Objective: The aim of this project was to examine whether asking a simple and direct question would affect patient-provider communication and hence quality of care for the lesbian population in healthcare encounters. We hypothesized that if providers routinely ask sexually active women, "Do you have sex with men, women or both?" they would elicit more accurate information from patients, help ease concerns about prejudicial treatment or negative judgment, and encourage non-heterosexual women to openly discuss a subject that, while personally and possibly sensitive, is also crucial to overall health and well-being. Data sources: Our subjects answered a 26-question online survey. Subjects volunteered to participate after receiving an email invitation via the "snowball method", viewing an invitation on lesbian, gay, bisexual and transgender web based social forums or receiving an invitation at New York City lesbian, gay, bisexual, trans gender events. Study selection: The inclusion criteria limited the study to participants who were female, over 18, and who did not consider themselves men. The exclusion criteria eliminated individuals under the age of 18, those who identified as men, or those who did not agree to the consent form. Data collected from women who identified as lesbian, heterosexual, bi-sexual, trans gender or 'other' were analyzed in this study. Data extraction: All data was extracted from the raw data provided from the online survey tool 'surveymonkey'; using the tools provided to change filters and view specific criteria of focus (i.e., sexual orientation as related to a specific response, etc.). A total of 257 responses were collected, of which 4 did not fit the inclusion criteria and 4 fit the exclusion criteria. The remaining 245 responses were analyzed in two major groups. Outcomes: The main outcome we were interested in was the comparison between· those participants who had ever been asked the question (group 1 ), "Are, you sexually active with men, women or both?" with those who had not (group 2). Other outcomes we were interested in included the perceived relevance and impact of questions about sexual orientation on patient-provider communication, and specifically the issue of trust. Results: Thirty-seven and a half percent had been asked either this specific question (16.7%) or a similar question (20.8%) vs. 62.5% who were never asked this kind of question. Our study showed that the majority of women in both groups were or would be comfortable with this inquiry, had or would answered the question honestly, did not or do not normally avoid talking about their sexual behavior, felt it was important for their provider to know about their sexual behavior and orientation and stated that being asked this type of question increased or would increase their level of trust with the provider. Conclusions: The responses to our survey indicated that asking a simple and direct question about sexual behavior is both widely accepted by female patients and liable to improve quality of care.
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