Digestive Health in Sexual and Gender Minority Populations

Abstract

It has been over 50 years since the Stonewall Inn Riots in June 1969, a seminal event for the lesbian, gay, bisexual, transgender, queer, intersex, and other sexual and gender-diverse minorities (LGBTQI1, or lesbian, gay, bisexual, transgender, queer, intersex, and everyone else) rights movement. However, sexual and gender minority (SGM) individuals still face discrimination and harassment due to their sexual orientation or gender identity. As such, the National Institute on Minority Health and Health Disparities has identified SGM communities as a "health disparity population." Broadly, there are higher rates of sexually transmitted infections, substance use and abuse, mental health conditions, obesity and eating disorders, certain cancers (breast, cervical, and anorectal), and cardiovascular disease in SGM communities. Transgender patients, especially those of color, are more likely to be uninsured, experience discrimination, and be denied health care than cisgender patients. In addition, SGM individuals have twice the risk of lifetime exposure to emotional, physical, and sexual trauma compared with heterosexuals. It is expected all these factors would negatively affect digestive health as well. This review summarizes the effects of social determinants of health and discrimination on health care access, highlights important digestive diseases to consider in the SGM population, and offers solutions to improve and prioritize the health of these communities. We aim to draw attention to SGM-specific issues that affect gastrointestinal health and spur research that is desperately lacking.

Family outcome disparities between sexual minority and heterosexual families: a systematic review and meta-analysis

“…have an increased risk for health problems. [4][5][6] In recent years, the number of children in families with parents who are lesbian, gay, bisexual, transgender and queer has increased. [7][8][9] A report in 2018 showed that, in the USA, same-sex couples are seven times more likely than different-sex couples to be raising an adopted or foster child, and there are an estimated 114 000 same-sex couples raising children.…”

“…Sexual and gender minorities is an umbrella term including lesbian, gay, bisexual, transgender, queer, intersex, gender non-conforming people and other populations whose sexual orientation or gender identity and reproductive development is considered outside cultural, societal or physiological norms 1–3. Compared with the heterosexual population, sexual and gender minorities have an increased risk for health problems 4–6. In recent years, the number of children in families with parents who are lesbian, gay, bisexual, transgender and queer has increased 7–9.…”

Health disparities experienced by sexual and gender minority individuals living with or at risk of chronic liver disease

“…[10,11] To care for this population, clinicians should be aware of liver disease burdens in SGM individuals and risk factors. A recently proposed conceptual framework, adapted from the Minority Stress Model, links the effects of life stressors, psychosocial factors, behavioral factors, and physiologic factors with the burden of gastrointestinal diseases and outcomes for SGM individuals (Figure 1), [3] which we use to frame our presentation of risk factors. For instance, behavioral factors, such as injection drug use (IDU), [12] more common in certain SGM communities, [12] are influenced by minority identity and life stressors (discrimination, violence, stigma, etc.)…”

Engaging Sexual and Gender Minority Communities in Digestive Health Research

“…Yet, SGM-focused research is hampered by inappropriate study design and inaccurate use of sex (biological attributes) vs gender (socially constructed norms varying over time). Recent work has highlighted significant knowledge gaps in SGM-focused digestive health (3). Addressing these deficits must be performed conscientiously through partnership with methodologic experts and community members to ensure high-quality data and ethical engagement with historically marginalized communities.…”