The urology clinic presents both a complex problem and a promising opportunity in the context of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health equity. Given the wide-ranging effects of urologic conditions on a patient’s sexual and mental health, effective clinical conversations with LGBTQ+ patients must consider the specific psychosocial forces that shape their experience of disease. Whereas these considerations complicate treatment decision-making, they also present a unique opportunity. Urologists can play a crucial role in addressing the sexual health needs of LGBTQ+ patients, offering care that can significantly impact their quality of life.

What stands between urologists and their capacity to advance LGBTQ+ equity through their clinical work? First, there can be a lack of cultural competence amongst urologic care providers.¹ This means a limited ability to understand and adequately account for intrapersonal and cultural factors that shape treatment expectations and outcomes for LGBTQ+ patients. These factors, including unique relationship structures, intragroup expectations of sexual performance, gender identity, expression, and affirmation, rarely trickle into the mainstream medical education of urologists.

Second, there is a systemic deficit of health outcomes data from the LGBTQ+ population that could otherwise inform tailored decision-making.² Although the CDC has prioritized the collection of health outcomes data in LGBTQ+ communities,³ current approaches to clinical data collection do not effectively capture sexual orientation and gender identity characteristics. Recent efforts to collect health outcomes data and shed light on LGBTQ+ patients’ experiences with urologic conditions will need to be sustained in order for the field to benefit from longitudinal, translatable findings.

Every urologist can contribute to the goal of providing competent, affirming, and equity-driven care. To improve health outcomes in the long term, steps to document sexual orientation and gender identity demographics and track health outcomes amongst minorities will be vital to generate clinically applicable knowledge. In the short term, however, our current knowledge of and experience with the LGBTQ+ population can help guide clinical conversations and open up physician-patient dialogue.

For instance, we know that LGBTQ+ patients in the urology clinic represent a diverse range of sexual identities, roles, gender expressions, and relationship structures. Our experience indicates that these factors have a significant bearing on how patients make sense of urologic diseases, make treatment decisions, and experience posttreatment outcomes.

The prostate cancer treatment decision-making journey is a telling example of how gay and bisexual patients often navigate a complex milieu of psychosocial forces. When choosing between surgery and radiation for treatment, patients often consider the distinct sexual side effects of each option.^4,5,6 Erectile dysfunction following surgical treatment means that patients who are predominantly insertive (“tops”) for anal sex may have to switch to being receptive (“bottom”) partners or find other creative ways to maintain their identity. Men who are primarily anal receptive partners may experience significant pain or bleeding with anal penetration after radiation.

This kind of complexity is not seen only in the prostate cancer realm but extends to any urologic condition that has any effect on sexual health. Broadly, change or loss in sexual function is experienced differently by each patient—sexual orientation and gender identity plays a pivotal role in these differences. Urologists should consider the specific landscapes their patients are navigating to ensure that patients are well informed before treatment and know what to expect following treatment. It is undoubtedly impossible for treatment options to always be tailored to evade negative outcomes. However, it is equally important for patients to not feel left in the dark about how their decisions may impact aspects of their lives that are important to them.

To accomplish transparency and communication, it is essential for urologists to give LGBTQ+ patients various channels to discuss their sexuality within a context that is both confidential and affirming. Administrative processes such as intake forms and open provider communication can both work to alleviate the burden on patients to “come out” to their providers. Research has shown that questions regarding sexual orientation and gender identity are welcomed by LGBTQ+ and non-LGBTQ+ patients alike.^7,8 Such an environment is empowering for both patients and providers—patients may openly ask specific questions and providers are able to offer better tailored medical advice and improve compliance to treatment plans.⁹

In conclusion, the urology clinic stands at a crossroads of challenge and opportunity within the realm of LGBTQ+ health equity. While LGBTQ+ equity–driven care necessitates nuanced clinical conversations, there is a significant gap in cultural competence among urologists. This deficiency, compounded by a paucity of health outcomes data, impedes the ability to provide tailored care. However, recognizing the pivotal role urologists can play in addressing the sexual health needs of LGBTQ+ patients is an important first step. The path forward will involve prioritizing cultural competence training, advocating for improved data collection, and fostering dialogue within the clinical setting. These measures will ultimately enhance the quality of care and health outcomes amongst LGBTQ+ individuals.