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Primary care is often the first point of contact with the healthcare system and should be a space of welcome, respect, and active listening. However, many individuals from the LGBTI+ community continue to face significant barriers when visiting their family physicians. These challenges may stem from the use of noninclusive language or a lack of specific training in sexual and gender diversity.

Barriers to Care

Fear of Discrimination

LGBTI+ patients report fear of disclosing their sexual orientation or gender identity during medical consultations because of the fear of being judged or treated differently by healthcare professionals. This fear is not without basis, as surveys have shown that some healthcare providers still hold unconscious discriminatory attitudes, contributing to distrust and patient withdrawal.

Invisibility and Heteronormative Assumptions

Heteronormative assumptions are common in clinical settings. Asking questions like “Do you have a girlfriend?” or “Do you have a partner?” followed by “What’s her name?” invalidate a patient’s identity unintentionally. Such assumptions may contribute to feelings of exclusion or the pressure to conceal one’s identity.

Training Gaps

LGBTI+ health content is rarely included in undergraduate, residential, or continuing education programs. As a result, key clinical needs are often unmet, including.

• Prevention of sexually transmitted infections (STIs) in same-sex relationships.
• Prescription and monitoring of preexposure prophylaxis (PrEP)
• Medical care for trans people, including hormone therapy
• Screenings adapted to sexual practices and gender identities, such as cervical cancer screening in trans men with a cervix

Impact on Mental Health

Invisibility, microaggressions, and stigma in healthcare settings can affect the mental health of LGBTI+ individuals. Combined with social or familial discrimination, these experiences increase the risk for anxiety, depression, and substance abuse among LGBTQ+ individuals. Primary care plays a critical role in the early detection and provision of support.

Noninclusive Environment

Minute details, such as forms that do not recognize nonbinary identities, can signal to patients that their experiences are not acknowledged. In contrast, inclusive symbols and visible LGBTQ+ resources can foster a more welcoming and trusting environment.

Improving LGBTQ+ Care

Family medicine, with its comprehensive, longitudinal, and person-centered approach, is uniquely positioned to lead efforts toward more inclusive and equitable healthcare for the LGBTQ+ community. Recently, the Spanish Society of General and Family Physicians (SEMG) signed a collaborative agreement with the Spanish LGBT+ Federation to address key gaps in care. The following areas were identified for improvement.

Targeted Training in LGBTQ+ Health

Although sexual and gender diversity topics are increasingly included in medical training, current coverage remains limited. Healthcare professionals should pursue ongoing education in the following ways:

• Sexual orientation, gender identity, and expression.
• Inclusive sexual and reproductive health that avoids norm-centric assumptions.
• Hormonal therapy and long-term care of transgender patients.
• Prevention and early detection of STIs across diverse sexual practices.
• Addressing stigma and associated psychosocial challenges.

Inclusive Clinical Communication

Communication significantly influences trust. An open, nonassumptive approach during history taking is essential.

• Ask “Do you have a partner?” rather than assuming the gender or orientation.
• Confirm the patient’s chosen name and pronouns, particularly in transgender individuals.
• Avoid terms such as “normal life” or “natural relationship,” which may imply judgment.

Personalized Screening and Prevention

Standard preventive protocols often overlook the nontraditional healthcare needs. Customization is essential.

• Transgender men with a cervix should be included in cervical cancer screening.
• STI screening should be offered on the basis of sexual practices rather than identity alone.
• Assess HIV risk without bias and discuss pre PrEP or postexposure prophylaxis as appropriate.

Creating an Inclusive Clinical Environment

Both physical and symbolic elements help foster a safe space in which patients feel comfortable sharing personal information.

• Display signage or guides indicating that the clinic is a safe and inclusive space.
• Provide informational materials that represent diverse identity.
• Ensure that condoms, lubricants, and brochures on STIs, PrEP, LGBTQ+ mental health, and related topics are readily available.

Emotional and Psychosocial Support

Mental health concerns among LGBTQ+ patients often arise from discrimination, exclusion, and violence. Healthcare should offer empathetic support rather than pathologizing these experiences.

• Screening for anxiety, depression, or social isolation linked to stigma or rejection.
• Provide emotional support and, when appropriate, refer patients to mental health professionals or community organizations for additional assistance.

Community Collaboration

Effective care extends beyond the clinic. Partnering with local LGBTQ+ organizations to support comprehensive care. These organizations often provide psychosocial services, legal support, sexual health workshops, and peer mentoring.

• Establishing collaboration between primary care teams and local community groups.
• Engage in public health initiatives that promote LGBTQ+ health and visibility.

Conclusion

Improving LGBTQ+ care in family medicine does not require significant resources; only awareness, consistent training, and commitment to inclusive clinical practice are needed. Creating an inclusive clinical environment can meaningfully improve the health and trust of LGBTQ+ communities, which have often been left out of the healthcare system.

Disclosure

This article is an editorial collaboration between the SEMG and Univadis Spain. Ríos is the lead of the Public Health Working Group at the SEMG.

This story was translated from Univadis Spain.