Physicians today need to be aware of the healthcare challenges faced by their lesbian and bisexual patient population. The key to providing optimal care lies in understanding the reasons why these patients may avoid seeking treatment, as well as identifying risks specific to lesbian and bisexual women and other individuals.
Healthcare Discrimination
Clinical organizations, such as the American College of Obstetricians and Gynecologists (ACOG), endorse equal treatment for all patients, including members of the LGBTQIA+ community. However, some physicians remain reluctant to treat gay, lesbian and bisexual patients. For instance, one recent survey by the Center for American Progress, a public policy research and advocacy organization, found that 8 percent of lesbian, bisexual and gay respondents said that a doctor or other healthcare provider refused to see them because of their actual or perceived sexual orientation. This same survey found that 7 percent said that a doctor or other healthcare provider refused to recognize their family, including a child or same-sex spouse or partner.
Such discrimination can keep lesbian and bisexual people away from medical treatment altogether. The Center for American Progress reports that 6.7 percent of surveyed LGBTQIA+ people said they avoided visiting a doctor within the past year due to concerns about discrimination. For respondents who had already experienced discrimination at least once in the last year, that proportion jumped to 18.4 percent.
Health Risks and Barriers to Care
As a result, many people who identify as gay, lesbian or bisexual face disproportionate disparities in their level of healthcare. According to the U.S. Office of Disease Prevention and Health Promotion, lesbian patients are less likely to receive preventive services for cancer, for instance, and lesbian and bisexual women are more likely to be overweight. These factors may, in turn, increase the risk of type 2 diabetes, lung cancer and cardiovascular disease. ACOG notes that higher rates of heart attack have been reported in lesbian patients. These disparities may be exacerbated for lesbian and bisexual women who are also transgender, disabled, people of color or part of another marginalized group.
When it comes to fertility, lesbian patients and their partners often face additional barriers to care, such as a lack of local healthcare providers offering reproductive care to non-heterosexual women or couples.
Understanding and Protecting Against STIs
Women who have sex with women are still at risk for sexually transmitted infections (STIs) such as herpes and chlamydia, which can be shared through bodily fluids. The Centers for Disease Control (CDC) notes that some LGBTQIA+ female patients, including teenagers and bisexual women, may be at an increased risk for STIs based on their reported risk behaviors. According to ACOG, bisexual women also have the highest rates of seropositivity for HIV compared to both lesbians and heterosexual women.
Physicians should encourage all patients, regardless of their sexual orientation, to engage in safer sex practices to reduce the risk of transmitting or acquiring STIs. For lesbian and bisexual women, that may mean using dental dams and latex gloves, using condoms on sex toys and avoiding sharing sex toys. By dispelling the myth that women cannot acquire STIs from other women, clinicians can educate patients and help them make informed decisions.
Physicians can also integrate clinical tools into their practice to help evaluate and diagnose Pelvic Inflammatory Disease (PID), a disease which may result from exposure to an STI. As with heterosexual women, lesbian and bisexual women may benefit from the use of transvaginal ultrasound for this purpose; ultrasound can complement pelvic exams and blood tests in the evaluation of PID. OB/GYNS should discuss the potential effects STIs can have on their patients' future fertility.
What to Screen For
OB/GYNs should also be aware that lesbian and bisexual patients may be at a higher risk for unhealthy behaviors such as substance use and abuse, and should consider screening for potential issues. The CDC notes that more than 20 percent of gay, lesbian and bisexual adults smoke cigarettes, compared with approximately 15 percent of their heterosexual peers.
Such issues may be partly a consequence of minority stress, a continual state of hypervigilance and anxiety, fear of rejection and exposure to discrimination that occurs in marginalized groups, including the LGBTQIA+ community. Minority stress is associated with higher rates of mental health concerns, including anxiety and depression, as well as substance abuse.
Due to lesbian and bisexual women's increased risk for chronic disease, including obesity, cardiovascular conditions and cancer, ACOG recommends that routine OB/GYN office visits should include counseling for weight control and smoking cessation as needed. Physicians who are able should also offer screening for cardiac risk factors, diabetes and lipid status as appropriate for the patient's age and medical history.
Maintaining a Welcoming Practice
OB/GYNs and other physicians have a crucial role to play in caring for members of the LGBTQIA+ community. Physicians should educate themselves on how to offer appropriate screenings, refer patients for mental health care if necessary and recognize the importance of fostering a welcoming, affirming environment.
Establish basic ways to avoid marginalizing vulnerable patients, such as asking for pronouns on intake forms and not assuming the gender of a patient's sexual partners in interviews. Patients of every sexual orientation should feel safe, affirmed and willing to share personal information with you and your clinical staff.
