Month: September 2022

Editor’s note: in honor of Pride Month, we’re re-publishing a 2019 post by Dr. Cecil Webster.

Generally speaking, discussing what happens in our bedrooms outside of the bedroom can be anxiety-provoking. Let’s try to make your doctor’s office an exception. Why is this important? People in the LGBTQ+ community contend not only with a full range of health needs, but also with environments that may lead to unique mental and physical health challenges. Whether or not you have come out in general, doing so with your doctor may prove critical in managing your health. Sexual experiences, with their impact on identity, varied emotional significance, and disease risk, are a keystone for helping your doctor understand how to personalize your healthcare.

Admittedly, talking about your intimate sexual experiences or your gender identity may feel uncomfortable. Many LGBTQ+ patients worry that their clinicians may not be knowledgeable about their needs, or that they’ll to have to educate them. Finding a LGBTQ+ adept doctor, preparing ahead of time for your next appointment, and courageously asking tough questions can give you and your health the best shot.

Finding a skilled clinician who is LGBTQ+ adept

Many large cities have healthcare institutions whose mission centers on care for LGBTQ+ peoples. However, these organizations may prove inaccessible to many for a variety of reasons. Regardless of your location, asking friends, family, or others to recommend a clinician may be a game changer. If your trans friend had a relatively painless experience visiting an area gynecologist, perhaps your Pap smear may go smoothly there as well. If your coworker has a psychiatrist who regularly asks him about his Grindr use, perhaps it may be easier to navigate your gay relationship questions with her.

Word of mouth is often an undervalued method of finding someone skilled and attentive to the needs of LGBTQ+ individuals. Online, many clinicians offer a short bio with their areas of expertise, and there are provider directories featuring trusted clinicians. Further, some doctors regularly write articles and give talks that may offer clues about desired knowledge. A simple Google search of your provider may yield a bounty.

Next, give your doctor or healthcare organization a call. Don’t be shy about requesting someone whose practice matches your specific needs. Your health information is protected, and generally, physicians hold your clinical privacy dear. Keep in mind that not all clinics will know or share whether or not your doctor is, for example, also a lesbian, but they may pair you with someone well suited to your request or point you in the right direction.

Preparing for your appointment

Let’s say you are nervous about coming out to your doctor. A little preparation may ease this burden. Here are some quick tips:

• Let them know you’re nervous at the start of the conversation.
• Be as bold as you can tolerate.
• Write down what you are excited about, nervous about, and/or curious about.
• Go in with a few goals and start with what’s most important.
• Maximize your comfort. If your partner is calming, bring them. If Beyoncé soothes what ails you, bring her along too.
• Lightly correct or update your clinician if they get something wrong.

Ask tough questions, give clear answers

As a psychiatrist who works with kids and adults, I often hear questions like, “I don’t know really how to say this, but I started experimenting with other guys. Does this mean I’m gay?” I may start by asking if you’ve enjoyed it. My colleagues in health care might begin with the same question.

Pleasurable experiences come in all sorts of constellations, and healthy exploration is part of being human. Additionally, clinicians need to assess and address your safety. Many LGBTQ+ people are at higher risk of intimate partner violence. We may ask about your use of condoms, how many partners you’ve had recently, your use of substances during sex, and how these experiences may shift how you see yourself. Give clear answers if possible, but don’t fret if you’re uncertain. Your doctor will not likely provide a label or pry unnecessarily. They may offer constructive information on the use of condoms, reasons to consider using PrEP (which can effectively prevent HIV), and places you can go for more guidance. Physicians enjoy giving personalized information so that you may make informed healthcare decisions.

There is no end to what is on people’s minds. Be bold. Will tucking reduce my sperm count? Maybe. Does binding my breasts come with risk? Likely. Was Shangela robbed of her RuPaul’s Drag Race: All Stars 3 crown? Utterly, but let’s get back to your cholesterol, shall we?

Remember that it is often impossible to squeeze everything into one appointment. Afterward, take time to catch your breath, reflect on what you’ve learned, and come up with more questions for next time. We’re here for that.

About the Author

Cecil R. Webster, Jr., MD, Contributor

Dr. Cecil R. Webster, Jr. is a child, adolescent, and adult psychiatrist in Boston. He is a lecturer in psychiatry at McLean Hospital and Harvard Medical School, and consultant for diversity health outreach programs at the … See Full Bio View all posts by Cecil R. Webster, Jr., MD

Editor’s note: Second in a two-part series on friendship and neurodiversity. Click here for part 1 .

We all are different. We all are unique. This is cause to celebrate.

Yet for many children and families, the current landscape of friendships and social spaces can feel unwelcoming. Flexibility and inclusivity are often lacking, leaving little room for children who are neurodiverse, such as those who are on the autism spectrum or who have attention deficit hyperactivity disorder or intellectual disability.

There are many tools and organizations to help children with neurodevelopmental differences practice friendship-building skills and connect through social opportunities. But a larger community effort is needed, as well.

Below are some ways to welcome those who are neurodiverse into your social circle and activities. Friendship is a two-way street, of course, and all of us stand to gain in creating wider, more inclusive circles of friends. Everyone can be a friend; everyone deserves to have friends.

Start here: Understanding neurodiversity

Understanding neurodiversity — the different ways that people think, communicate, learn, and interact with their environment — is a crucial first step.

Becoming aware and accepting of these differences creates room for people who are neurodiverse to participate in social spaces just as they are. By making room for differing abilities, we demonstrate that we value authenticity and diversity.

It may help to know that:

• Many children who are neurodiverse engage in self-stimulatory behaviors like rocking back and forth, hand movements, or pacing. This may be a helpful way for them to self-soothe, or might satisfy sensory needs such as feeling too much stimulation or not enough stimulation.
• As with all children, behavior is communication and expresses desires, wants, needs, and dislikes.
• And as is true with many children, some behaviors, like silly noises or loud remarks, can also be ways of obtaining attention or communicating what is wanted, or not wanted, in a given situation.

What does it mean to be inclusive?

There is more to inclusion than being together.

Inclusion is the practice of making someone part of a group. It ensures that those who might otherwise be excluded, such as people with disabilities or members of marginalized groups, have the same rights, choices, and access to opportunities as others in the community.

Being in the presence of others opens the door to new friendships and social opportunities. But this alone is not true inclusion and does not promote belonging. Children with diverse abilities are often still stuck on the sidelines.

Sitting next to someone new at lunch or inviting someone to join a game or activity on the playground helps others feel invited and included. Parents, teachers, and other adults can help by modeling or encouraging warm, inclusive actions like these — and not just on the playground or at school.

Expanding from inclusion to belonging

Belonging goes one step further by ensuring that people feel valued and fully a part of their community. For children, cultivating belonging could mean

• going the extra mile after inviting a new friend to join a game of soccer at the park by making sure to pass them the ball.
• at the lunch table or at a birthday party, including a child with neurodiverse abilities into the conversation and creating the space for them to participate.

Actions like these help us recognize the value we each have to share. And, of course, it’s not only children who can hold out a hand. Together, by prioritizing genuine connections with people who are neurodiverse, learning and understanding one another’s needs, we can create a social landscape where everyone can belong.

How to be a good friend

Openness and kindness can foster a meaningful connection. Whether you’re a child or an adult, you can help through:

• Clear communication
  • Use clear and concise language and repeat information as needed.
  • Be open to different ways of connecting, such as through text messaging, online gaming, social media, or structured activities based on shared interests.
  • Outline plans in advance and be open to when a particular event, activity, or social interaction might need to be cut short.
• Awareness and openness
  • Be aware of sensory sensitivities and needs. Adjustments to lighting, noise, and seating can help create a more sensory-friendly environment.
  • Sometimes a consistent social space is most comfortable for people who are neurodiverse. Learn the types of socializing and social gestures your friend appreciates best.
  • Be welcoming to different ways of communicating, whether through signs, gestures, pictures, devices, or other equipment.
  • Focus on connection and shared interests rather than social convention.
• Listen and learn
  • Listen and learn how to support people who are neurodiverse — don’t assume!
  • Ask questions to understand social preferences and needs. Figure out together what fosters connection and comfort in your friendship.
  • Make space for people with diverse abilities to be themselves and be comfortable.
  • Be patient. Be flexible.

Make a commitment to wholeness

An inclusive community is one that values all people, and becomes whole by embracing its diversity and making all people feel like they belong. Schools, recreational programs, and community organizations all have a role in fostering inclusive social spaces and opportunities for people who are neurodiverse. And so do each of us.

About the Authors

Sydney Reynders, ScB, Contributor

Sydney Reynders, ScB, is a clinical research coordinator in the Boston Children’s Hospital Down Syndrome Program. She assists in research investigating educational, behavioral, and medical interventions in Down syndrome and other neurodevelopmental disorders. She received her … See Full Bio View all posts by Sydney Reynders, ScB

Nicole Baumer, MD, MEd, Contributor

Nicole Baumer, MD, MEd is a child neurologist/neurodevelopmental disabilities specialist at Boston Children's Hospital, and an instructor in neurology at Harvard Medical School. Dr. Baumer is director of the Boston Children's Hospital Down Syndrome Program. She … See Full Bio View all posts by Nicole Baumer, MD, MEd