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

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.