Inside the Doctor’s Office

Why every gay man needs an LGBTQ-affirming practitioner, and what to ask and talk about during your next doctor visit.

Health Sexual Health Dr. Evan Goldstein

This article was published on June 27th, 2018

Dr Evan Goldstein - affirming care for LGBTI communityEven though it’s 2018, there are still so many individuals within the LGBTQ+ community who do not have access to the non-biased and non-judgmental healthcare that all other members of society have come to expect. Visiting an LGBTQ-affirming practitioner, someone who fully understands our specific wants and needs, allows for a more profound relationship that ultimately benefits everyone involved. As we mature, constant recalibration of our expectations and limits is vital, and without proper care one may never reach their true potential.

Doctor-Patient Relationship

One of the most important things in the pursuit of proper healthcare is defining the doctor-patient relationship. An open line of communication allows for true understanding on both the side of the doctor and the patient. Sometimes it is so easy to put up barriers instead of communicating honestly and openly, but we need safe outlets where we can receive high-quality gender and sexual-specific care. A true and honest relationship lends itself to the deliverance of unparalleled healthcare. With that said, our country is so divisive in the care one receives that the responsibility tends to fall upon the individual to take control and vocalize their specific needs, demanding our practitioners have a comprehensive understanding of all the sensitivities and concerns that fall within our community. All facets — psychological, social, and physical — should be evaluated at least yearly, if not more, depending upon one’s risk. If the evaluation feels inadequate or lacking in any way, don’t hesitate to find a different practitioner that covers all the angles. In this day and age there are so many accessible medical leaders and resources, and now with websites highlighting sex-positive professionals, like Lighthouse, the move is yours to make; and trust me — you will not be disappointed.

The Sexual History 

The cornerstone of the mind, body, and spirit lies within the extent of one’s sexual history. All the rest of the medical analytics are routine and standard across the profession, with limited disparity on the care one receives. Yet, the stigma surrounding gay sexual health continues to be ever-present in my profession, and the duty tends to fall upon the client to be aware enough to ask the necessary questions. These questions range from defining one’s sexual interests and desires to physical and risk assessments, all helping to minimize any harm or disease.

The Yearly Must Have’s

Once the client’s full sexual history has been discussed and all parties have an appropriate understanding complete with risk assessment, the next steps fall within the actual physical examination, all to ensure prevention of harm and restoration of one’s assets. The physical exam should be focused on a mutual understanding that gay individuals are very much anal and oral individuals. This is what should constitute standardized care:

  • Human Papilloma Virus (HPV) anal screening with anal pap smear and for high risk HPV subtypes detected, a new anal chromosomal testing (called TERC FISH) all for HPV analysis and cancer screening, prevention, and/or detection
  • Complete high resolution microscopic external and internal anal canal inspection allowing for detection of any localized issues, i.e. hemorrhoids, skin tags, warts, pre-cancer changes or fissures
  • Full anal sphincter evaluation for optimizing and maintaining function and/or understanding limitations of engagement (pain on entry) or overall increased laxity (decreasing sensations/stimulation)
  • Oral HPV sampling and assessment with oropharyngeal cancer screening, prevention, and treatment
  • Comprehensive prostate/testicular/penile examination
  • Complete dermatological evaluation, specifically focusing in sexual contact regions
  • Full HIV/STD panel – blood and urine, swabs of oral, anal, and penile orifices
  • Evaluation for vaccinations and administration, if necessary (if negative for high risk HPV subtypes, one may benefit from being administered the HPV 9 talent vaccine, known as Gardasil, even if over the age of 26)


We must strive to understand the importance of taking actions into our own hands in the doctor’s office, and the time to take responsibility is now. Bespoke Surgical are taking on the new norm and delivering superlative, sex-positive care with data and analytics to substantiate one’s practice, all with the goal of long-lived and enhanced experiences.

Here are the 3 things you must never forget:

  • Find a doctor you feel comfortable opening up to.
  • Make sure you are completely honest and detailed about your sexual history and current habits.
  • Demand standardized testing, treatment, and care with constant reevaluations.


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