Adolesanlarda Cinsel Yönelimler ve Sağlık Bakım Uygulamaları
Özet
Adolesan dönemi, bireylerin cinsel kimlik ve yönelimlerini keşfettiği, biyolojik, psikolojik ve sosyo-kültürel değişimlerin yoğun yaşandığı bir süreçtir. Cinsel kimlik, bireyin kendini nasıl tanımladığını belirlerken, cinsel yönelim romantik ve cinsel çekim eğilimlerini kapsar. Heteroseksüellik, homoseksüellik, biseksüellik ve panseksüellik gibi yönelimler, çeşitli biyolojik ve sosyal faktörlerin etkisiyle şekillenir. Ancak, LGBTQ+ adolesanlar, toplumsal damgalanma, ayrımcılık ve aile baskıları nedeniyle ruhsal ve fiziksel sağlık sorunlarıyla karşı karşıya kalabilir. Depresyon, anksiyete, intihar riski ve madde bağımlılığı gibi olumsuz sonuçlar, sağlık hizmetlerine erişimdeki yetersizliklerle daha da artmaktadır.
Dijital çağ, sağlık hizmetlerinde yenilikçi çözümler sunarak bu sorunların aşılmasına katkıda bulunur. Tele-sağlık, çevrimiçi danışmanlık ve mobil uygulamalar, destek mekanizmalarını güçlendirerek hizmetlere erişimi artırır. Türkiye’de pandemi sonrası gelişen tele-sağlık altyapısı, LGBTQ+ bireyler için önemli bir fırsat sunsa da, hizmet entegrasyonu ve dijital okuryazarlık gibi alanlarda eksiklikler devam etmektedir. Bu bölüm, adolesanların cinsel yönelim süreçlerini ve dijital sağlık uygulamalarının önemini ele alarak, kapsayıcı bir sağlık sisteminin gerekliliğini vurgulamaktadır.
Adolescence is a period of intense biological, psychological, and socio-cultural changes in which individuals explore their sexual identity and orientation. While sexual identity defines how individuals perceive and express themselves, sexual orientation encompasses romantic and sexual attraction patterns. Orientations such as heterosexuality, homosexuality, bisexuality, and pansexuality emerge through the interaction of various biological and social factors. However, LGBTQ+ adolescents often face societal stigma, discrimination, and family pressure, which can lead to significant mental and physical health issues, including depression, anxiety, suicidal ideation, and substance abuse. Limited access to healthcare services further exacerbates these risks.
The digital era offers innovative solutions to address these challenges in healthcare. Telehealth, online counseling, and mobile applications strengthen support mechanisms and improve access to essential services. In Turkey, the post-pandemic development of telehealth infrastructure presents a significant opportunity for LGBTQ+ individuals. However, gaps remain in service integration and digital literacy. This chapter examines the sexual orientation development of adolescents and the role of digital health applications, emphasizing the necessity of an inclusive healthcare system.
Referanslar
Quinn CA, Rollock D, Vrana SR. A test of Spielberger’s state-trait theory of anger with adolescents: Five hypotheses. Emotion. 2014;14(1):74-84.
Akbaş E, Yiğitoğlu G. Adölesan dönemde psikososyal sorunlar. OPUS Int J Soc Res. 2021;18(43):7277-7299.
Polat A, Turan H. Tanımlar ve dil kullanımı. In: Polat A, ed. Cinsiyet Disforisi, Multidisipliner Yaklaşım İlkeleri. Ankara: Nobel Tıp Kitabevleri; 2020:3-15.
Arcelus J, Bouman WP. Language and terminology. In: Bouman WP, Arcelus J, eds. The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals. New York: Nova Science Publishers; 2017:1-12.
Saewyc EM. A global perspective on gender roles and identity in adolescent sexual development. J Adolesc Health. 2017;61(4 Suppl):S9-S11.
Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend. 2012;13(4):165-232.
Johns MM, Poteat VP, Horn SS, Kosciw J. Strengthening our schools to promote resilience and health among LGBTQ youth: Emerging evidence and research priorities from The State of LGBTQ Youth Health and Wellbeing Symposium. LGBT Health. 2019;6(4):146-155.
Gowen LK, Winges-Yanez N. Lesbian, gay, bisexual, transgender, queer, and questioning youths' perspectives of inclusive school-based sexuality education. J Sex Res. 2014;51(7):788-800.
Diamond LM, Butterworth M. Questioning gender and sexual identity: Dynamic links over time. Sex Roles. 2008;59:365-376.
Başar K, Yüksel Ş. Çocukluktan yetişkinliğe cinsiyet kimliği ile ilgili sorunlar: Uygun değerlendirme ve izlem. Psikiyatride Güncel. 2014;4(4):389-404.
Katz-Wise SL, Priess HA, Hyde JS. Gender-role attitudes and behavior across the transition to parenthood. Dev Psychol. 2010;46(1):18-28.
Hatzenbuehler ML. Structural stigma and the health of lesbian, gay, and bisexual populations. Curr Dir Psychol Sci. 2014;23(2):127-132.
Arbeit MR, Fisher CB, Macapagal K, Mustanski B. Bisexual invisibility and the sexual health needs of adolescent girls. LGBT Health. 2016;3(5):342-349.
American Psychological Association. Guidelines for Psychological Practice with Sexual Minority Persons. Published 2021. Accessed March 2025. https://www.apa.org/about/policy/psychological-sexual-minority-persons.pdf
Duman NB. Cinsellik ve cinsel sağlık: Tanımlar, kavramlar, cinsel hak ve özgürlükler. In: Büyükkayacı Duman N, ed. Cinsel Sağlık. Ankara: Nobel Tıp Kitabevleri; 2019:27.
Moser C. Defining sexual orientation. Arch Sex Behav. 2016;45(3):505-508.
Sarı U, Yıldız Gündoğdu Ö. Çocuk ve ergenlerde cinsiyet disforisi. In: Polat A, ed. Cinsiyet Disforisi, Multidisipliner Yaklaşım İlkeleri. Ankara: Nobel Tıp Kitabevleri; 2020:108-122.
LeVay S. Gay, Straight, and the Reason Why: The Science of Sexual Orientation. 2nd ed. Oxford University Press; 2016.
Meier SC, Labuski CM. The demographics of the transgender population. In: Baumle AK, ed. International Handbook on the Demography of Sexuality. Dordrecht: Springer Netherlands; 2013:289-327.
Farvid P. Heterosexuality. In: Richards C, Barker M, eds. The Palgrave Handbook of the Psychology of Sexuality and Gender. Palgrave Macmillan; 2015:92-108.
Katz JN. The invention of heterosexuality. In: Gabb J, Fink J, eds. Routledge International Handbook of Heterosexualities Studies. Routledge; 2019:58-74.
Herek GM. A nuanced view of stigma for understanding and addressing sexual and gender minority health disparities. LGBT Health. 2016;3(6):397-399.
Roberts TS, Horne SG, Hoyt WT. Between a gay and a straight place: Bisexual individuals’ experiences with monosexism. J Bisexuality. 2015;15(4):554-569.
Bogaert AF, Skorska MN. A short review of biological research on the development of sexual orientation. Horm Behav. 2020;119:104659.
Rice K. Pansexuality. In: Whelehan P, Bolin A, eds. The International Encyclopedia of Human Sexuality. Wiley-Blackwell; 2015:861-1042.
Sprott RA, Benoit Hadcock B. Bisexuality, pansexuality, queer identity, and kink identity. Sex Relatsh Ther. 2018;33(1-2):214-232.
Hall WJ, Dawes HC, Plocek N. Sexual orientation identity development milestones among lesbian, gay, bisexual, and queer people: A systematic review and meta-analysis. Front Psychol. 2021;12:753954.
Wang Y, Wu H, Sun ZS. The biological basis of sexual orientation: How hormonal, genetic, and environmental factors influence to whom we are sexually attracted. Front Neuroendocrinol. 2019;55:100798.
Steensma TD, Kreukels BP, de Vries AL, Cohen-Kettenis PT. Gender identity development in adolescence. Horm Behav. 2013;64(2):288-297.
Rodríguez-Hidalgo AJ, Hurtado-Mellado A. Prevalence and psychosocial predictors of homophobic victimization among adolescents. Int J Environ Res Public Health. 2019;16(7):1243.
Snapp SD, Watson RJ, Russell ST, Diaz RM, Ryan C. Social support networks for LGBT young adults: Low-cost strategies for positive adjustment. Fam Relat. 2015;64(3):420-430.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull. 2003;129(5):674-697.
Silva JCPD, Cardoso RR, Cardoso ÂMR, Gonçalves RS. Sexual diversity: a perspective on the impact of stigma and discrimination on adolescence. Ciênc Saúde Coletiva. 2021;26:2643-2652.
Berry K. LGBT bullying in school: A troubling relational story. Commun Educ. 2018;67(4):502-513.
Veale JF, Watson RJ, Peter T, Saewyc EM. Mental health disparities among Canadian transgender youth. J Adolesc Health. 2017;60(1):44-49.
Wittgens C, Fischer MM, Buspavanich P, Theobald S, Schweizer K, Trautmann S. Azınlık cinsel yönelimlerine sahip kişilerde ruh sağlığı: Nüfus temelli çalışmaların bir meta-analizi. Acta Psychiatr Scand. 2022;145(4):357-372.
Mustanski B, Newcomb ME, Garofalo R. Mental health of lesbian, gay, and bisexual youths: A developmental resiliency perspective. J Gay Lesbian Soc Serv. 2011;23(2):204-225.
Reisner SL, Greytak EA, Parsons JT, Ybarra ML. Gender minority social stress in adolescence: Disparities in adolescent bullying and substance use by gender identity. J Sex Res. 2015;52(3):243-256.
Watson RJ, Adjei J, Saewyc E, Homma Y, Goodenow C. Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. Int J Eat Disord. 2017;50(1):22-31.
Calzo JP, Austin SB, Micali N. Sexual orientation disparities in eating disorder symptoms among adolescent boys and girls in the UK. Eur Child Adolesc Psychiatry. 2018;27(11):1483-1490.
Santos, G. M., Do, T., Beck, J., Makofane, K., Arreola, S., Pyun, T., ... & Ayala, G. (2014). Syndemic conditions associated with increased HIV risk in a global sample of men who have sex with men. Sexually Transmitted Infections, 90(3), 250-253.
Shover, C. L., DeVost, M. A., Beymer, M. R., Gorbach, P. M., Flynn, R. P., & Bolan, R. K. (2018). Using sexual orientation and gender identity to monitor disparities in HIV, sexually transmitted infections, and viral hepatitis. American Journal of Public Health, 108(S4), S277-S283.
Lindley, L. L., & Walsemann, K. M. (2015). Sexual orientation and risk of pregnancy among New York City high-school students. American Journal of Public Health, 105(7), 1379-1386.
Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 205-213.
McConnell, E. A., Birkett, M., & Mustanski, B. (2016). Families matter: Social support and mental health trajectories among lesbian, gay, bisexual, and transgender youth. Journal of Adolescent Health, 59(6), 674-680.
Dewinter, J., De Graaf, H., & Begeer, S. (2017). Sexual orientation, gender identity, and romantic relationships in adolescents and adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(9), 2927-2934.
Budge, S. L., Adelson, J. L., & Howard, K. A. (2013). Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping. Journal of Consulting and Clinical Psychology, 81(3), 545.
Aitken, M., Steensma, T. D., Blanchard, R., VanderLaan, D. P., Wood, H., Fuentes, A., ... & Zucker, K. J. (2015). Evidence for an altered sex ratio in clinic‐referred adolescents with gender dysphoria. The Journal of Sexual Medicine, 12(3), 756-763.
Paveltchuk, F. D. O., Damásio, B. F., & Borsa, J. C. (2019). Impact of sexual orientation, social support and family support on minority stress in LGBT people. Trends in Psychology, 27(3), 735-748.
Hafeez, H., Zeshan, M., Tahir, M. A., Jahan, N., & Naveed, S. (2017). Health care disparities among lesbian, gay, bisexual, and transgender youth: A literature review. Cureus, 9(4), e1184.
Bialer, P. A., & McIntosh, C. A. (2016). Discrimination, stigma, and hate: The impact on the mental health and well-being of LGBT people. Journal of Gay & Lesbian Mental Health, 20(4), 297-298.
Gates, G. J. (2014). Lesbian, gay, bisexual, and transgender demographics. Williams Institute. Gay, Lesbian, Bisexual, and Transgender Civil Rights (1st ed.).
Diana, P., & Esposito, S. (2022). LGBTQ+ youth health: An unmet need in pediatrics. Children, 9(7), 1027.
Patterson, J. G., Jabson, J. M., & Bowen, D. J. (2017). Measuring sexual and gender minority populations in health surveillance. LGBT Health, 4(2), 82-105.
Centers for Disease Control and Prevention [CDC]. (2024). Health disparities among LGBQ youth. https://www.cdc.gov/healthy-youth/lgbtq-youth/health-disparities-among-lgbtq-youth.html
Kemaloğlu, A. (2023). Türkiye'deki LGBTİ+’ların ruh sağlığı hizmetlerine erişimi ve önündeki engeller. D. Güzel, U. Güner, M. Köylü, & K. Dikmen (Eds.), 17 Mayıs Derneği & Kaos GL Derneği.
Human Rights Campaign [HRC]. (2024). Healthcare Equality Index 2024. https://www.hrc.org/resources/healthcare-equality-index
Trevor Project. (2024). National Survey on LGBTQ Youth Mental Health. https://www.thetrevorproject.org/survey-2024
Miller, K. K., Watson, R. J., & Eisenberg, M. E. (2020). The intersection of family acceptance and religion on the mental health of LGBTQ youth. Annals of LGBTQ Public and Population Health, 1(1), 27-42.
World Health Organization [WHO]. (2024). Adolescent Health and Inclusion. https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/adolescent-and-young-adult-health/resource-bank-for-adolescent-health/global-status-reports
