Today's article is part of "Blog for Lesbian Health Day," which was started by organizers of the National Lesbian Health Summit 2009. Back in December, I was approached by an organizer and asked to write about issues that affect me in all or some of those roles within the overall health-care experience. More specifically, I was asked about my personal health-care experiences as a lesbian, and also what issues I am concerned about for myself and community.
So, without further ado, here are my individual thoughts and experiences. As a patient and a nurse. And always, as a lesbian:
The first and most obvious issue of concern regarding lesbian health revolves around lesbian sexual health. A term within the (LBT-knowledgeable) health-care community is "lesbian neglect." Lesbian neglect refers to the fact that many lesbians fail to get Pap smears, do not get them regularily, and/or do not think they need to get them.
Dr. Jeanne Marrazzo of the University of Washington has published several reports on the sexual health of sexual minority women. In one, she discusses barriers to infectious disease care among lesbians. For one, there is relatively little data on STIs, Pap smear screening, and cervical dysplasia among lesbians, all of which are needed to make clinical guidelines for lesbians. Secondly, health-care providers and lay-people commonly assume that a.) sex between women confers virtually no risk, or b.) it is at the bottom of a hierarchy of higher-risk behaviors. However, transmission of HPV, syphilis, and HIV between women have been reported. All of that being said, it is important to reiterate that virtually no data exists of the relative risk of STD transmission in same-gender sex among women.
Of the data that exists, it does show that lesbian neglect is a fair portrayal in regards to lesbians and Pap smears. In the Marrazzo articled previously mentioned, 95% (236) of lesbians in one study believed they should receive Pap smears annually or every 2 years after normal results, yet 36% (90) provided a reason for not having done so. The most commonly cited reasons were "lack of health insurance, adverse experience at prior Pap smear screening, and a belief they did not need it because they were not sexually active with men."
Sadly, 9 of the women reported being told by their health-care provider that they did not need a Pap smear since they did not have sex with men. As an FYI, Marraazzo and other LBT-knowledgeable health-care providers recommend that lesbians follow the same cervical cancer screening guidelines as all women.
Per the American Cancer Society that means that women should begin getting a Pap within 3 years of their first sexual activity, and no later than age 21 for women sexually active after the age of 18. For all of the recommendations, please go here.
Pap smears and lesbian neglect hit close to home for me. I received my first one at the tender age of 26, when I finally had health insurance...and, when I got over my case of lesbian neglect. It was quick and relatively painless. My doctor had been practicing for 30 years or so, and I didn't feel uncomfortable. She also did a sexual history, inquired about the gender of my sexual partners, and provided non-judgmental care. She was nice. But she wasn't LBT knowledgeable. At the end of my visit, she came back to my exam room and told me that since I didn't sleep with men, I didn't need another Pap, ever.
Needless to say, even though she was nice and the procedure was painless, I never went back to her. Everyone deserves culturally competent care, and sexual orientation should always be a part of that competence and knowledge base.
That is my one major advice to lesbians (and any sexual minority): You have the right to be treated compassionately, non-judgmentally, and competently. You also should always be given the change to disclose your orientation or identity in a non-awkward manner. A health-care provider should never just assume you are heterosexual without first asking you who your partners are.
Which brings me to my other point, the one major issue I would LOVE to see incorporated into nursing schools and med schools is sexual minority health.
I graduated from nursing school within the past 5 years, so I know that the lack of education on sexual minorities we received is not a matter of time-appropriateness.
The one time in my nursing school program that lesbian health was even mentioned was when my professor stated, "Lesbian and bisexual women will have...other... concerns, but we aren't going to discuss those today" before venturing to the next nursing school topic du jour. (because we ALL need yet another lecture on HIPPA or standard precautions)
I was forced with a milli-second decision on whether I was going to risk outing myself (by virtue of guilt-by-association) to a class that considered it somewhat okay to make fun of gays and lesbians occasionally, or sit there and silently wonder to myself just what these "other" issues unique to lesbians were.
In retrospect, and having since come out to my nursing school and classmates, I should have raised my hand and demanded a further explanation. A discussion, at the very least. But that didn't happen at the time. And thus, none of my classmates nor I ever received education on lesbian health.
Instead, I chose to go into the field of LGBT healthcare following graduation from nursing school. I take part in any related continuing education courses offered by organizations in my area. However, my education on LGBT healthcare is taught to me, 9 out of 10 times, by my colleagues and patients. Sometimes it feels like we are making it up as we go. But usually there is someone more senior, more knowledgeable, and with more experience we can go to. I am thankful that the tide seems to be turning in regards to lesbian health awareness.
There are, of course, other health issues that occur more often in lesbians (like smoking, depression, obesity, etc.) that I believe definitely need more attention. Our little community is, I believe, doing a decent job of addressing these issues.
And thanks to the groundbreaking work of people like Dr. Marrazzo and others who study sexual minority women, and the National Lesbian Health Summit, we can all look forward to a day in the near future when it is no longer taken for granted that all women are either heterosexual or have no health issues.
To a day that lesbian health is deemed a worthy topic in nursing and medical schools.
And most importantly, to a day that lesbians are included in national guidelines relating to "women's health" and not simply overlooked as unimportant or (mistakenly) without risk.
After all, we are women, too.
Marrazzo JM. Barriers to infectious disease care among lesbians. Emerg Infect Dis [serial on the Internet]. 2004 Nov [retrieved on 1/5/09]. Available from http://www.cdc.gov/ncidod/EID/vol10no11/04-0467.htm
Monday, January 5, 2009
Posted by Jane Know at 5:07 PM