Sexual Orientation 1

Sexual Orientation and
Adolescents
Morning Report
April 19, 2010
Jennifer O’Donohoe, MD
Definitions
Sexual orientation: an individual’s pattern of physical
and emotional arousal toward other persons
Heterosexual: individuals are attracted to persons of
the opposite sex
Homosexual: individuals are attracted to persons of the
same sex
Bisexual: individuals are attracted to people of both
sexes
Important to remember…
 Sexual orientation is not
synonymous with sexual
activity
 Many self-identified
homosexuals report
heterosexual sexual
activity in adolescence and
visa versa
 Pediatricians need inquire
separately about sexual
attraction and sexual
activity
Theories of Adolescent Sexuality
 Psychosexual States
(Freud): Oral -> Anal ->
Pahllic -> Latency ->
Genital
 Social Development:
Gender assignment -> Self-
exploration/mutual
exploration -> genital play
-> dating, petting, coitus
 Cognitive Stages (Piaget):
Sensory motor ->
preoperational -> Concrete
operational -> Formal
Biological Theories
 Chromosomal - > 7, 8, 10
 Immune-like response to
presence of successive
male fetuses
 Imaging studies: symmetry,

amygdala connections, size
of the hypothalamus
 Phermones
 Prenatal androgen
exposure
Take Home Messages
We don’t know…
Most likely human sexual orientation exists as a

continuum and is somewhat fluid (at least for some
individuals)
It is not a mental disorder
It is not a choice

Prevalence
Kinsey -> 37% of adult men and 13% of adult women
reported at least one same sex experience resulting in
an orgasm
Remafedi et al -> 25% of 12 year olds felt uncertain
about their sexual orientation
A dramatic range depending on definitions
Pediatricians Role
 Promote normal adolescent
development
 Social and emotional well-

being
 Physical health
Special Concerns for Nonheterosexual
and Questioning Youth
Isolation and fear of discovery
 Increased risk for harassment and violence
Higher risk for dropping out of school
Higher risk for homelessness
Increased substance abuse
Increased suicide attempts
Eating disorders
How do we approach these concerns?
 Raise issues of sexual
orientation and behavior
 Normalize the range of
sexual orientation
 “Have you ever had a
romantic relationship with
a boy or a girl?”
 “When you think of people
to whom you are sexually
attracted, are they men,
women, both, neither, or
are you not sure yet?”
 Not knowing is okay too

Office Policies
 Protect patient confidentiality
 Policies against insensitive or

inappropriate jokes and remarks
by staff
 Information forms should use

gender neutral, nonjudgmental
language
 Display posters, brochures, and

information on bulletin boards
 Provide information about

support groups and other
resources if requested
Pediatricians Should…
Be aware of the special issues surrounding the
development of sexual orientation
Assure the patient that his/her confidentiality is
protected
Ensure that colleagues to whom adolescents are
referred are respectful of the range of sexual
orientation
Discuss emerging sexuality with all adolescents
During the Discussion, Remember…
 Labeling is not the goal
 Use gender-neutral language
 Give support and acceptance
 Provide resources
 Ask all adolescents about risky behaviors
 Provide “safer sex” guidelines
 Discuss link between substance use and

unsafe sexual intercourse
 Screen all adolescents for violence
 Provide additional screening and

education as indicated
Other Issues
 A pediatrician may need to
refer an adolescent if they
have a personal barrier to
providing care
 Disclosure or “coming out”

Parents
Be supportive
Educate
Refer – PFLAG, AAP website (healthychildren.org)
Recommend open discussions and unconditional love
Let them know that their support of their child can

literally be “life saving”
Family Rejection as a Predictor of
Negative Health Outcomes
Study of 224 white and Latino self-identified lesbian,
gay, and bisexual young adults aged 21-25: family
rejection was significantly associated with poorer health
outcomes
 8.4 times more likely to have a suicide attempt
 5.9 times more likely to report depression
 3.4 times more likely to use illegal drugs
 3.4 times more likely to engage in unprotected sex
Current Events
 A prom was canceled in
Mississippi after a senior
requested to bring her
girlfriend and wear a
tuxedo
The American College of Pediatricians:
Facts about Youth
www.americancollegeofpediatricians.org
• The etiology of homosexual attraction is determined by a combination of

familial, environmental, and social influences. For some individuals the
inheritance of predisposing personality traits may also play a role.• While
homosexual attraction may not be a conscious choice, it is changeable for
many individuals.• Declaring and validating a student’s same-sex attraction
during the adolescent years is premature and may be harmful.• Many youth
with homosexual attractions have experienced a troubled upbringing, including
sexual abuse, and are in need of therapy.• The homosexual lifestyle carries
grave health risks.• Sexual reorientation therapy can be effective. Students
and parents should be aware of all therapeutic options.• There is no evidence
that pro-homosexual programs, such as on-campus student clubs, ease the
health disorders of homosexual youth.• The Just the Facts brochure is based
upon statements of endorsement of adolescent homosexuality by coalition
organizations, and not upon citations of evidence-based research. Regardless
of an individual’s sexual orientation, sexual activity is conscious choice. Any
sexual activity outside of a monogamous, heterosexual, married relationship
is unhealthy and ill-advised.
Resources in Salt Lake City

The Utah Pride Center's Youth Program

355 North 300 West, 1st floor
Salt Lake City, UT 84103
(801) 539-8800
Affirmation
Affirmation: Gay & Lesbian Mormons
serves the needs of gay Mormon
women and men, as well as bisexual
and transgender LDS and their
supportive family and friends, through
social and educational activities.
GLSEN: The Gay, Lesbian and Straight

Education Network
GLSEN is the largest national
organization that brings together
teachers, parents, students, and
concerned citizens to work together to
end homophobia in our schools.
Resources Continued
 The Homeless Youth Resource Center of
Salt Lake City provides information on many
good shelters, free medical help, meals,
and other services available to youth, ages
15-22. They do not discriminate on the
basis of race, ethnicity, disability, beliefs,
or sexual orientation. Story
655 South State Street
Salt Lake City, UT 84111
(801) 364-0744
 Ogden’s OUTreach Resource Center is open

on Wednesdays from 3:30pm to 8:00pm for
open-minded youth, especially LGBT&Q
youth and their straight friends and allies,
between the ages of 14 and 17.
705 23rd Street, Lower Level
Ogden, UT 84401-1707
801-686-GLBT (4528)
 PFLAG: Parents, Families and Friends of

Lesbians and Gays
References
 Frankowski BL; Amerian Academy of Pediatrics, Committee on Adolescence.
Sexual Orientation and Adolescents. Pediatrics. 2004; 113;1827-1832.
 Ryan C, Huebner D, Diaz RM, Sanchez J. Family Rejection as a Predictor of

Negative Health Outcomes in White and Latino Lesbian, Gay and Bisexual Young
Adults. Pediatrics. 2009;123;346-352.
 Papalia DE, Olds SW, Feldman RD. Human Development. Eleventh Edition. New
York, NY: McGraw Hill Higher Education; 2008.
 Levine MD, Carey WB, Crocker AC. Developmental Behavioral Pediatrics. 3rd
Edition. Philadelphia, PA: W.B. Saunders Company; 1999.
 American Academy of Pediatrics. www.healthychildren.org and Facts for Families:

Gay and Lesbian Adolescents.
 Just the Facts about Sexual Orientation and Youth. A primer for principals,
Educators, and School Personal.
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Sexual Orientation and

 Imaging studies: symmetry,

Most likely human sexual orientation exists as a

It is not a choice

 Social and emotional well-

 Increased risk for harassment and violence

Higher risk for dropping out of school

Higher risk for homelessness

Increased substance abuse

Increased suicide attempts

 Not knowing is okay too

 Policies against insensitive or

 Information forms should use

 Display posters, brochures, and

 Provide information about

 Use gender-neutral language

 Give support and acceptance

 Ask all adolescents about risky behaviors

 Provide “safer sex” guidelines

 Discuss link between substance use and

 Provide additional screening and

 Disclosure or “coming out”

Refer – PFLAG, AAP website (healthychildren.org)

Recommend open discussions and unconditional love

Let them know that their support of their child can

• The etiology of homosexual attraction is determined by a combination of

The Utah Pride Center's Youth Program

GLSEN: The Gay, Lesbian and Straight

 Ogden’s OUTreach Resource Center is open

 PFLAG: Parents, Families and Friends of

 Ryan C, Huebner D, Diaz RM, Sanchez J. Family Rejection as a Predictor of

 American Academy of Pediatrics. www.healthychildren.org and Facts for Families:

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