Some general points that are worth repeating, as you consider each of the cases. Particularly important is the ability of the physician to identify individuals at risk for a variety of sexual problems, especially sexually transmitted diseases and unplanned pregnancy. The comfort and willingness of the physician to discuss ways in which patients can modify risky sexual behaviors is a crucial skill. You need not avoid raising issues of sexuality out of fear of ignorance. If you do not know the answer to a person's questions, you can find out.
Patients are often very relieved to share a private sexual problem with an understanding physician.
Few other individuals can provide the confidentiality and medical knowledge to address a person's concerns. Referral for further care is always possible and is part of what a competent physician does when a problem requires a set of skills that she or he may not have. For example, a mother may ask what to do when her 14 year old son confides in her his concerns about his sexual orientation. Although you may feel comfortable in beginning this discussion, appropriate referrals would include the boy's pediatrician and, perhaps, a psychiatrist or endocrinologist.