Providing Healthcare for Lesbian and Bisexual Women
Health-care providers often overlook the unique health needs of lesbian and bisexual women.
“What is your sexual preference?” It is a one-line question buried on the middle of the second page of the three-page intake form that my practice gives to new patients.
It is easy to miss among questions about menstrual and obstetric history.
After the first visit, this form gets buried in the back of the chart and there is no other place in the chart that indicates sexual preference, unless the provider notes it on the side of the patient history form.
I hope this problem is rectified when we change over to electronic health records. But until then, before seeing a patient who is new to me, I try to remember to go back and read the intake form. I've learned the hard way that it can be an embarrassing situation when the provider does not know her patient is a lesbian, and asks, “What do you use for contraception?”
Lesbian and bisexual women share the same needs for comprehensive health care and preventative services as heterosexual women, but are often an underserved population. In May, the American College of Obstetricians and Gynecologists (ACOG) released a position statement on the importance of healthcare for lesbian and bisexual women. This bulletin outlined some of the barriers to healthcare for this population, as well as guidelines for making patient care settings more receptive and inclusive to every woman.
Many patients and providers mistakenly believe that lesbian women have no risk for sexually transmitted infections. Bisexual and lesbian women do need to be screened for cervical cancer with routine pap smears, and should be educated on safe sexual practices, including condom use on sex toys and use of dental dams.
According to ACOG, lesbian women have a higher incidence of obesity, as well as tobacco and alcohol use, and therefore may be at higher risk for cardiovascular disease and type 2 diabetes. Depression, addiction and other mental health issues can also be common among gay women.
Knowing the risk factors and health disparities of any underserved population is crucial to providing good care. But it is often the more personal concerns that women want addressed. Many of my lesbian patients are extremely anxious about a speculum exam, particularly if they have never had sex that involved penetration. Often they are concerned and angry that they do not have health insurance coverage because their partner's employer does not recognize same-sex unions. Some want to discuss fertility and options for getting pregnant.
Understanding, awareness and compassion goes a long way in establishing a good relationship with any patient, but these are particularly important tools when working with lesbian and bisexual patients. Providers need to be comfortable discussing all aspects of sexual and reproductive health with every patient, regardless of their sexual orientation.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, NJ.
“Healthcare for Lesbians and Bisexual Women. Committee Opinion #525.” Obstet Gynecol. 2012;119:1077–1080.