For the purposes of this article, the term LGBTQIA+, which stands for lesbians, gay, bisexual, transexual, queer, intersex, and asexual (or sometimes ally) and is widely used for comprehensiveness, will be shortened to LGBTQ but is meant to inclusive of everyone who identifies as part of the LGBTQIA+ community. This term also refers to anyone who identifies as pansexual and non-gender binary.
Why should sex-ed be LGBTQ-inclusive?
There is still a lot of stigma associated with being LGBTQ. In most countries, sex education often alienates the LGBTQ community. Most curriculum only covers basic sexually transmitted diseases (STDs) facts, or how to practise abstinence or use condoms - this type of heterocentric and cis-gendered way of teaching often disproportionately affects those who do not fit into the “social norms”. In addition, the stigma associated with the LGBTQ community and HIV may prevent people from getting tested.
While there is more awareness in recent years and societies are more readily accepting of LGBTQ couples, they are still a heavily marginalised population. There is a lot of disinformation out there about the LGBTQ community, resulting in many negative stereotypes and even objectification. It is important for us to not confuse the difference between acceptance and fetishization. When you fetishize gay sex, you are objectifying these couples for your own sexual pleasure and in doing so, you have disempowered them and taken away their sense of agency.
Sexually transmitted diseases (STDs)
While the incidence of HIV amongst the LGBTQ community has decreased significantly over the past few decades, men who have sex with men (MSM) are still disproportionately affected. This is not often due to unsafe sex practices but rather due to structural inequalities such as barriers with access to basic health care and treatment.
Most basic information about STDs have been covered in other sections and apply to the LGBTQ community too. For example, it is important to practise safe sex habits such as using barrier protection for all forms of sex if you are sexually active with multiple partners, including oral and anal sex. It is also important to screen for STDs regularly even if you are having non-penetrative sex and especially if you have multiple partners. Similarly, all women who are sexually active should still undergo regular HPV testing due to the risks of cervical cancer as it can still be transmitted between women who have sex with other women.
As mentioned before here, STDs can still be transmitted through oral sex. Moreover, parasitic infections like Shigella can be transmitted through oral-anal sex (rimming), for which the incidence is higher amongst MSM. Studies have also suggested that STDs like chlamydia and gonorrhoea are more likely to be manifested in non-penile or vaginal regions, such as the throat and rectum in MSM. For women who have sex with women (WSW), bacterial vaginosis is more common amongst this population.
It is possible for anyone who has a womb to become pregnant, even for those who identify as trans men who have completed hormone therapy. Unless your physician informs you that it is impossible for you to become pregnant i.e., sterile, or if you have already had a hysterectomy (surgery to remove your womb), you should continue to exercise precaution when having sex. This applies to trans men who still have a womb and are having sex with those who have a functioning penis that produces sperm (i.e., cis-gendered men or trans women who have not had a vaginoplasty etc.).
The forms of contraception that are available have been discussed here and here, and also apply to everyone in the LGBTQ community.
It is recommended for everyone, including those of the LGBTQ community, to stay up-to-date with vaccines. For sexually active MSM, they should receive both the hepatitis A and B vaccines as they can be transmitted through sexual contact. HPV vaccines are also recommended for everyone. In Singapore, while only women under the age of 26 are eligible for Medisave claims if they receive HPV vaccines, everyone, including men, can be vaccinated. Guidelines vary worldwide - you should discuss with your doctor to assess the risks of these infections and the type of vaccines you need.
Support and advocacy
It is essential that we, regardless of what our sexual orientations or sexual identities are, come together to support the LGBTQ community. Even till today, they are highly discriminated against and often disadvantaged by the social systems. As a medical provider I am aware of the roles we play and our responsibilities in ensuring that we provide a safe space for our LGBTQ patients to come to us and disclose their personal issues. I am also aware that at times we are part of the problem - I have heard stories and personally witnessed my colleagues being judgmental of their LGBTQ patients and their sexual histories, which often deter them from seeking help for their problems. However, rest assured that there are many other doctors out there who are professional in their conduct and will always be there to help you if you need any.
There are little steps that we can take to show our support. If we know someone who identifies as LGBTQ - be it a family member or a friend - we can offer a listening ear without any judgements. By normalizing the conversation surrounding LGBTQ issues, We are tackling the stigma and raising awareness of gender and sexual diversity. If you come across someone who has made discriminatory remarks against the LGBTQ community, call them out and explain to them why that is destructive to the movement. You could also contact your Grassroots leaders, or actively participate in LGBTQ-related discussions in your local council if any.
We can play a part in making this society more inclusive for others.
N.B. This is by no means a comprehensive guide to LGBTQ-inclusive sex education. If you have any sexual health-related concerns, talk to your doctor. He/She/They are obligated to address any of your concerns and educate you on the right safe sex practices.