Web Extras for "Is Being Lesbian Hazardous to Your Health?"
Web extras for “Is Being Lesbian Hazardous to Your Health?”
- Who Says So? (Research results on LGBT health disparities)
- Take two suggestions and call me in the morning (Dr. Patricia Robertson suggests how lesbians can improve their own healthcare, and how healthcare providers can help)
- You won’t believe what the doctor said… (Alumnae stories of their “adventures” in healthcare)
The statistics used in the Quarterly’s charts were taken, with permission, from research into LGBT health disparities reported by The Center for American Progress.
You can read the full article (“How to Close the LGBT Health Disparities Gap”) and check their sources here.
“How to Close the LGBT Health Disparities Gap” (By Jeff Krehely December 21, 2009) also analyzes health disparities by race and ethnicity.
Dr. Patricia Robertson, the physician profiled in ““Is Being Lesbian Hazardous to Your Health?” provided the following suggestions to lesbian patients, and to all healthcare providers, on improving healthcare for lesbians.
What can lesbians do to improve their healthcare?
1. Find a LGBT-sensitive physician by taking time to check out the credentials of all doctors you might see. Choosing a bad doctor “can be hazardous to lesbians’ health.”
The Gay and Lesbian Medical Association maintains a nationwide directory of LGBT-sensitive physicians. (Other LGBT organizations and listservs do too.) GLMA’s site includes “Ten Things Lesbians Should Discuss With Their Health Care Providers”
2. Advocate for your own health by contributing to organizations doing lesbian health research (such as the Lesbian Health Fund).
3. Educate yourself about health care; what you don’t know may hurt you. For example, if you don’t know that some sexually transmitted diseases can be passed from woman to woman, or if you believe that only women who have sex with men need pap smears and pelvic exams, you may not get proper diagnosis and treatment of related problems.
4. “Come out” to your healthcare providers. “The majority of lesbians in many studies did not share their sexual orientation with their provider, and that puts their health at risk. There are issues the provider will need to inquire about to provide good healthcare.”
5. Be patient with your provider, and help educate him or her. “We’re all learning about lesbian health issues, because the field has just started having research significant enough to be applied to clinical practice.”
6. Nurture your straight allies; “they can be an important part of the solution.”
What can healthcare providers do to improve care for their lesbian patients?
1. “If a lesbian comes out to a medical practitioner, the person could say, ‘I have a number of lesbians in my practice. Welcome! And please let me know if you encounter any barriers or if there’s any way I can improve my delivery of health care to you.”
2. Use the term lesbian. “Saying the word ‘lesbian,’ while it sometimes is difficult, goes a very long way.”
3. Use your influence to get the research that does exist on lesbian health into the mainstream journals, where it will be seen by more providers than if it appears only in publications with an LGBT focus.
Lesbian alumnae have allowed us to share their personal stories of encounters—positive and negative—with the healthcare system. All stories are used with permission of the writer; names have been withheld to protect writers’ privacy; some stories have been edited for length and clarity.
Homophobia “not an issue” for this family
More than twelve years ago, my partner and I decided to begin the process of getting pregnant. We went to the Advanced Reproductive Medical clinic at the University of Connecticut. It took a year and a half and both of us trying before I became pregnant. During that time, we were treated with as much compassion, dignity and respect as I imagine any other couple encountered. One of the nurse practitioners that inseminated me was a MHC grad. We were sorry to leave the clinic and happy to return two years later to get pregnant again.
As we transitioned into working with my OB’s practice, once again, I felt like we received extraordinary care. My partner was included in every appointment and every decision. When I gave birth, she cut the cord and accompanied the baby into the nursery for her first check up. My older daughter is now ten and my younger daughter is now eight. In their experiences with their doctors, homophobia towards their family has not been an issue. I am unclear if this is a regional trend or if we have just been very lucky but I feel completely supported by the medical community in Central CT.—a 1990 alumna
”Thank god you’re gay…”
I have been blessed to have a general practitioner who is an alumna: Heidi Behforouz ’90. She is the most thorough and caring doctor I have ever had. She treats me as she treats anyone else and doesn’t leave out some questions that she might ask straight couples such as “Do you practice safe sex?”, a question which, in the past, has been glossed over because I’m gay.
Specifically, she has helped us on the road we are taking toward conception. With my health issues and my weight a little higher than it should be, it has been a struggle to carry a baby to term. I suffered two miscarriages and while it would be easy for her to say my wife, who is healthy, should carry first while I work on my issues, she never has. After my second miscarriage, we saw a reproductive endocrinologist—fertility specialist—to see what could be done, if anything, to allow me to carry to term. She took one look at me—and my medical issues—and said, “Oh thank god you’re gay. It’ll be so much easier on me to just inseminate your wife.”
I left her office in tears, with her telling me I probably have diabetes and would never carry, so let’s make an appointment to inseminate Jen “and get it over with.” Heidi being Heidi was appalled and said regardless of my health, we would find a way to make it work. She directed us to Fenway Health Clinic, which specializes in gay inseminations, and she has led me to drop a significant amount of weight—without judgment.
While we will be trying to conceive again, it will be on our terms and with someone who respects us … and our decisions.—a 1996 alumna
The doctor who wouldn’t say “lesbian”
One of my early exchanges was with a nurse taking my history. She could not understand how I could be sexually active, not use birth control, and never have been pregnant, so I had to be very clear with her how that works. This was in the ’70s.
I also had a problem with spot bleeding in the ’70s, and the teaching doctor with the student in tow asked me a whole lot of questions about the number of my sex partners and practices that made me wonder if he thought all queers were like the most promiscuous of gay men in the ’70s.
By the mid to late ’80s, I pretty much would only see women doctors who were my age or younger. I figured that I had a better chance of less ignorance, and mostly that was true. However, when I had to find a new doctor quickly, my [healthcare insurance] plan only had a couple of female doctors in my area who were taking patients. One of them could not bring herself to use the word lesbian and called me a female homosexual. That relationship did not last.
I went back to the teaching hospital and its clinics. And when they started their intake questionnaire for women patients, it was decidedly biased in the assumption that all the patients were heterosexual. I felt free to comment both on the form and to my doc about the absurdity of that.—a 1976 alumna
A case of mistaken identity
My partner’s got a good seven years on me, but you’d never know it from looking at her. Both of us look like we’re about eighteen. And despite her admitted maturity, Kristie’s got a fear: shots.
We had to make that dreaded trip to her doctor for a routine immunization. Kristie called out of work for the day, knowing she’d spend the rest of it recovering in bed, and I hauled myself up at what felt like the crack of dawn to accompany her, and then drive home afterward because she’d likely be dizzy, nauseated, and all-around upset.
It was early in the morning and neither of us were looking, let’s say, our best. I was in sweatpants and a baseball cap, and hadn’t bothered to put on any makeup, so I’m sure I looked even younger than usual.
As the physician’s assistant weighed Kristie and began trying to talk her out of her nerves, the PA looked at me and said, “Oh, it’s so nice of you to wake up so early and come with your mom to her doctor’s appointment.”
Kristie and I looked at each other and laughed a little, uncomfortable. I turned red. “She’s actually my partner,” I told the PA. “Oh,” she said. “Oh! I’m so sorry!
Cue awkward silence and, shortly thereafter, a painful shot. —a 2009 alumna
Answering the question: Why aren’t you using birth control?
I always get nervous before meeting a new physician for the first time. There are the usual questions about general health, medications, and any health complaints. And, without fail, because I’m of “childbearing age,” there are the birth-control questions. This seems like a particularly awkward way to “come out,” but it usually gives me a good opportunity to gauge a new physician’s comfort level with my sexual orientation.
I usually say, “Well, because I sleep with women” or “My girlfriend and I are monogamous, and I don’t need it” and then wait for a response. In some instances, I have had physicians express shock when I say that I’m not taking birth control and then they quickly follow the question with, “Well, why not?” One physician even asked if I were sure that I didn’t want a prescription for birth control “just in case.” Fortunately, I’ve had several physicians not bat an eyelash and continue on with questions about safe sex or if I take any other medications. My current physician even referred to my girlfriend in a subsequent conversation about my plans for the weekend. She’s a keeper!”—a 2004 alumna
Finding a doctor together
I moved with my partner from California to Portland, Oregon, in 1996 [and had] our first experience of finding a medical practice for both of us.
My health issue at the time was anxiety: I was overdue for a colonoscopy recommended at age 50 by my doctor in California as a precaution, since my father is a colon-cancer survivor. I had just experienced an intense GI episode, and the doctor I saw repeated the advice. So the day after I arrived in Portland, I began asking neighbors for a recommendation. Neighbors on both sides recommended the same medical practice. I dropped by, they had an opening, and it was automatic that my partner would also be a patient there. The result was back to back (so to speak) colonoscopies by the same doctor, and we were each a part of the process, receiving the other’s reports.
During the past four plus years our doctors have always inquired about our partners during exam conversations and it was especially important for me to know that I could talk to my doctors about anything during a difficult, now past, menopause. The psychological support I received from my medical doctors at that time was very valuable. I think the issue of two lesbians living together and going through menopause side by side is an area that needs much more research and attention.—a 1976 alumna
“Doctors who treat with any bias are just bad doctors.”
For me good healthcare has not been about being a lesbian but finding the right physician that can help me, regardless of their gender, my sexual orientation, or any other ancillary aspect of our doctor-patient relationship.
Also, I am at a point in my life as a lesbian where anything that will cull us out once again might be counterproductive. We’ve come a long way in some parts of this country to appreciate the diversity and I won’t have any part of division from the left or right, especially when the extreme righties would love to have us all (black, Jewish, gay, liberal, etc.) in our tight little boxes again.
I’ve come to the conclusion where doctors who treat with any bias are just bad doctors. I interview every doctor I use before they see me or one of my kids. Dawn, my spouse, and I grilled our pediatrician during our daughter’s adoption. Before we even had a referral we had a pediatrician who we flat out asked about her feeling on same-sex parents and international adoption. We just don’t eff around any more. I’m too old for that shit. The pediatrician appreciated our frank and open discussion before we chose her to be our kids’ doctor.—a 1982 alumna
Why was I charged for a pregnancy test?
1. While living in Cincinnati, Ohio, I had terrible stomach pain and went to the local hospital with my partner. They asked if I could be pregnant. I said no. I told them my form of birth control was not having sex with people with sperm. (I thought it was pithy and cute.) When I received my bill for the hospital I discovered I was charged $60 for a pregnancy test. Needless to say I was shocked! The only plus to this visit was that my partner was able to stay by my side in the hospital emergency room; we were terrified that she would not be allowed to stay with me.
2. The second year of visiting a gynecologist, she basically asked me, “So, are you still, like you know, a lesbian?” (rather than “Are you still in the same monogamous relationship?” or “Has anything changed in the past year in terms of your sexual relationships?” or anything more appropriate). I did not go back to that doctor. In fact, it definitely led me to wait more time than was appropriate before I sought out a doctor for my annual exam because I didn’t want to be put in that uncomfortable situation again.—a 2004 alumna
In 1998, I left a ten-year abusive marriage to a man. In 1999, I came out as a lesbian. Once settled into my new life, I set about building my network of supports. It was important to me in choosing a new primary care provider that she be sensitive to my trauma history and someone with whom I could discuss my sexuality. I chose Dr. B. based on recommendations from coworkers, who described her as a thorough and sensitive provider.
A ten-year abusive relationship left me suffering from the effects of PTSD and depression. After six months of weekly therapy, my therapist suggested that I make an appointment with my primary care provider to discuss prescription medication to help treat my depression. I followed her advice and made an appointment with Dr B.
I was shocked by the course of treatment recommended by Dr. B. She asked me if I had discussed the cause of my depression with my therapist. She said that she was “reluctant to prescribe antidepressants on a whim.” She suggested that I try St. John’s wort for a month and try getting out to exercise. She said, “You know, being overweight isn’t going to help how you feel about yourself. It’s a simple equation: eat less, exercise more. And, perhaps you should discuss your choice of sexual orientation with your therapist. I think you are forcing this lesbian thing.”
A week later, I had an appointment with a lesbian provider—Dr. Z. Dr. Z. provided a compassionate ear and a prescription for an antidepressant. At my one-month follow-up appointment with Dr. Z., I showed marked improvement in my symptoms and weight loss.—an 1987 alumna
“He couldn’t believe I had chosen a life without men.”
Out of convenience, I saw the son of the obstetrician who delivered me. I had gone in for a complete exam. He asked me what form of birth control I used. I told him I was a lesbian. He asked again, and I told him I only had relations with my girlfriend. I told him I couldn’t get pregnant that way. I was in my late twenties, pretty, white, and privileged. He could not believe I had chosen a life without men. I now see his nurse-midwife, and things are much easier. —a 1992 alumna
Does lesbian = abstinent?
1. When I was twenty, I had a summer internship at a women’s health clinic. Ninety-five percent of the job was arranging for contraception, but I had been trained not to assume that the client was heterosexual. A woman my age came in and my job was to help her with the intake. I asked her what form of birth control she used. She said she didn’t use any. I said, “Are you trying to get pregnant?” She said, “I’m a lesbian. Is it okay for me to get my pelvic done here?” I apologized, but everything after that felt awkward. I still feel bad that I made her uncomfortable. As a lesbian myself, I should have been more aware that not everyone has sex with men.
2. Two years ago I went to see a well-regarded gynecologist in Reno, Nevada, for my routine pap and pelvic. She asked me what form of birth control I used. I had written on my medical history form: lesbian. I doubt doctors often read that medical history form; this one certainly had not. I told her, “I am a lesbian.” She said, “So you’re abstinent?” I replied, “Well, no, but I don’t have sex with men.” She insisted, “What I mean is, you don’t have intercourse.” I conceded, “I suppose.” I know how doctors think. She was merely checking off all the various diseases I was not likely to catch. Still, as I put my feet in the stirrups, I felt irritable, and I haven’t been to a gynecologist since.—a 1990 alumna
A teaching moment for medical interns
I feel strongly that the best medical care results from a comfortable doctor/patient relationship. That is what I have with my openly lesbian primary care provider. I have always felt she is more aware of lesbian-specific health issues than a straight doctor would be, and there is no awkwardness when she raises them with me. I am also much more comfortable talking with her about any concern I have, such as my fears when my partner was diagnosed with skin cancer.
When my partner and I were trying to get pregnant, she understood the steps we needed to take, and was there with reassurance when it took longer than I thought it would.
The best part is catching her new interns and residents off guard, when they go through their standard list of questions during their interview and ask me about birth control. She always seems to get a kick out of their momentary stammering when I respond, and makes it a teaching moment on how to ask more open-ended questions of patients.
I delivered both of my boys at a very gay-friendly hospital. My ob/gyn is also openly lesbian and it was business as usual on the maternity ward when my partner and I showed up. Having that level of comfort and support was so critical in those early days with our first newborn. Friends of ours who delivered at other hospitals had to explain repeatedly to staff that there was no father—on purpose, they really did not need to worry about birth control, and it was okay for that woman sleeping in the chair to still be there.—an 1989 alumna
Choosing a doctor
I dated women for about thirteen years, coming out in my first year at MHC. I had never been on birth control or sexually active until the point when I needed an STD test. I had heard all the jokes about going to the health center, where they ask you if you could be pregnant, and the cheery reply was “my girlfriend’s good, but not that good!” My experience at MHC was positive.
My experience outside of Mount Holyoke was also primarily positive. Hearing and reading that lesbians had a harder time with health issues, every time I chose a new doctor, I had some criteria they had to fit. It had to be a woman; she had to be board certified in family practice and OB-GYN; and if she had a rep. as being GBLTQ friendly, all the better. She also had to have a good bedside manner; if she was a bad listener, I didn’t go back. I found that I was protective of myself and as a result had good experiences with doctors and nurse practitioners.
It is awkward and hard to have to come out over and over again—when you move—and since I moved almost every year, I had to find a new doctor every time. Many of them, when hearing how long my regular [menstrual] cycle was, wanted to put me on birth control right away. You have to be a good advocate for yourself in order to be a lesbian or just a woman in our society. Since reading the book aptly titled The Flow, I found that modern Western medicine medicalizes having a period. So I fought that as long as I possibly could.
Now dating a man and being engaged, it is amazing the amount of straight privilege I experience. I went on birth control and I feel like the awareness I had of my own body is gone. And since I am grieving my identity as a lesbian, I grieve that part of my health as well.—a 1999 alumna
Pay attention to behaviors, not labels
I have had relationships with both men and women in my life, and yet I was told by a primary care provider that I did not need to undergo routine Pap smear testing because I was dating a woman. I have worked in a clinic where a patient was referred to in weekly staff-only status meetings as “that gay woman”; while I am sure she received the appropriate medical treatment for her serious neuromalignancy, she may not have felt fully welcomed and supported by our staff due to their perception of her difference.
It’s important for individuals to seek health care that’s in line with the behaviors they practice rather than the labels they give sexual orientation. There are lesbian-identified women who have sex with men. and straight-identified women who have sex with women, and bisexual women who only have sex with women, behaviors that may change their risk potential and, therefore, how a provider should approach their care.
I do see improvements in education that will change the way providers are educated in sexual history taking. Nursing, nurse practitioner, physician assistant, and doctor of medicine students at Duke, in tune with national progression on this issue, have been trained to ask, “Do you have sex with men, women, or both?” of all adult patients, regardless of gender, age, race, ethnicity, socioeconomic status, or marital status.
Changing our practice to asking this simple question of everyone, instead of presuming we know the behaviors the patient in front of us is practicing because of other information they have given us or assumptions we have made, will help ensure that patients feel their provider is a safe and receptive person with whom to discuss their sexual practices and concerns, and, in turn, will help them receive appropriate, individualized care.—a 2005 alumna
Being gay is contagious?
Back in the early 1980s, I had a gynecologist (male) who told me I really didn’t need to come in for check ups because I was a lesbian. He also strongly urged me to get an IUD, “in case you change your mind.” I stopped going to him.
In the late 1980s, I had a chiropractor (male) stop an examination in the middle when I told him I was gay. He left the room; I got dressed; I yelled at him and left. I have no idea why he was so upset–perhaps he thought being gay was contagious.
Because I’m gay, the wife of a boss I had in 2001 told me I was a carrier of HIV/AIDS. She apparently believed all gay people had AIDS. Every time I got a cold, she told me it was AIDS. Happily I am not infected, and my colds are just colds. But her assumption was breath-taking.
All doctors’ office forms assume “straight” and I generally have to edit each form to make it clear who my contact person is and how we are related (as spouses). I always mention to a doctor how frustrating this is and how easy it would be to change just a couple of words to make these forms more generic.
My spouse and I, because we are a gay couple, cannot be covered on each other’s health insurance policies. We have to have individual policies which take a huge chunk out of our family pocket.
I think I have stayed away from gynecologists for the past 20 years because of the treatment I received as a gay woman. It was generally snide and inappropriate. Now I find that some doctors don’t blink or respond negatively, and that’s a huge relief. Because for most of my adult life, I had to worry not only about whatever medical problem I might be having, but also about how the simple fact of my sexual orientation would affect the quality of the care I would receive. —a 1970 alumna
Explaining sex to the doctor
I’m two for two on health care providers who have been puzzled when I tell them that I am gay. I had one female physician, when discussing sex, give me a strange smile and ask, “So what do you do?” My ex-girlfriend had a similar experience during which her male doctor asked her, “How does that work?” I would find it much more heartening if the physicians I went to were more knowledgeable about lesbian sex, period. It’s not that I need to be treated differently, but I was startled that I had to explain sex to my doctor!—a 2008 alumna
Sex(ual healthcare) and the city
I saw a gynecologist for a little while who had not made a note in my file that I was a lesbian, so I’d get asked about birth control every time I went. I dumped her after a few visits.
My internists in NYC never paid particular attention to my lesbianism as a health risk, but I have a fantastic internist in Chicago who sees both my partner and me, so she is our family doctor and discusses lesbian health risks with us.
We have had positive (well, in regards to being gay) experiences in presurgery and postop rooms with nurses and the doctors. My partner gave birth to our first daughter in a birthing center within a hospital in Brooklyn, NY, and we used midwives who were awesome and no one batted an eye when I was identified as our daughter’s other mother.
We’ve made a few trips to Children’s Memorial Hospital in Chicago, and the triage nurses and doctors have all accepted that we are both our daughters’ mothers. Frankly, the only thing—other than getting the kids well—that the hospital staff seem to care about is who is going to pay the bills.
Maybe we are just lucky or an exception to the rule. Maybe our mostly positive experience is because we have always lived in big cities–a decision we’ve made, in part, because we are lesbians.—a 1983 alumna
January 26, 2011