Physicians use of inclusive sexual orientation language during teenage annual visits

Stewart C. Alexander, J. Dennis Fortenberry, Kathryn I. Pollak, Terrill Bravender, Truls Østbye, Cleveland G. Shields

Research output: Contribution to journalArticle

9 Scopus citations


Purpose: Physicians are encouraged to use inclusive language regarding sexuality in order to help all adolescent patients feel accepted. Non-inclusive language by physicians may influence relationships with adolescent patients, especially those with still-developing sexual identities. The aim of this study was to identify patterns of physicians' use of inclusive and non-inclusive language when discussing sexuality. Method: A total of 393 conversations between 393 adolescents and 49 physicians from 11 clinics located throughout the Raleigh-Durham, North Carolina, area were audio recorded. Conversations were coded for the use of inclusive talk (language use that avoids the use of specific gender, sex, or sexual orientation language), direct non-inclusive talk (language use that assumes the teenager is heterosexual or exclusively engages in heterosexual sexual activity), and indirect non-inclusive talk (language use that frames talk heterosexually but does not pre-identify the adolescent as heterosexual). Results: Nearly two-thirds (63%, 245) of the visits contained some sexuality talk. Inclusive talk rarely occurred (3.3%) while non-inclusive language was predominant (48.1% direct and 48.6% indirect). There were no significant differences in language use by gender, age, adolescent race, or visit length. These non-significant findings suggest that all adolescents regardless of race, gender, or age are receiving non-inclusive sexuality talk from their providers. Conclusion: Physicians are missing opportunities to create safe environments for teenagers to discuss sexuality. The examples of inclusive talk from this study may provide potentially useful ways to teach providers how to begin sexuality discussions, focusing on sexual attraction or asking about friends' sexual behavior, and maintain these discussions.

Original languageEnglish (US)
Pages (from-to)283-291
Number of pages9
JournalLGBT Health
Issue number4
StatePublished - Dec 1 2014


  • adolescents
  • annual visits
  • preventive health visits
  • sexuality

ASJC Scopus subject areas

  • Dermatology
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health
  • Urology

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    Alexander, S. C., Fortenberry, J. D., Pollak, K. I., Bravender, T., Østbye, T., & Shields, C. G. (2014). Physicians use of inclusive sexual orientation language during teenage annual visits. LGBT Health, 1(4), 283-291.