Key takeaways:
- Welcoming LGBTQ patients into gynecologic care begins with visible representation, standardized pronoun and preferred-name intake, and scheduling options that reduce waiting room discomfort for patients who may feel out of place in traditional clinical settings.
- Clinicians should not make assumptions about contraceptive needs or menopausal symptom burden based on a patient's appearance or stated identity—direct, compassionate questioning is essential for LGBTQ and transgender patients who may not volunteer these concerns.
- Technology-based fertility awareness methods have advanced significantly and represent a viable non-hormonal contraceptive option for patients who prefer to avoid hormones or for whom hormonal methods conflict with cultural or religious values.
Creating a genuinely welcoming clinical environment for LGBTQ patients begins well before the exam room—and the most meaningful changes are often also the simplest, according to Kathleen S. Walsh, MD, FACOG, an ob-gyn with Hackensack Meridian Health, who spoke with Contemporary OB/GYN at the 2026 American College of Obstetricians & Gynecologists (ACOG) Annual Clinical & Scientific Meeting.
Walsh described a set of practical, low-barrier interventions that collectively signal to LGBTQ patients that they are expected and respected. In the reception area, artwork that represents diverse family structures—including same-sex couples and transgender partnerships—communicates inclusion before any clinical interaction takes place. Front desk staff should be trained to ask patients their preferred name and pronouns as part of standard intake.
"Representation is really helpful and important," Walsh said.
In her own patient encounters, Walsh addresses the reality of pronoun use directly.
"If I slip up with their pronouns, it is not with mal intent—it's an acknowledgement that yes, I am making an effort to be comfortable with you, and I hope that you trust me," she said. For patients who may feel uncomfortable in a waiting room alongside patients in more traditional family configurations, she suggested offering dedicated appointment times that create a more comfortable environment.
"Making that door open—to me that's very important," she said.
The clinical content of those visits also requires recalibration. Walsh noted that LGBTQ patients—including transgender men and nonbinary individuals—are frequently not asked about contraceptive needs or perimenopausal symptoms, either because providers make assumptions based on appearance or because patients do not raise these concerns unprompted.
"If you ask, you will find out," she said. The questions clinicians need to ask are specific: what kind of sex a patient is having, and what body parts they currently have. "Those questions need to be answered in a casual, comfortable way, which takes some practice and some integrity and some compassion."
New technology for natural birth control
Walsh also addressed the growing patient interest in hormone-free contraception. She acknowledged that natural birth control has historically drawn skepticism from clinicians trained on hormonal methods, IUDs, and barrier contraception—in part because of the well-documented variability in menstrual cycles. However, she pointed to newer technology-based fertility awareness methods that integrate temperature, pulse, and algorithmic modeling of fertility windows as a meaningful advance over earlier calendar-based approaches.
"The technology is really there," she said. These options are of particular interest to younger patients as well as those for whom hormonal contraception conflicts with cultural or religious values.
Across all of these areas—affirming clinical environments, inclusive history-taking, and expanding the contraceptive toolkit—Walsh returned to a common theme: The specialty has work to do.
"Our specialty has a lot of catching up to do with women across all definitions, and remembering that there is no one size fits all."
