Ten Things Lesbians Should Discuss with Their Health Care Providers

Press release

By: Katherine A. O'Hanlan

Date: July 17, 2002

Source: O'Hanlan, Katherine A. "Ten Things Lesbians Should Discuss With Their Health Care Provider." Gay and Lesbian Medical Association, July 17, 2002.

About the Author: Dr. Katherine A. (Kate) O'Hanlan is an oncological gynecologist affiliated with the Stanford University Medical Center as well as the past president of the Gay and Lesbian Medical Association. In the 1990s, she joined the National Center for Lesbian Rights in a letter-writing campaign urging researchers to include lesbians in their studies.

INTRODUCTION

To a large extent, lesbians have been an invisible population in the health care system. Although the health care needs of lesbians are the same as those of all women in most cases, lesbians have not attracted as much attention as heterosexual women. Meanwhile, health care in the gay community has focused on gay men.

The particular health needs of lesbians were first addressed by the women's liberation movement. Our Bodies, Ourselves, the landmark 1970 book about women's health and sexuality, was produced by the Boston Women's Health Book Collective because women had experienced doctors who were condescending, judgmental, and uninformative. The book briefly addressed lesbian health issues, but it was aimed at laypeople. Most health care providers remained unaware of lesbian health concerns while the women's health movement focused on the concerns that primarily affected straight women, such as abortion and birth control.

Most of the clinics that emerged in the 1970s and 1980s to serve homosexual populations focused on gay men. Only a handful of health clinics developed specifically for lesbians appeared at this time and these were limited to large cities such as San Francisco and New York. Lesbian-specific mental health, gynecological, and substance abuse services were generally absent. In 1987, the National Gay and Lesbian Health Foundation attempted to address lesbian needs by publishing "The National Lesbian Health Care Survey." However, a dramatic increase in lesbian health research began only in 1999, following the publication of a major private report and the U.S. Department of Health and Human Services Scientific Workshop on Lesbian Health. The increased number of articles about lesbians in health professional literature and in lay publications reflected increased tolerance, but prejudice and ignorance remained obstacles to good health care.

Lesbians have special barriers to health care that include homophobia from the health care provider; internalized homophobia; heterosexist assumptions; lack of knowledge about special risks and screening needs of lesbians by lesbians themselves; incorrect knowledge about health care needs of lesbians by health care providers; the false belief by lesbians and health care providers that lesbians are immune to sexually-transmitted diseases, cervical cancer, and HIV; preventive care sought less since lesbians need routine contraceptive and prenatal care less often; and a lack of insurance coverage.

PRIMARY SOURCE

TEN THINGS LESBIANS SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS

SAN FRANCISCO—A survey of members of the Gay and Lesbian Medical Association (GLMA) released today listed 10 health care concerns lesbians should include in discussions with their physicians or other health care providers.

"We did the survey," said GLMA Executive Director Maureen S. O'Leary, RN, "because many lesbians and far too many health professionals are not comfortable or do not know how to discuss health issues related to sexual orientation. Unfortunately, there are some health risks that are of greater concern to lesbians, and we need to make sure they are addressed."

Gynecologist and former GLMA President Kathleen O'Hanlan, MD, said that the medical community must look at all factors—gender, age, family history, and current health—but that there are cultural competence issues involved in treatment of lesbians that many do not understand.

"We in the medical community need to find remedies for all the factors that reduce utilization of medical services and screening compliance among lesbians," she said. "Short of changing the laws of the country to reduce the sting of ubiquitous disdain, clinicians need to provide a safe haven for medical care for all women.

"We know from research," said O'Hanlan, "that lesbians are less likely to seek medical care than other women because of the stigma they experience everywhere in society. They also experience it when they go for medical care. Health care providers may feel uncomfortable asking questions they feel to be personal. They then limit their visit and dash out without counseling the patient.

"Although more research is needed to understand the prevalence and causes," O'Hanlan continued, "there is evidence that lesbians smoke more and drink more. It is also more likely they are overweight, which adds significant health risks. Unfortunately, some health care providers make the presumption of heterosexuality or they may offend the lesbian patient in their conversations since they lack understanding of the salient cultural issues. Either way, it reduces the likelihood that the lesbian patient will return for care."

"We need to get the discussions going," O'Leary said. "Most health care professionals understand that there are certain risks that come with being a woman or with the aging process. However, we need to make sure that lesbians get equal care and that means incorporating this kind of understanding into the regular approach to treatment."

Lesbian Health Concerns

1. Breast Cancer
2. Depression/Anxiety
3. Gynecological Cancer
4. Fitness (Diet and Exercise)
5. Substance Use
6. Tobacco
7. Alcohol
8. Domestic Violence
9. Osteoporosis
10. Heart Health

"Of course," O'Leary added, "and it is important to repeat—many of the health concerns for lesbians are the same as they are for other women. But we must have a medical community that understands that there are cultural issues—orientation, gender identity, ethnicity, race, economic status—that must be understood as well. For lesbians, the 'Ten Things' list is a place to start."

1. Breast Cancer—Lesbians have the richest concentration of risk factors for this cancer than any subset of women in the world. Combine this with the fact that many lesbians over 40 do not get routine mammograms, do breast self-exams, or have a clinical breast exam, and the cancer may not be diagnosed early when it is most curable.
2. Depression/Anxiety—Lesbians have been shown to experience chronic stress from homophobic discrimination. This stress is compounded by the need that some still have to hide their orientation from work colleagues, and by the fact that many lesbians have lost the important emotional support others get from their families due to alienation stemming from their sexual orientation.
3. Gynecological Cancer—Lesbians have higher risks for some of the gynecologic cancers. What they may not know is that having a yearly exam by a gynecologist can significantly facilitate early diagnosis associated with higher rates of curability if they ever develop.
4. Fitness—Research confirms that lesbians have higher body mass than heterosexual women. Obesity is associated with higher rates of heart disease, cancers, and premature death. What lesbians need is competent advice about healthy living and healthy eating, as well as healthy exercise.
5. Substance Use—Research indicates that illicit drugs may be used more often among lesbians than heterosexual women. There may be added stressors in lesbian lives from homophobic discrimination, and lesbians need support from each other and from health care providers to find healthy releases, quality recreation, stress reduction, and coping techniques.
6. Tobacco—Research also indicates that tobacco and smoking products may be used more often by lesbians than by heterosexual women. Whether smoking is used as a tension reducer or for social interactions, addiction often follows and is associated with higher rates of cancers, heart disease, and emphysema—the three major causes of death among all women.
7. Alcohol—Alcohol use and abuse may be higher among lesbians. While one drink daily may be good for the heart and not increase cancer or osteoporosis risks, more than that can be a risk factor for disease.
8. Domestic Violence—Domestic violence is reported to occur in about 11 percent of lesbian homes, about half the rate of 20 percent reported by heterosexual women. But the question is where do lesbians go when they are battered? Shelters need to welcome and include battered lesbians, and offer counseling to the offending partners.
9. Osteoporosis—The rates and risks of osteoporosis among lesbians have not been well characterized yet. Calcium and weight-bearing exercise as well as the avoidance of tobacco and alcohol are the mainstays of prevention. Getting bone density tests every few years to see if medication is needed to prevent fracture is also important.
10. Heart Health—Smoking and obesity are the most prevalent risk factors for heart disease among lesbians; but all lesbians need to also get an annual clinical exam because this is when blood pressure is checked, cholesterol is measured, diabetes is diagnosed, and exercise is discussed. Preventing heart disease, which kills 45 percent of women, should be paramount to every clinical visit.

SIGNIFICANCE

Lesbians were an integral part of both the women's and the gay health movements that emerged in the 1970s, but these movements did not specifically address lesbian health concerns. For the most part, lesbians are an invisible constituency in the health care system, either entering the system incognito or opting out of the system altogether.

In the 1990s, organized efforts to make lesbians visible to the medical community began to bear some fruit. The largest study of women, the Women's Health Initiative (163,000 women studied over a ten-year period), agreed to include questions about the gender of sexual partners. This allowed researchers to compare data among women with different sexual behavior. The Harvard Nurses Study, the longest ongoing study of women's health, agreed to ask their study participants (127,000 female nurses) about their sexual orientation.

Studies that include lesbians have revealed that lesbians do not receive as much care as their straight female or gay male counterparts. Most lesbians have regular health care providers but more than half seek care only if they have a problem. Of concern is the fact that care is often delayed and noncare (negative care) is common. Noncare occurs when lesbians sense a lack of respect from a health care provider, do not feel safe enough to continue with a particular provider, and generally feel that they receive poor care. Behaviors from providers that discourage lesbians from seeking health care include prejudicial language, clipped voice tones, roughness in handling, a hurried pace, and false endearments. The current problems of the health care system, notably the spiraling level of the uninsured, is likely to further increase the number of lesbians who receive inadequate medical care.

FURTHER RESOURCES

Books

Solarz, Andrea L. Lesbian Health: Current Assessment and Directions for the Future. Washington, D.C.: National Academy Press, 1999.

Stern, Phyllis Noerager. Lesbian Health: What Are the Issues? New York: Taylor and Francis, 1993.

Youngkin, Ellis Quinn, and Marcia Szmania Davis. Women's Health: A Primary Care Clinical Guide. Upper Saddle River, N.J.: Pearson Prentice Hall, 2004.

White, Jocelyn, and Marissa C. Martinez. The Lesbian Health Book: Caring for Ourselves. Seattle: Seal Press, 1997.