Provider Ignorance, Bias Turn Lesbian Patients Off Health Care

Pamela Merritt

The lesbian community faces unique challenges when accessing health care, from widespread provider misconception 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.

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.

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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

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.


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

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.

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