Lesbians are more likely to seek health care if they are in an accepting healthcare environment, a new opinion paper argues.
"Clinicians who have an understanding of lesbian women and their unique stressors, who provide a welcoming and inclusive environment, and who provide cross-cultural care are well positioned to reduce healthcare stigma and improve clinical outcomes," Drs. Jordan E. Rullo and Stephanie S. Faubion of the Mayo Clinic in Rochester, Minnesota, write in Menopause, in an essay focusing on lesbians in middle age.
The authors note that LGBTQ people have health and sexual relationship patterns like those in the general population but “have higher rates of substance use, psychological disorders, and suicide attempts than their heterosexual counterparts."
Lesbians, specifically, also have higher prevalence of smoking and obesity than heterosexual women -- and they're less likely to have had a recent mammogram or to have been screened for cervical cancer, the authors add.
Dr. Lori R. Muskat, a psychology professor at Argosy University in Atlanta who was not an author on the opinion piece, said by email, "This paper is particularly important regarding lesbians who are now in middle age. Most of these women grew up and 'came out' when being a lesbian was even more taboo than it is now. Recent legalization of gay marriage and more widespread visibility of lesbians in public life, entertainment, and the media may obscure the factors at play when women who are now middle-aged were coming of age."
To make lesbian patients feel accepted and comfortable, Drs. Rullo and Faubion offer these suggestions to health care providers:
1. Don't assume the gender(s) of the people your patient is attracted to, or their sexual partners.
2. Consider that lesbians are at greater risk for coronary heart disease, diabetes, and potentially breast and cervical cancer and that they may have a higher prevalence of cervical cancer than heterosexual women.
3. Educate patients about the risks for bacterial vaginosis, HPV, and HIV, due to same-sex sexual behaviors and sharing of sexual devices - and encourage screening, prevention, and treatment.
4. Regularly assess anxiety, depression, and substance use.
The American College of Obstetricians and Gynecologists recommends that providers don't assume that patients are heterosexual and that they ask patients about marital and partnership status, sexual activity (or lack of it), and potential sexual interest in men, women, or both.
Dr. Muskat believes “culturally literate” clinicians are more likely to offer an environment that is “emotionally safer” for middle-aged lesbians, “resulting in a freer reporting of symptoms and concerns.”
Dr. Valerie Fein-Zachary of Beth Israel Deaconess Medical Center in Boston, also not an author on the paper, said by email, "By learning about the specific health issues of lesbian, bisexual and transgender women, we as providers can better counsel them - including about screening exams for breast, cervical/ovarian or prostate cancer, depending on their individual needs; and about risk-reduction strategies." She also suggests asking patients if they feel safe at home, at work, and in the community.
She identified several barriers to care: “lack of access to insurance, lack of knowledgeable providers, lack of culturally competent providers, and lack of institutional acceptance - including hospitals denying LGBT people basic rights such as visitation by family members (non-blood relatives). . . . Lack of insurance coverage may hamper access to healthcare because most insurance still relies on employment or spousal insurance through employment.”
Drs. Rullo and Faubion suggest that providers learn to create LGBTQ-inclusive health care environments by consulting resources from the American Medical Association (), the Health Professionals Advancing GBT Equality directory, the Healthcare Equality Index 2017 and the National LGBT Health Education Center.