Synopsis
Sexual Orientation in Child and Adolescent Health Care serves as a resource for child health care professionals including pediatricians, family physicians, nurses, pediatric psychologists, child and adolescent psychiatrists, and social workers. The issues of sexuality and sexual orientation now generate great interest among those who treat children. This volume describes the effects of stigmatization on non-heterosexual physicians, patients, and students, and discusses a variety of clinically relevant topics including the development of sexual orientations, children of gay or lesbian parents, young children with gender atypical behavior, and the healthcare needs of gay and lesbian adolescents. The last two chapters describe methods for improvement in medical education and medical care, and provide extensive resources available to professionals and consumers.
From The New England Journal of Medicine
Homosexual orientation often emerges during the throes of adolescence, when it can increase the potential risks, both physical and psychological, faced by young people who are encountering the challenge of accepting a new identity. In recent years, mental health workers have emphasized sexual orientation and its correlates, and research on the topic has increased considerably. But medicine is lagging behind in education and practice. In Sexual Orientation in Child and Adolescent Health Care, Perrin takes an important step toward opening a dialogue on this issue for the medical profession. Her book comprehensively documents the current deficiencies in the field, integrates research with clinical observations, and offers incisive theoretical and practical suggestions to aid pediatric health care professionals in serving the needs of their young homosexual patients, as well as the needs of children of gay or lesbian parents. The purpose of the book, to improve the quality of care available to such children and adolescents, is served by the strong, research-based foundation on which it is built. Perrin presents an impressive review of the medical and psychological literature, commenting on all the essential issues. Biologic, endocrine, genetic, familial, and social factors thought to contribute to sexual orientation are presented without bias. Also included are descriptions and discussions of gender identity disorder and two models of the formation of sexual identity in adolescence. These models are similar, are only two of several existing standard models, and have been criticized by some experts; therefore, the inclusion of additional models would have strengthened the book. Considering the scope and purpose of the book, however, Perrin adequately covers relevant material and acknowledges the mutable quality of work on sexual identity. The thorough coverage of basic issues and the inclusion of a list of relevant terms will make the book accessible to readers with little or no knowledge of the experiences or concerns of gays and lesbians and their families. Perrin's exceptional and comprehensive discussion of social stigmas and their negative consequences could easily be applied to a variety of other minority groups. Perrin explores the pervasive problem of homophobia in the medical profession, which is directed not only against patients, but also against gay and lesbian medical students and physicians. She notes that the stigma is compounded and the cycle perpetuated by the limited attention given to homosexuality and its associated health risks in medical school curriculums. She proposes explicit curriculum changes designed to provide students with accurate information concerning gay and lesbian patients and to improve the quality and scope of their training experiences and subsequent practices. In discussing practice, the book highlights the importance of a trust-based relationship between patient and doctor in preventing and attending to health problems. Perrin decries the tendency of physicians to neglect to request information about sexual behavior and orientation when taking a medical history. In noting the risks associated with homosexuality, particularly human immunodeficiency virus infection and the acquired immunodeficiency syndrome and eating disorders among gay men, Perrin stresses that it is essential that physicians create open environments in which adolescents will be likely to discuss sexual behavior and body image. She emphasizes that physicians and other health care professionals have important obligations to be listeners, educators, advocates, and specialists in prevention, and she offers numerous practical ideas to help readers fulfill these responsibilities. The book also discusses the needs and concerns of young persons whose parents are among the first major wave of gay men and lesbians to raise children. This insightful discussion will undoubtedly be of great use to practitioners who will be seeing more of these children in coming years. Perrin emphasizes the need to encourage gay and lesbian young persons to disclose their sexual identity to their families. Although she does caution that families must be given time to adjust to the idea, she does not explore the possibility that a young person's home life may make such a disclosure impossible. Perrin does not offer recommendations for ways to support young persons who are rejected by their families after disclosing their sexual orientation. In general, however, the practical recommendations offered by Perrin will make her book valuable not only to pediatricians, but also to professionals who evaluate medical school curriculums and supervise residents. Sexual Orientation in Child and Adolescent Health Care will surely help health care professionals to embrace their homosexual patients and families and will educate those who have been unaware of the needs and experiences of a small, but nonetheless important, segment of the population. Esther D. Rothblum, Ph.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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