Lesbian Health Care Bi Trans Queer Jo Lambert

Lesbian Health Care (& Bi & Trans & Queer) Jo Lambert Ph. D©, RN U of D Mercy For University of Windsor Faculty of Nursing Oct 5, 2004

Why does sexual orientation matter? • Health care system & our culture is heterosexist & homophobic • Sexual minorities are just that – minorities • Lesbians have worse health care outcomes than heterosexual women • We want to provide high quality culturally competent care to our clients • 10% of the population maybe homosexual

Problems/Barriers • Homosexuality was a mental illness until 1973 (removed by the APA) • Insensitivity; negative experiences – forced birth control, verbal abuse, rough physical treatment, denial of care • Info & data collection forms in office/clinic assume heterosexuality • Next of kin not acknowledged in system

Barriers (con’t) • Disproportionately uninsured because spouse not acknowledged, also, women earn less • May prefer alternative/complementary medicines which are not re-imbursable • Lack of women- and/or nurse-run clinics (which may make lesbians more comfortable)

Barriers (con’t) • Practitioners’ discomfort asking for a sexual history (may result in client leaving or not returning for care) • Worries about confidentiality • Lack of self esteem may preclude woman from speaking up

Health care issues Prevention & health promotion – All require routine screening for STIs, cervical & breast cancer Higher risk for breast cancer – lower access to mammography, low rates of SBE, lack of routine health care, often nulliparous Rates of alcoholism & substance use have been reported to be higher in the gay/lesbian community Risk for depression & suicide

Health Care Issues (con’t) • Domestic violence • Parenting issues – may be co-parenting, may have opposite-sex ex, may have sperm donor in picture; alternative family structures • STIs – current identification as lesbian does not negate previous sexual contact with a man (HPV is also transmitted from female to female)

More issues… • Nulliparity • Obesity/overweight • smoking • alcohol use • use of birth control pills This cluster of factors can put women at risk for cardiac disease, lung cancer, breast cancer, diabetes, etc.

Bi/Trans/Queer? • First know definitions: • Bisexuals have sex with men & women • Transgendered folks are either M to F, F to M, pre-surgical, post-surgical or somewhere in-between. Depending on their sexual behavior you have different diagnoses to think about • Queer folks are typically unwilling to be categorized (so ask!!)

What to do ? • Get an effective & meaningful social & sexual history • PRACTICE – PRACTICE • Ask about intimate relationships, what kind of sexual activity – penetrative (vaginal, anal), cunnilingus, use of ‘toys’, multiple partners, etc. • You can’t do health promotion without knowing risks

More to do… • AA, NA, care-givers’ groups, cancer support groups should have non-heterosexual counterparts • Children of divorce – conflict related to parents’ sexual identity • Stresses of “coming out” – adolescents & adults may ‘lose’ their families of origin • Pregnancy concerns • Sexual rehabilitation after cancer surgery, heart disease, hysterectomy, diagnosis of scleroderma/Sjogren’s, ostomy surgery, etc

More to do… • Use open, inclusive language • Educate yourself • Know that you will take care of sexual minorities & you may not recognize them! • Make sure that all sexual practices and behaviors & intimate relationships are on your radar screen • Do not make us invisible!!