When seeking medical care, LGBT people are often confronted with a system that denies our existence or insults who we are. From medical forms that ask for a patient's marital status to doctors who refuse care to lesbians who seek to parent to medical ignorance of intersex conditions, even LGBT people with health insurance struggle to get the healthcare services they are paying for and need.
The lesbian community faces unique challenges when accessing health care, from widespread provider misperception about STI risks for women who partner with women to doctors who tailor their medical advice to stereotypes they have of lesbians' lives and needs.
Misperceptions About Sexual Risk and Behavior
Many medical providers erroneously believe that women who have sex with women are not at risk for sexually transmitted diseases or infections and that we are not in need of regular preventative care. Although there is a lack of research on the issue of sexually transmitted diseases and infections among women who have sex with women, it is known that the risk of STD transmission between women varies significantly from STD to STD. Herpes, HPV, and bacterial vaginosis are easily transmitted between women during sex. HIV, hepatitis B, gonorrhea, and chlamydia are less likely to be transmitted between women during sex, but it is still possible. Most lesbian and bisexual women who have had sex with both men and women are at risk for STDs that can be transmitted between men and women during sexual intercourse. Since many STDs do not have symptoms, it is possible for a woman to have an STD and unknowingly share it with her partner. Women who have sex with women may encounter a healthcare provider who harbors the misconception that they are not at risk and, therefore, actually be put at risk if they are not encouraged to relate their full sexual history, seek regular screenings and get tested for STDs.
An Our Bodies Ourselves report on health care for LGBT patients states that health care providers should take a thorough health and family history from all patients, ask gender-inclusive, open-ended questions that allow patients to come out to them or give them the information they need to provide appropriate treatment when necessary.
But some doctors do not even know how LGBT people have sex.
Evident discomfort and confusion about lesbian sexuality faced a friend, Keisha, at an annual well woman exam:
"I had always used my local Planned Parenthood for my yearly exam, but I finally had a job with full benefits and thought I'd try to find a gynecologist since well woman exams were part of my coverage. So, I found a doctor who was a woman and just assumed it would be the same kind of experience that I'd always had at Planned Parenthood; LGBT friendly and positive. What I got was a gynecological version of the who's on first joke. It all started when the doctor asked if I was a virgin. I said no, but that I was a lesbian, to which she responded with a question about whether I am sexually active. I said yes, but that I would need a smaller Pederson specula for the exam since I have never had sex with a man. She seemed confused and asked again if I was sexually active and I found myself telling a gynecologist that there are more ways to have sex than with a man. "So you're not a virgin?" she asked. "No," I replied. She finally asked if I had ever had sex with vaginal penetration, but by that time I was done. There was no way I was going on with the exam. I'm sticking with Planned Parenthood from now on."
When Keisha shared her story at my lesbian women of color support group's monthly gathering, we all related. As the evening went on and my friends related story after story, the emotional impact of a homophobic gynecological experience became clear. Many of us spoke of the anxiety of coming out to a healthcare professional and too many of us were met with judgment or an apathetic acceptance of our "lifestyle." Some of my friends felt like they had to educate their gynecologist on how lesbians have sex and several said that their doctor didn't seem to think lesbians are at risk for sexually transmitted diseases.
Stereotypes About Patients
I shared my own story with my friends in the group. When I had to switch gynecologists while undergoing treatment for fibroids, one appointment with with the new doctor was enough to show me the match wouldn't work. The physician reviewed my form and said that since I was "gay" I wouldn't be having children and so I should have a hysterectomy rather than continue treatment. My jaw dropped, but before I could recover enough to tell him where he could put his medical advice he added, "You might as well get that uterus out now since you're not going to use it." I told him I was incredibly offended, and the man had the audacity to look shocked when I abruptly ended the appointment.
Misunderstanding Families
As we move forward with our national discussion of healthcare needs, we must include the specific needs of all people including those of us who identify as LGBT. Medical professionals need training, informational pamphlets and websites need to be revised to include inclusive language and laws need to be passed to insure access to healthcare services regardless of an individual's sexual orientation or gender identity. We can all learn from the experiences of LGBT patients to improve patient care.
Cammie and her partner's experience stands out in this regard. The two have been together for ten years and decided the time was right to have a baby. The first hurdle they faced was finding an OB/GYN who had experience with same-sex couples. Friends recommended an OB/GYN but that physician wasn't within Cammie's provider network. Though her insurance allows for out of network treatment, Cammie was concerned about the cost. So, the couple selected an in-network doctor and set up an appointment.
"I knew we were in for some drama when we signed in at the front desk and the receptionist asked if my husband was with me," Cammie recalls. "I replied that my partner was with me and she acted embarrassed and flustered. The patient forms all contained references to a person's husband or spouse and I had to scratch the word out and replace it with partner."
Cammie went on to tell us that the OB/GYN confessed that he didn't think he had even treated any lesbians or "at least not one who made a big deal about it." As she and her partner sat back in shock over the phrasing of that statement he continued the conversation by calling Cammie's partner her "friend or whatever" and adding that he didn't have any problem with their "chosen lifestyle."
Once Cammie and her partner realized their safest bet was to turn to the provider recommended by their friends, Cammie reports, "The only problem we faced there was trying to get an appointment. It seems that every lesbian couple in the metropolitan area was trying to use the same doctor at the same time." The couple finally secured an appointment and had the kind of welcoming experience everyone hopes for when visiting an OB/GYN. They are now the proud parents of a daughter and are considering having more children.
When Patients Avoid Care
Beyond the emotional impact, there are the very real health risks associated with going to a gynecologist who lacks an understanding of LGBT people. How many of my friends haven't received STI counseling because their doctors assumed they have never had sex with men, even though several of them had relationships with men before coming out? How many have withheld healthcare concerns from their doctors because they didn't want to deal with insulting questions or judgment? How many avoided yearly exams because they didn't want to add another homophobic incident to their medical history?
Thankfully, the medical community has begun to address the need to include sexual orientation and gender identity in medical training. But doctors are people and are subject to the same issues of homophobia and ignorance that anyone else is subject to. Addressing the need for training will go a long way to improving the reproductive healthcare experiences of lesbians and other members of the LGBT community. Well woman exams are crucial for all women, and we need to do whatever we can to create medical environments that encourage women to visit their healthcare provider rather than fear another disrespectful, alienating ordeal.
