Sexual Behaviors Among Lesbian, Gay, Bisexual, Transgender, and Other Sexual and Gender Diverse Medical Students: A National Study of Thai Medical Schools

Abstract

Objective

This study aims to investigate sexual behaviors among gender diverse (LGBT and other sexual/gender minorities) and nongender-diverse medical students.

Methods

In 2021 academic year, medical students from five Thai medical schools completed questionnaires identifying demographic data, psychosexual factors, sexual experiences, and risks.

Results

Among 1,322 students, 32.1% were gender-diverse students who had lower age at first sexual intercourse and more experiences in solitary and partnered sexual activity.

Conclusions

Use of hookup applications was more frequent among gay and bisexual males. Risky sexual behaviors were significantly higher among bisexual females. Gender-diverse medical students showed higher involvement in sexual activities. Future studies should be addressing sexual health in Thai medical education.

Introduction

The conversation into sexual health issues has been previously limited even in medical education. Important factors of the limitations included the lack of regulate sexual healthcare provision and control the discourse of lesbian, gay, bisexual, transgender (LGBT+) acceptance through laws by several countries. For example, sexual harassment protection has neither been legislated in Thailand nor integrated in the national education curriculum; as a result, Thai undergraduate students become aware of sexual harassment either through media or direct observation/experiences (Puchakanit & Rhein, 2022). The lack of inclusive policies and laws for LGBT + is also evidenced in many Southeast Asian countries, resulting in exclusion and marginalization of these people (Tan & Saw, 2022). In Asian countries, a lower use of condoms and higher prevalence of sexually transmitted infections (STIs), especially in men who have sex with men and transgender people, has been reported, compared with Western countries (De Torres, 2020; M. Sharma et al., 2021). This high-risk situation among the specific population was reported to be associated with stigmatization, discrimination, inadequate and ineffective sexual education, and difficulties in accessing sexual health care (Anderson & Kanters, 2015; Kamaludin et al., 2022; Lyu et al., 2020; Sharma, 2020). The knowledge from adequate sexual education related to cultural competency and health disparity is associated with providers’ assessment and management in services for patients who have sexual health problems. Accordingly, the education that encourage providers to understand their own sexual issues would also play important role in sexual health services (Rambarran et al., 2021; Worly et al., 2021).

Because more vulnerability to sexually transmitted disease was reported in LGBT+ and other sexual and gender diverse individuals, proper preventative interventions, as well as further research into related factors, are necessary (Campbell, 2013; Tat et al., 2015). Among LGBT people, there have been several sexual health studies investigating risky sexual behaviors and sexualized drug use, among other behaviors (Becasen et al., 2019; Hibbert et al., 2021; Wood et al., 2016). The experiences of being discriminated and stigmatized are being reported by most LGBT students (Newman et al., 2021). One study showed that LGBT medical students tended to be distant from faculty staff and support, especially from those who showed a disrespectful attitude toward LGBT patients (Toman, 2019).

However, only a few have focused on medical students, a specific population in which sexual-related problems such as sexual dysfunctions have been reported to be relatively high (Wallwiener et al., 2017). Although medical students’ attitude toward sexual health morbidities did not differ from non-medical students, (Pourjam et al., 2020) one study reported that approximately 25–30% of medical students still reported a poor attitude and stigmatization toward people living with AIDS/HIV (Kuete et al., 2016). Similar to stigmatization of mental illnesses, stigmatization of sexual-related problems are notably accountable for preventing access to healthcare. In addition, some medical students have expressed fear of being seen at a sexual health clinic or their confidentiality being jeopardized, which might in turn disadvantage their prospects for post-graduate specialty training (Chiddaycha & Wainipitapong, 2021). This evidence suggests that medical students, regardless of other sociocultural and gender factors, might be an at-risk population, and so evaluating their sexual behavior could inform preventative sexual healthcare strategies.

Nowadays, the medical curriculum might not be an effective strategy to address patients’ sexual health issues in clinical practice because this issue has not been taught comprehensively in the curriculum in low- and middle-income countries (Ariffin et al., 2015; Ivanova et al., 2020) and high-income countries (McGarvey et al., 2003). This leads to medical students being underprepared for tackling their patients’ sexual issues after graduation such as sexual history taking, patient’s sexual behavior, and sexual dysfunction (Beebe et al., 2021; Gordon, 2021). Similarly, medical students’ own sexual health might be susceptible. Other than limited lectures regarding sexual health in medical curriculum, specific sexual health education that is always delivered in classroom lectures as hands-on sessions have been deemed to be ethically inappropriate, especially within the Asian cultural context (Fu, 2011). To equip with information on sexual health, individuals may seek discussion or experiences outside the educational system, from sources such as one’s family, peers, and media (Izdebski et al., 2022; Onyeonoro et al., 2011; Osadolor et al., 2022). As a result, medical students with inadequate sexuality training and personal issue pertaining to sex might be associated with confidence to provide sex education as professionals (Shindel et al., 2008, 2010). However, little can be known about the reality of sexual healthcare and sexual education, due to stigma and censorship regarding sexual issues, which are considered inappropriate in Asian countries. Introducing of topic on sexual health and LGBT in current medical curriculum is one of the methods that were reported as a potential solution for medical students to provide sexual health care more effectively (Shindel et al., 2010). In Thailand, sexual health education is generally taught only in the reproductive (sexually transmitted disease, sexual dysfunction) and psychiatry rotation (gender dysphoria and paraphilia) (The Medical Council of Thailand, 2012).

To the best of our knowledge, few studies have explored sexual behaviors of Asian LGBT medical students. Such an investigation could be beneficial for holistic improvement of sexual health care for medical students and highlight the importance of the integration of sexual and LGBT health into the medical education curriculum in the future. Therefore, our study aimed to describe sexual behaviors, including sexual experiences, risky sexual behaviors, and sexual dysfunctions, and compare such issues between LGBT and non-LGBT medical students from five medical schools in Thailand.

Materials and methods

This cross-sectional study recruited medical students aged at least 18 years old from first to sixth year during the 2021 academic year from five medical schools over the country. Two of them (Chulalongkorn University and Siriraj Hospital, Mahidol University) are in Bangkok, the capital city of Thailand. The other three are the medical schools of regional areas (Chiang Mai University—Northern region; Khon Kaen University—Northeastern region, and Prince of Songkla University—Southern region). Students who were on academic leave were excluded. Sample size calculation was calculated by using the prevalence of depression from a study on mental health problems among Thai medical students with the minimum medical students of 323 (n= [z²*p{1 − p}]/d², z = 1.96, p = .31, d = 0.05) (Kolkijkovin et al., 2019; Pourhoseingholi et al., 2013; Wayne & Chad, 2018). After providing participants with information regarding this study, we invited all eligible students to participate in our online questionnaire in Thai language and convenient sampling was done. A self-administered informed consent was obtained prior to answering all questionnaire items. The participants had the right to not answer any questions in the online survey.

This multicenter study was completed in accordance with the Declaration of Helsinki as revised in 2013. Ethical approval for this study was granted by the Institutional Review Board from all study locations including (1) Institutional Review Board, Faculty of Medicine, Chulalongkorn University; (2) Ethics Committee for Human Research, Faculty of Medicine, Chiang Mai University; (3) Human Research Ethics Committee, Faculty of Medicine, Prince of Songkla University; (4) Center for Ethics in Human Research, Khon Kaen University; and (5) Siriraj Institutional Review Board.

Demographic data and sexual behaviors

Demographic data, including age, academic year of study, hometown, current underlying health issues, parental marital status, substance use, and income per month were collected. Sexual and gender diversity was identified by self-reported sex assigned at birth, gender identity (personal sense of own gender), and sexual orientation (gender they are sexually attracted to). The definition and explanation of each factor were provided in the questionnaire. In our study, the sexual and gender diversity was categorized into lesbian, gay, bisexual/pansexual male or female, transgender (with any sexual identity and orientation), non-binary, asexuality, and questioning. All participants were asked to report their sexual identity (sex assigned at birth) as male, female, or intersex, and gender identity (personal sense of own gender) as male, female, questioning or non-binary. Sexual orientation (gender they are sexually attracted to) was also identified by using multiple choices including heterosexual, homosexual, bisexual, asexual, questioning, and others. The participants were allowed to select only one response for each question.

Sexual behaviors were investigated by using a set of questionnaires comprised of age at first sexual intercourse, solitary (masturbation) and partnered sexual experiences, use of geosocial networking/dating applications for sexual hookup, risky sexual behaviors (unprotected sex or having multiple sexual partners), and sexualized drug use. All sexual behaviors were indicated by using the question format “How frequently do you engage in unprotected sex/other risky sexual behaviors?” and the answers ranged from “no sexual experience,” “never exposed to aforementioned risk,” “sometimes exposed to aforementioned risk,” and “frequently exposed to aforementioned risks”. The questions relating to sexual experiences of medical students were also explored by open-ended and binary (yes/no) questions asking about difficulties during solitary or partnered sexual activity.

Statistical analysis

Descriptive statistics were used to report the demographic data. Categorical variables were presented as counts and percentage while continuous variables were described using the mean and standard deviation or the median and interquartile range depending on data distribution. We exclude the participants who have the missing data before analysis. Chi-square or Fisher’s exact test and t-test or Mann-Whitney test were used as appropriate to determine the difference between the two groups. All statistical tests were two-tailed comparisons and a p value of ≤.05 was considered statistically significant. The SPSS version 29.0 (IBM) was used in the analysis of this study.

Results

In total, 1,322 medical students participated in the study. Most of them attended medical schools in Bangkok (75.6%), and the preclinical year was slightly higher in number (52.3%). Approximately one-third (31.2%) identified themselves as LGBT. The proportion of LGBT students was significantly greater in the regional, compared to central, medical schools (36.7% vs. 24.4%, p value < .001), which was consistently with more LGBT students originating from a regional hometown (54.1% vs. 43.6%, p value < .001). A significantly higher proportion of LGBT students reported not living with their family compared with non-LGBT medical students. The prevalence of physical and mental underlying morbidities in all medical students was 16.5% and 9.4%, respectively. Among LGBT medical students, mental disorders were significantly more common (15.0%, p value < .001). For substance abuse, the number of students with social or regular use of alcohol was 62.5%, while the prevalence of smoking was a lot smaller. All demographic data are shown in Table 1.

Table 1.

Demographic data of all participants and LGBT medical students.

Variables	Total (N = 1,322) n (%) or M ± SD	LGBT students (n = 412) n (%) or M ± SD	p value
Medical schools			<.001*
Central	1000 (75.6)	261 (63.3)
Regional	322 (24.4)	151 (36.7)
Age (years)	21.06 ± 1.8	21.06 ± 2.0	.13
Year of academic study			.61
Preclinical year	691 (52.3)	211 (51.2)
Clinical year	631 (47.7)	201 (48.8)
Hometown (n = 1,313)			<.001*
Bangkok and Central region	740 (56.4)	188 (45.9)
Regional area	573 (43.6)	222 (54.1)
Parental marital status			.16
Living together	1138 (86.1)	344 (83.5)
Divorced	134 (10.1)	48 (11.7)
Widowed	50 (3.8)	20 (4.9)
Current living situation			.02*
With family or family members	765 (57.9)	215 (52.2)
With friend(s)	275 (20.8)	95 (23.1)
Alone	282 (21.3)	102 (24.8)
Reported health status
Diagnosed physical illness	218 (16.5)	79 (19.2)	.08
Diagnosed mental illness	124 (9.4)	62 (15.0)	<.001*
Family history of mental illness	100 (7.6)	39 (9.5)	.08
Substance use
Alcohol (social or regular use)	825 (62.4)	269 (65.3)	.15
Smoking (social or regular use)	73 (5.5)	18 (4.4)	.22
Financial support
Income per month (Thai Baht)	10,582.21 ± 7,395.8	10,398.02 ± 9,040.9	.55

*Statistically significant.

Table 2 shows details regarding sexual identity, orientation, and LGBT specifications. Sex assigned at birth was equal between males and females. Among LGBT identity, bisexuality was the most prevalent (16.8%), particularly bisexual females (11.5%), followed by gay men (7.6%). On the contrary, nonbinary and questioning people were less frequent than 1%. From the total sample, eight participants (0.6%) declined to report their sexual orientation.

Table 2.

Specified LGBT profiles.

Variables	Total (N = 1,322) n (%)	Variables	Identifies as LGBT (n = 412) n (%)
Sexual identity		Specifications of LGBT
Female	666 (50.4)	Lesbian	22 (1.7)
Male	656 (49.6)	Gay	101 (7.6)
Sexual orientation		Bisexual male	70 (5.3)
Heterosexual	931 (70.4)	Bisexual female	152 (11.5)
Homosexual	138 (10.4)	Transgender	27 (2.0)
Bisexual/Pansexual	227 (17.2)	Non-binary	9 (0.7)
Asexual	18 (1.4)	Asexual	18 (1.4)
Prefer not to answer	8 (0.6)	Questioning	12 (0.9)

Sexual behaviors compared between LGBT and non-LGBT medical students were investigated (Table 3). The average age at first sexual intercourse was 19.34 ± 2.1 years old, and LGBT students had a significantly earlier age (18.76 ± 2.5 vs. 19.75 ± 1.8, p-value < .001). Also, higher sexual experiences were found among LGBT medical students, both in solitary (86.8% vs. 71.1%, p value < .001) and partnered sexual activity (31.8% vs. 21.6%, p value < .001). Using geosocial networking/dating applications for sexual hookup (hookup applications) was more common among LGBT students (43.1% vs. 12.2%, p value < .001), whereas no significant difference regarding either risky sexual behaviors or sexualized drugs use between LGBT and non-LGBT students was observed.

Table 3.

Sexual behaviors between non-LGBT and LGBT medical students.

Variables	Non-LGBT students n (%) or M ± SD	LGBT students n (%) or M ± SD	p value
Age at first sexual intercourse (years)	19.75 ± 1.8	18.76 ± 2.5	<.001*
Solitary sexual activity (n = 1224)			<.001*
Never experienced	242 (29.0)	50 (13.2)
Experienced—no problems	585 (70.1)	323 (85.0)
with problems	8 (1.0)	7 (1.8)
Partnered sexual activity (n = 1,254)			<.001*
Never experienced	671 (78.4)	264 (68.2)
Experienced—no problems	169 (19.7)	106 (27.4)
Experienced—with problems	16 (1.9)	17 (4.4)
Use of hookup applications (n = 323)			<.001*
Never used	172 (87.8)	70 (56.9)
Used—sometimes	19 (9.7)	41 (33.3)
Frequently	5 (2.6)	12 (9.8)
Risky sexual behaviors (n = 310)			.31
Never	132 (69.5)	75 (62.5)
Risky—sometimes	53 (27.9)	43 (35.8)
Frequently	5 (2.6)	2 (1.7)
Sexualized drugs use (n = 290)			.47
Never	174 (95.6)	106 (98.1)
Chemsex—sometimes	7 (3.8)	2 (1.9)
Frequently	1 (0.5)	0 (0.0)

*Statistically significant.

Proportions of using hookup applications, risky sexual behaviors, and sexualized drug use between each LGBT identity, compared with the rest participants, are demonstrated in Table 4. Significantly higher use of sex application was found in both gay (66.7%, p value < .001) and bisexual males (60.0%, p value = .002). Only bisexual females reported significantly higher risky sexual behaviors (48.5%, p value = .01), and none of the LGBT identities revealed a significant difference in their history of sexualized drugs use. p Value was computing by contrasting individuals within LGBT category to all other students.

Table 4.

Use of hookup applications, risky sexual behaviors, and sexualized drug use among different LGBT identities, compared with all other students.

Variables	Use of hookup applications n (%)	p value	Risky sexual behaviors n (%)	p value	Sexualized drug use n (%)	p value
Lesbian (n = 6)	0 (0.0)	0.19	0 (0.0)	0.09	0 (0.0)	0.81
Gay (n = 42)	28 (66.7)	<0.001*	14 (33.3)	0.33	1 (2.4)	0.66
Bisexual/pansexual
Male (n = 25)	15 (60.0)	0.002*	9 (36.0)	0.99	0 (0.0)	0.33
Female (n = 33)	6 (18.2)	0.07	16 (48.5)	0.01*	1 (3.0)	0.79
Transgender (n = 10)	2 (20.0)	0.55	3 (30.0)	0.56	0 (0.0)	0.73
Non-binary (n = 4)	1 (25.0)	0.67	1 (25.0)	0.60	0 (0.0)	0.87
Questioning (n = 1)	1 (100.0)	0.24	0 (0.0)	0.67	0 (0.0)	0.97

*Statistically significant.

Among all students, sexual problems were more likely to be reported during partnered sexual activity (Table 5). Problems with achieving orgasm were the most frequent in both solitary (33.3%) and partnered sexual activity (23.5%).

Table 5.

Problems during sexual activity among all medical students.

Variables	Solitary sexual activities (n = 15) n (%)	Partnered sexual activities (n = 34) n (%)
Problems with desire	5 (33.3)	3 (8.8)
Problems with arousal	0 (0.0)	3 (8.8)
Problems reaching orgasm	5 (33.3)	8 (23.5)
Sexual pain	1 (6.7)	3 (8.8)
Performance anxiety	3 (20.0)	7 (20.6)
Others	1 (6.7)	10 (29.4)

Discussion

The average age at first sexual intercourse found in our sample of medical students was 19.75 years old, which was older than previously suggested by a multinational study which found that 40.0% of Thai adults had an early sexual debut (first sexual intercourse before 14 years old) (Peltzer & Pengpid, 2020). Our finding was slightly older than the one found by one previous study on North American medical students, which was relatively similar to other general populations at approximately 18 years old (Shindel et al., 2010). We hypothesized that medical students might be more susceptible to the influence of social norms, as pursuing a medical career is very coveted in Asian cultures, and this might also extend to social attitudes toward sexual behaviors. As such, following Asian cultural belief, they might consider abstinence an honorable practice, and thus delay having their first sexual intercourse (Parthiban et al., 2021). This might not apply as much to LGBT medical students, who were found to have earlier sexual debut than non-LGBT medical students in our sample, which was accordance to another medical student survey conducted in the US and Canada (Shindel et al., 2010). The higher proportion of both solitary and partnered sexual experiences seen in LGBT students could be due to LGBT individuals being more comfortable with sexual issues (Shindel et al., 2010).

Regarding sexual risks, three variables were collected: use of hookup applications, risky sexual behaviors, and sexualized drug use. Significantly higher use of hookup applications among LGBT than non-LGBT students was found which raised concerns about potential harmful consequences such as the use of methamphetamine, unprotected sex, and HIV infection (Piyaraj et al., 2018). Several studies demonstrated a link between use of hookup applications as an internet-based method for seeking casual sex partners in gay and men who have sex with men (Lewnard & Berrang-Ford, 2014). Consistently, our findings reported a higher rate of use of hookup applications in gay and bisexual male medical students. However, transgender females were at an inflated rate of using the services (Benotsch et al., 2016). Compared with transgender adults, transgender students seem to be less involved with sexual activity, as found in our study (Sok et al., 2020). In addition, limited number of participants should be considered because there were only 27 transgender students (of any sexual orientation/gender identity) in our sample. One-third of them replied to questions regarding sex-related risks and no significant differences between transgender and cisgender students were found.

We found that the LGBT identity of bisexual females was significantly associated with riskier sexual behaviors. The increased sexual risks encountered by bisexual females might from sharing contaminated sex toys, unprotected sex, passionate kissing with a stranger, and having multiple sexual partners (Anderson et al., 2014; Stokłosa et al., 2021). According to Thai law, sex toys are illegal, so explanations from previous studies might be partially applicable to our population. We hypothesized that Thai bisexual women may have a higher number of sexual partners than the general population (previous surveys that failed to report a difference between Thai men and women may have excluded people of bisexual orientation (Peltzer & Pengpid, 2020). Previous studies have demonstrated higher sex-related risks, such as the risk of STI, for bisexual women, which was linked to sexual experiences with both men and women (Bailey et al., 2003; Evans et al., 2016). Substances abuse was also common in bisexual women, which, if occurring before sexual intercourse, was associated with risky sexual behaviors, particularly in the case of alcohol (Griffin et al., 2020; Kim et al., 2019). Only a small percentage of medical students declared sexualized drugs use (3.4%). One common and illegal drug was methamphetamine, including its intravenous form, which was considered a serious issue and has been strongly linked to the risk of HIV infection (Martin et al., 2010). We believe that Thai medical students are expected to be comparatively conscientious and may display a lower use of sexualized drugs due to their attitudes complying with social expectations (Parthiban et al., 2021).

Our study highlighted several sexual problems. Problems with sexual desire were most frequently reported for difficulties during solitary sexual activity in our study, which is inconsistent with a prior Western study that problems with sexual desire were less prevalent (Shindel et al., 2008). Higher prevalence of low sexual desire was found in Asian countries, which was proposed to be due to stronger feelings of sexual guilt and less frequent sexual satisfaction (Irfan et al., 2020). Problem reaching orgasm was not reported in male students’ solitary sexual activity; meanwhile, female orgasmic problems could be ameliorated via direct clitoral stimulation, which might require several sexual experiences to be achieved (Marchand, 2021), and our sample might be less experienced in that domain. Problem reaching orgasm during partnered activity/sexual intercourse commonly occur in both males and females and are strongly related to stress or anxiety (Fiala et al., 2021; Pyke, 2020). The difference between the average age at first sexual intercourse and the current age of our participants was approximately 2–3 years. Thus, it was no surprise that they might have sex-related anxiety or problems reaching orgasm because of their limited sexual experiences. Interestingly, our study found that the prevalence of LGBT students was more frequent in regional areas where homonegativity and discrimination are rather common (Henriquez & Ahmad, 2021). Most Thai LGBT-related publications have focused on this population in urbanized and metropolitan settings (Newman et al., 2021). We believe that one essential factor associated with higher discrimination within regional areas is higher visibility and perceived difference (Kosciw et al., 2015). Even though there are limited studies investigating acceptance and attitudes toward LGBT individuals in Thai regional areas, disclosure of their identity would inevitably be accompanied by victimization. On the contrary, visibility could link others with similar identities to form a group or community of LGBT people who shared common interests, supported, and promoted satisfaction (Amati et al., 2018). Through childhood and adolescent periods, they had gradually developed their identity as peer modeling and group formation as a supporter against discrimination or victimization (Kiperman et al., 2022). However, the epidemiological profiles of Thai LGBT and worldwide were understudied and the exact prevalence in rural or urban areas from previous literatures was unknown. The higher proportion of LGBT individuals observed in medical education, compared to other social settings, is an interesting finding and requires further anthropological or sociological explanation (Shindel et al., 2010).

Mental health morbidities were common among the LGBT population and this could be explained by various factors, such as intrapersonal and interpersonal relations and sociocultural contexts (Russell & Fish, 2016). Social acceptability, bullying and discrimination, and internalized homonegativity were notably accountable for poor mental health (Berg et al., 2016). The significantly higher prevalence of mental illness within the LGBT community requires further exploration and investigations to provide a potential intervention or inclusion of such issues in the medical curriculum (Moagi et al., 2021), highlighted also by our study.

Independence or freedom of expression played a major theme in identity formation (Cerezo et al., 2020). LGBT medical students reported living independently of their families so they might live their LGBT selves in an authentic manner and ultimately be affected by their identity formation. However, our finding did not indicate the residency status timeframe, so the causality could not be inferred. Also, living alone or with others apart from their family members possibly postulated relationship quality between family and LGBT individuals. One critical review found underrepresentation of LGBT’s family-related studies focusing on family commitment or spending quality time together (Brown et al., 2020). Our finding suggested examining LGBT family quality time for this might be a candidate for promoting the mental health of LGBT people in the future.

Our study is among the first descriptive investigations into the sexual health of LGBT and non-LGBT medical students in Thailand. The findings highlight the importance of such issues that should be implemented in the curriculum as either their roles of practitioners or clients. Furthermore, by adding the concern of sexual pleasure as a focus to assess sexual health status would allow the practitioners to get more information from clients and facilitate healthcare delivery and use (Ford et al., 2021). It is a national study resulting from the collaboration of large medical schools around the country. The number of enrolled participants was higher than in previous studies performed in a single Thai medical school (Pongthai, 1990a, 1990b). We included diverse identities and varied areas of residence to represent our whole country’s demographics. The survey respected the anonymity and confidentiality of all students, so they were able to reply authentically without fear of discrimination or stigmatization.

Limitations

No systematic sampling was performed and only eligible students who were interested in taking part were recruited. This led to voluntary response bias. Because studies on LGBT issues are more likely to attract more LGBT participants, any inference of Thai LGBT prevalence should be done with caution as it might be overestimated. Open-ended questions regarding sexual difficulty were used in our study, as there were no Thai translated standardized questionnaires for sexual dysfunctions covering all LGBT identities available (Charoenmakpol et al., 2022). All answers to our questionnaires were self-reported, which could lead to recall bias. The assessment of LGBT identity also required inclusiveness and dichotomous items were not fit with some participants, particularly non-binary students. We therefore used the categorical list with explanation provided; however, this option limit the fluidity of sexual orientation and definitions of sexual orientation that may change over time.

Conclusion

LGBT medical students, especially homosexual and bisexual male students, showed a higher exposure to all sexual activities and had a higher risk of using geosocial networking/dating application for sexual hookup. Bisexual female students had the highest engagement with risky sexual behaviors. Factors such as mental health and family conditions might be associated with sexual health and require further investigation. Future studies should focus on the impact of such issues and develop preventative sexual healthcare strategies to be applied in the context of Thai medical education.

Funding Statement

This study was financially supported by the Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University, grant no. RA65/040. Awirut Oon-arom, corresponding author, a Fogarty UCGHI GloCal Fellow was supported by the Fogarty International Center of the National Institutes of Health under Award Number D43TW009343 and the University of California Global Health Institute and partially supported by Faculty of Medicine, Chiang Mai University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.