Introduction to Gender and Sexuality Issues in Medicine and Public Health

Sex behaviors affect personal and public health. Without antibiotics or effective prophylactics, it was once difficult to treat and contain the spread of venereal diseases (VD). Noting the increased incidence of venereal disease during World War I, posters, flyers, and pamphlets instructed soldiers to abstain from sex with prostitutes. Inadequate means of diagnosis, as well as shame and embarrassment, kept many infected persons from seeking medical attention. Women, and sometimes children, were disproportionately affected by VD. In some locations, there was a greater social stigma—and even legal consequences—for women with VD. By the time of the Sexual Revolution in the 1960s, both treatment and prophylactics had greatly improved, but the problem had shifted to being one of the proliferation of individual sex partners and a lack of established "safe-sex" practices. The liberated sexual climate of the 1960s and 1970s abruptly ended with the discovery of AIDS in the early 1980s.

While to some extent sexually transmitted diseases had always been intertwined with issues of sex and sexuality, the AIDS crisis brought these issues to the forefront. AIDS first appeared in gay men—many of whom had numerous sexual partners. It was derided in early media reports as a "gay cancer." Even as AIDS reached an increasing number of people in heterosexual population, the disease retained its association with the gay community. Indeed, the community the disease first devastated embraced the struggle against AIDS as a unifying cause, raising money for research, sponsoring awareness campaigns, and forcing AIDS into the spotlight of the mainstream media.

The intersection of sex, gender, and sexuality is not limited to sexually transmitted diseases. Gender and sexuality issues arise everyday healthcare. Since 1980, there has been significant growth in healthcare directed specifically towards women. From childbirth to breast cancer, health care providers have invested in woman-centered facilities and patient care strategies. Part of this institutional response is driven at the grassroots level by women themselves. Women's groups have heavily funded research and treatment, and conducted international breast cancer awareness campaigns. Similarly, sexuality issues are also driving patient care. This chapter features two articles that discuss specific health issues that gay and lesbian patients should discuss with their health care providers.