Reproductive History taking 2 - homosexuality and unwanted pregnancy.

in the history taking of reproductive system diseases, there are some issues that are worth discussing.

the two in particular that i'll talk about here is homosexuality and unwanted pregnancy.

in homosexual patients, there are several things we need to have in mind, that homosexuals are treated differently in some regions of the world and in some places, even considered an abomination.

as a medical profession, we need to keep all our judgments, whatever they are, aside and concentrate on their diagnosis and management and provide a fair treatment.

here are some things to keep in mind when taking a reproductive history of homosexual.

• it is important to stress that we never judge people according to their sexual orientation.
• some diseases have a higher risk of contraction, especially STDs due to their nature of sexual activity (they may not see the need to use contraceptives, or they may be bisexual which would increase the range of people they can have sex with)
• the social support they get, MAY be scarce if the society is not welcoming towards homosexuality.
• they may face extra troubles in their life - because of the social trauma.

for example, if we were to relate these points above to a case;

Mr.X presents with a history of genital discharge for 3 days, with genital itch, swelling, bleeding when urinating and pain on urination. he has had unprotected sex with a man 1 week prior to the presentation of illness. his discharge is foul smelling, whitish yellow in colour and is in small amounts.

he has had one hospitalization when he was 18, due to an assault. he lacerated his postetior head, and treated accordingly.

both his parents are well, and he has 2 siblings.

he does not do drugs, does not smoke, but takes 2 units of alcohol twice a week. he regularly goes out with his friends to clubbing.

when given a case scenario like this, a suspicion of an STD is raised, (most probably gonorrhea) but we also have some more questions we may want to ask, for example;

• do you know the person whom you had sex with?
  -he may want to bring the person to the clinic / hospital as well, since we have a suspicion that he may be the source of infection
• does he need a HIV screening?
  -not because he is homosexual -yes, being a homosexual does raise the probability but by right, all sexually active person should take a screen.
• follwing the question above, if he needs a screening, you will need to council him and educate him prior to the HIV screen.
• how much social support does he have? is he treated fairly by his parents?
• was there a reason for the assault?
• was he treated fairly in the hospital when he was hospitalised?

and so on. it will differ on each case.

of unwanted pregnancy, we need to keep in mind;

• is it a pregnancy in the first place?
• consider ectopic pregnancy
• why does she feel she doesn't want a pregnancy
• is there anything we can do to solve the above issue (e.g. if no money, find out about govt funds, suggest adoption etc)
• how did she attempt to contracept
• does she have the husband's support?
• what will she do if she actually was pregnent?
• think about issue of illegal abortion.

hope it helped.