5 percent of young people consider themselves lesbian, gay or bisexual

Approximately 5 percent of young people consider themselves lesbian, gay or bisexual, and many adolescents know a friend, classmate, neighbor or relative who is nonheterosexual. Pediatricians are being asked with increasing frequency about sexual behavior and sexual orientation. In a newly revised clinical report entitled, "Sexual Orientation and Adolescents," the American Academy of Pediatrics (AAP) advises pediatricians to be attentive to the needs of patients who are gay, lesbian, bisexual, or transgendered, or who may be confused over their sexual orientation.

The report states that pediatricians are not responsible for identifying gay and lesbian youth, but they should create a clinical environment where adolescents feel safe to discuss sensitive personal issues, including sexuality and sexual orientation.

According to the report, sexual orientation is not synonymous with sexual activity or sexual behavior. Especially during adolescence, individuals may participate in a variety of sexual behaviors. Many youths label themselves as gay, lesbian or bisexual if they are attracted to someone of the same sex.

The overall goal in caring for all youth, including those who are, or think they might be gay, lesbian, or bisexual is the same: to promote normal adolescent development, social and emotional well-being, and physical health. That said, one stark difference between nonheterosexual and heterosexual adolescents is the suicide rate. According to the report, studies found nonheterosexual youth were two to seven times more likely to attempt suicide than their heterosexual peers. They are also 2 to 4 times more likely to be threatened with a weapon at school, and are more likely to engage in the use of alcohol, marijuana and cocaine. These psychosocial problems are not attritutable to homosexuality per se, but are associated with societal stigmatization and the lack of support offered to nonheterosexual youths.

The report urges pediatricians to offer a safe and supportive environment to youth. Among the recommendations:

• Assure patients that their confidentiality is protected.
• Be aware of the special issues surrounding the development of sexual orientation.
• Use gender-neutral language in discussing sexuality; use the word "partner" rather than "boyfriend" or "girlfriend," and talk about "protection" rather than just "birth control."
• Encourage abstinence, discourage multiple partners and discuss "safer sex" guidelines with all adolescents.
• Provide information and resources regarding gay, lesbian and bisexual issues to adolescents and/or their families who are interested or concerned about these issues.

The report acknowledges that not all pediatricians may feel able to provide the type of care described in the report. Any pediatrician who is unable to care for and counsel nonheterosexual youth should refer the patient to an appropriate colleague.

The American Academy of Pediatrics is an organization of 57,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.