to me, because it's tantamount to "are you gay" or "are you straight", which, for a goodly number of people, isn't digital, but analog, and, as such, not delicate. (As to why it is relevant, it can direct the workup; if you want examples, I can outline them by PM.)

So, help me out here - I just don't want to step on toes. I went to military college for undergrad, so, I have heard my life's worth plus more of homophobic jokes and statements, which, in historical perspective, were overcorrections of personal fears. I winced then, and wince now. I'm happy that one person can find another in a situation where both (or more) are happy, and equal. I don't care who you kiss at night, as long as you do your job as best as you can.

I usually just ask people if they are sexually active and then, if yes, ask if they are active with men, women, or both. How people identify often differs significantly from their sexual behaviors, and sexual behavior is what determines risk factors more than orientation. Plenty of "straight" guys that are sexually active with men from time to time, or bisexuals that have no sexual experience with one gender or the other.

 

[Mad Jack]

The way I rattle of "men women or both I ask everyone this" has never failed me. In my experience people are used to very blunt questions from doctors and as long as you make it seem matter-of-fact and just part of the job, nothing personal, I've never had issues.

I think it was Kinsey which had the scale that the idea of orientation and preference were separate concepts. Or maybe it was orientation/preference vs behavior.

For example, there are a lot of cases of people with a heterosexual orientation engaging in homosexual behavior, often against their orientation or preference when options are limited. Eg jail.

Also, I've seen sexual orientation used to ascertain if there is a sex/gender preference for most sex acts, and sexual preferences used to describe specific behaviors (ie I'm heterosexual and fellatio and cunnilingus are some of my sexual preferences)

Oh you beat me to it, I'm far too slow

 

[Osminog]

I think “preference” implies choice.

So my orientation is straight, but my preference is long dark haired women.

I’m not so sure that preference implies choice. In fact, I don’t think it’s possible to choose your own preferences. I’m guessing that you didn’t wake up one morning and consciously decide to be more attracted to long, dark-haired women than to, say, buzzcut black-haired women. That’s just your instinctive inclination, driven by cultural and genetic factors outside of your direct control.

I think the main reason that some people prefer the term “sexual orientation” over “sexual preference” is that some preferences we have can change over time (e.g., gaining an appreciation for a food we used to abhor), and people want to emphasize the fact that sexual orientation is largely immutable.

 

[FutureInternist]

I’m not so sure that preference implies choice. In fact, I don’t think it’s possible to choose your own preferences. I’m guessing that you didn’t wake up one morning and consciously decide to be more attracted to long, dark-haired women than to, say, buzzcut black-haired women. That’s just your instinctive inclination, driven by cultural and genetic factors outside of your direct control.

I think the main reason that some people prefer the term “sexual orientation” over “sexual preference” is that some preferences we have can change over time (e.g., gaining an appreciation for a food we used to abhor), and people want to emphasize the fact that sexual orientation is largely immutable.

Its semantics.

I can see two versions of Sherlock Holmes and prefer one over the other.

The main thrust behind the “its a lifestyle/lifechoice” BS is that usually its considered OK to discriminate against someone for “choices” but not for something inherent (race, age etc).

The obvious problem with this (although lost on religious fanatics), is that religion itself is a choice (why else would there be so many people proselytizing), but they want that under the “cannot discriminate against” umbrella.

 

[TragicalDrFaust]

"Sexual orientation" is the politically correct term and, as a queer cis woman, I would be most comfortable being asked indicate my "sexual orientation". Though some may disagree with the semantics, I believe "preference" undermines sexual orientation as an identity. Sexual orientation is who you are. Preference is what you like but makes it sound like you could settle on something else. I prefer green tea ice cream but vanilla's fine. Most people wouldn't settle on a partner who wasn't the gender they were attracted to. So I would argue the only queer folk who could have a preference are those who are attracted to people of 2+ genders because they could prefer one over the other(s) but still be open to the other(s).

Asking if someone is "homosexual" sounds a little old-fashioned and goofy, like being way too careful about saying "African-American" instead of "Black" so your instinct is good on that.

Side note: Most people would ask "what are your pronouns"? to determine someone's gender. Asking "how do you identify?" to ascertain that information can be offensive to some because it implies that they're choosing their gender. For a trans man who was born biologically female, say, they ARE a man. They don't just IDENTIFY as one. Same way as a cis woman I AM a woman. I don't "identify" as a woman. Some people may feel differently or think it's not a big deal but this is how it was explained to me a few years ago. I personally believe everyone identifies as a gender (or agender) because gender is a social construct (I don't believe biological sex is a quite as much of a social construct though). But if you don't believe that cis folks identify as their gender because they just ARE, then trans/nonbinary/agender folks shouldn't have to either if you are trying to avoid stepping on toes. Any trans folks please feel free to jump in here or PM me if I've said something that doesn't sit right. I don't want to speak for you!

As far as an exam goes, it's more pertinent to ask about behavior than identity. Practices who wish to flag that they are lgbtq friendly may wish to put this demographic info on their intake forms using appropriate terminology. Check boxes for straight/gay/bisexual and male/female don't even begin to cover it, although I guess points for trying. So how do you get this information if it's not on your intake form without feeling like a boor? Give the patient avenues to self-disclose by avoiding assuming their gender or their partner(s). Don't say "she" or "he" and force the patient to correct you. Once they think you've assumed they might think you're not a safe person to come out to. Use gender neutral words like "partner" or "they". If you must know, perhaps explain why you're asking, ie "x group is at higher risk for y condition or responds better to z treatment so I am asking if your sexual partners in the past 12 months have male, female, other or a combination".

 

[tantacles]

I usually just ask people if they are sexually active and then, if yes, ask if they are active with men, women, or both. How people identify often differs significantly from their sexual behaviors, and sexual behavior is what determines risk factors more than orientation. Plenty of "straight" guys that are sexually active with men from time to time, or bisexuals that have no sexual experience with one gender or the other.

“nah, I just lie there.”

 

[pubhealthdent]

In what type of situation would you be asking a patient about their sexual orientation? Genuinely curious.

Preference insinuates choice. Orientation aligns with scientific evidence that its not a choice. American Psychological Association along with every LGBT organization says sexual orientation, so go with that

 

[Apollyon]

In what type of situation would you be asking a patient about their sexual orientation? Genuinely curious.

Preference insinuates choice. Orientation aligns with scientific evidence that its not a choice. American Psychological Association along with every LGBT organization says sexual orientation, so go with that

Sore throat in sexually active homosexual male, for example, needs consideration for gonorrheal pharyngitis. Pregnancy test in lesbian can be foregone (however, true story from residency: pt there with her SO. I ask, "any possibility of being pregnant?" SO becomes indignant, and says "No, we're lesbians!" Guess which test turns out positive?).

 

[pubhealthdent]

Sore throat in sexually active homosexual male, for example, needs consideration for gonorrheal pharyngitis. Pregnancy test in lesbian can be foregone (however, true story from residency: pt there with her SO. I ask, "any possibility of being pregnant?" SO becomes indignant, and says "No, we're lesbians!" Guess which test turns out positive?).

I would think in both of those situations the better question to ask would be along the lines of have they engaged in sex with a member of whichever gender. Orientation doesn't always match up with sexual behavior. For example, in college I identified as heterosexual but had several sexual relationships with women. And even with your second example, they identify as homosexual but obvi one of them had sex with a guy. Just something to consider

 

[Apollyon]

I would think in both of those situations the better question to ask would be along the lines of have they engaged in sex with a member of whichever gender. Orientation doesn't always match up with sexual behavior. For example, in college I identified as heterosexual but had several sexual relationships with women. And even with your second example, they identify as homosexual but obvi one of them had sex with a guy. Just something to consider

You asked, I answered. I'm EM (emergency medicine), so, these cases are right there. I don't have the privilege of developing a long-standing, deep physician/patient relationship. My patient encounters have to be directed. I'm not debating the nuance of someone who identifies as hetero, but, occasionally, fellates another man. I just need salient facts. If it takes you more than 15 seconds to explain, that's too much for me to need to treat your medical problem. Whomever above said that they ask, "Do you have sex? With males, females, or both?", that works for me. At the end of my shift, it doesn't leave with me, unless I made an inaccurate diagnosis. But, is that my fault if the amateur patient thought "I didn't think you needed to know that", when I, as the professional, did, but didn't have the chance to use that information for a complete evaluation?

 

[mvenus929]

I would think in both of those situations the better question to ask would be along the lines of have they engaged in sex with a member of whichever gender. Orientation doesn't always match up with sexual behavior. For example, in college I identified as heterosexual but had several sexual relationships with women. And even with your second example, they identify as homosexual but obvi one of them had sex with a guy. Just something to consider

I work with trans teens who are often in relationships with other trans teens (or other members of the LGBT community), so I go a step further and detail anatomy that I'm concerned about. If there is a penis belonging to someone who has testes going into a vagina belonging to someone with functioning ovaries/uterus, pregnancy could ensue.

Which is also why I don't tend to harp on how they identify other than deciding how much emphasis I need to put on the above point (mentioning it in passing vs stressing the importance of condoms or other forms of birth control).