Sexual Orientation in Child and Adolescent Health Care This page intentionally left blank Sexual Orientation in Child and Adolescent Health Care Ellen C. Perrin, M.D. The Floating Hospital for Children, Tufts-New England Medical Center Boston, Massachusetts KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW eBookISBN: 0-306-47643-6 Print ISBN: 0-306-46761-5 ©2002 Kluwer Academic Publishers NewYork, Boston, Dordrecht, London, Moscow Print ©2002 Kluwer Academic/Plenum Publishers New York All rights reserved No part of this eBook maybe reproducedor transmitted inanyform or byanymeans,electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: http://kluweronline.com and Kluwer's eBookstore at: http://ebooks.kluweronline.com For Andy and Ben, forever my best teachers This page intentionally left blank Acknowledgements It was a long and circuitous path that led to the completion of this volume. Along the way I appreciated the considerable guidance, support, and wisdom I received from many friends and colleagues. This book would have been very different without their contributions, if indeed it had come to exist at all. I thank you all for your part in the journey, and I hope that you are at least satisfied with its resting place. Special thanks are due to Bill Cohen, Sarah Cohen, Liz Coolidge, Murray Kappelman, Anne Kazak, and Stanley Sack. They helped me to formulate and crystallize my ideas, provided information and insight, made perceptive and helpful comments on various drafts of various chapters, and gave me continu- ing encouragement. As student, colleague, and friend, Jannette McMenamy deserves extra gratitude for her persistent support, enthusiasm, and wise sug- gestions about both substance and style. Adrienne Asch especially helped me to understand stigma and its effects, and how pervasively it affects us all. Fern Miller knows how bumpy was the road between my idea to write this book and its completion, helped me steer around the obstacles, and was always a supportive cheerleader. My mother did not live to know of this project; although I imagine that we might have argued about various aspects of it I trust that she would have applauded its intent. I appreciate the lifelong learning I received from her and her mother, and from my father, about the importance of idealism, determina- tion, and commitment to justice. Without the persistence, care, and enthusiasm of Virginia Gow the ideas would never have become a manuscript. Her patience and skill in taking my notes, dictations, and heavily edited drafts through to a final form have been remarkable, and her good cheer sustaining. Thank you. Last but not least I do as always thank Jim Perrin for his constant support, his faith in me, and his patience with all the sacrifices that this process has required. vii This page intentionally left blank Foreword 1. The challenges associated with the development of sexual identity and behavior are central to child and adolescent health care. Although often hidden, sexuality exists as a critical aspect of health care providers’ interactions with their patients at all ages. By adolescence these issues take center stage. Both primary care providers and subspecialists who deal with adolescents must not only be knowledgeable about the range of sexual orientation, but also be aware of their own atti- tudes about that range. Recent data describing the continuing prevalence of HIV infection and of suicide among gay adolescents highlight the various health risks these adolescents face. In addition to adolescents, child health care providers are caring for increasing numbers of patients who have a gay or a lesbian parent, or have been born to or adopted by a gay or lesbian couple. These families encounter all the usual challenges of parenting and in addition may have special concerns based on their family constellation. Parents and children may welcome caring guidance about experiences of stigma, discrimination, and misunderstanding. Raising many strong emotions, the issue of homosexuality is buffeted by myths, misinforma- tion, and often intense societal judgment. The neglect of sexuality in medical education and in medical care have led to ignorance of important risks, discriminationagainst sexual minority stu- dents and practitioners, and marginalization of research about the concerns of gay and lesbian teens and their families, and gay and lesbian parents and their children. Traditional pediatric and adolescent medicine textbooks address the development of sexual orientation and the issues of gay and lesbian individuals and their families cursorily at best. In welcome contrast, this well researched and written book by Ellen Perrin focuses on the whole range of relevant topics. Anyone who knows Ellen is aware that she never shies away from controversial topics, especially when the mental and physical health of all children and youth are concerned. This book is no exception. In a thoughtful, balanced manner, she presents us with the gamut of ways that issues related to homosexuality affect child and adolescent health care. She addresses problems in medical education, discusses the paradox of so-called “gender identity dis- order”, describes the risks faced by gay and lesbian adolescents, and provides a summary of the latest research about children whose parents are gay or lesbian. She is passionate about the expan- sive role of pediatricians and other child health care professionals: these issues, she insists, are important for all children, all adolescents, all parents. But this is not a theoretical academic trea- tise; Ellen Perrin applies her first-hand clinical experience to provide practical, concrete sugges- tions to address the problems she describes. She provides also a comprehensive listing of reading materials, organizations, and videos that will be valuable resources to parents, teenagers, and pediatricians who are curious about issues of sexual orientation. As health care providers of the twenty-first century, we should all read and heed the wisdom and perspective that this textbook gives us. It will help us to be better, more complete providers to all our patients, parents, and colleagues, regardless of their sexual orientation. Thomas G. DeWitt, M.D. Weihl Professor of Pediatrics Cincinnati Children’s Hospitaland Medical Center ix