Navigating the Health Care System
LBTI Health Care Concerns
Based in part on the "Relationships with Women," chapter from the 1998 edition of Our Bodies, Ourselves. Special thanks to Cheryl Chase, Diego Sanchez, Hawk Stone, and Jessica Xavier.
Single or Married? Heterosexist Assumptions and Homophobia in Medical Settings
Male or Female? The Gender Binary and Transphobia in Medical Settings
What We Can Do
Coming Out to Our Health Care Providers
Finding an LGBTI-Friendly Health Care Provider
LGBTI Health Resources
Do women who partner with women have special health care needs? Could our gender identity, intersex condition, or sexual orientation put us at increased risk for certain health problems and decreased risk for others? While many organizations have begun to identify the specific health needs and concerns of lesbian, gay, bisexual, transgender, and intersex (LGBTI) people, relatively little research has been done to answer these questions.
One thing, however, is clear: We experience unique barriers to getting competent, sensitive health care. These barriers prevent many of us from getting the regular check-ups and treatments we need and are entitled to receive. Some of these barriers include heterosexism (discrimination against any nonheterosexual behavior), homophobia (fear of people who are lesbian, bisexual, and transgender), and transphobia (fear of people who are transgender).
We often feel that the forms we fill out when we arrive at a health care provider's office, the pamphlets lining the wall, and the language that is used by our provider and the intake staff are directed to someone else. Although this is changing and some providers are LGBTI-friendly, too many doctors and other practitioners lack knowledge about our lives and needs as LBTI people, and they use language and procedures that favor heterosexuality and are biased toward a female-male binary. This means that those of us who are lesbian, bisexual, transgender, or intersex may not feel comfortable in these spaces.
Sometimes we do not seek health care because we believe or are told that we do not need certain services. For example, some women and health care providers think that women who have sex with women are not vulnerable to sexually transmitted infections or do not need regular preventive care. This is not true.
A lesbian explains why she did not get a gynecological exam until she was 27:
|All of my friends had gone to the gynecologist the first time because they wanted birth control or because they had begun to have sex (with guys). Growing up, our sex ed and health classes always said to either go when you start having sex or when you turn 18 (probably because they were anticipating that you would have sex soon). Things just didn't happen that way for me...I never had sex (with guys) and I therefore had no need for birth control.|
A 23-year-old from a "relatively small and isolated city that is severely lacking resources and support for LGBT individuals" wrote:
|The worst health advice I was ever given was by a doctor who informed me after I had disclosed my sexuality that I did not require a Pap smear to test for cervical cancer becauseˇKthe sex I was having did not constitute "real sex."|
A good health care provider should take a thorough health and family history, and ask appropriate questions that will allow us to come out to them or give them the information they need to treat us properly. This conversation should give us the opportunity to disclose our intimate relationships. The health care provider should ask about sexual activity in the form of gender-inclusive, open-ended questions, such as "Are you sexually active?" and "If so, do you practice safer sex?" rather than "What kind of birth control do you use?"
|Last time a doctor asked me what birth control I was using (which, she admitted, was completely irrelevant to the reason for my visit), I said that I didn't need to use any at the moment. She wrote "not sexually active" on my form, and I left the room furious, not only at her but at myself for not challenging her.|
Assumptions about our behaviors and risk factors can prevent our providers from giving us the information we need. We may have to ask very specific questions and provide very detailed information in order to get the answers we seek. One woman describes her experience during a pre-surgery appointment for removal of a fibroid tumor:
|I told him I had a female partner, and asked him how long we would have to wait after my surgery to have sex again. "Sex?...Well, you shouldn't shoot water up each other or anything like that for a few weeks." I wondered what kind of crazy lesbian porn this guy had seen. I asked him, "Well, what about if she just wants to put her fingers in me?" His answer to that was more expected; he mentioned that everything going into me should be clean and have a condom on it.|
Another woman explains how a provider's failure to ask questions can prevent him or her from getting the information they need from us.
|My docs are pretty cool, although I don't think they quite understand what bisexual means, and they tend to dismiss it because I'm married and therefore appear straight. I am poly though and date other men and women (at least in theory).|
Many of us feel frustrated or experience anxiety because we do not feel our providers can answer our questions. They may not have educated themselves about our lives, as two women describe.
|I've been with my partner for over two years. A year ago I found out I had genital herpes--I still don't know how I got it. I have been with both men and women, but not with very many people. [My partner] was angry at first, but then took care of me throughout the first outbreak. The hardest thing was the complete lack of information for lesbians with herpes. We talked to many doctors and did lots of research, but we weren't able to find out definitively how to keep her safe from the virus. Most doctors had no information for us at all. So far, she's still healthy...I am so disappointed about the lack of information for lesbians on STDs in general.|
|When my partner had an unusual discharge we didn't know how much if any sex to practice and/or how to be safe when practicing.|
Sometimes we are frustrated by our health care provider's lack of sensitivity. Even providers who are lesbian or bisexual may not understand or be sensitive to the needs of women who are less privileged, have a different racial and/or cultural background than their own, are trangender, have intersex conditions, work as sex workers, or use drugs.
Many of the systems in place, the intake forms and the language used by our providers and their staff, can make going for a check-up very stressful.
|Many health care providers (except for my local Planned Parenthood) have intake forms that ask marital status. I always change it to relationship status and hand-write whatever is true for me at the time. I hope they get it.|
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