January 24, 2009, 1:20 pm

Health Care for Lesbian/Bisexual Women: Did You Know?

Why is a nurse talking about dentists and tooth decay?

Nice cap, but I’ve never had an RN talk to me about tooth decay.

Wouldn’t an “ammoniated dentifrice” taste like, yuck?

3 out of 4 dentists recommend it?

I’ve had two dentists in my lifetime and neither one of them ever even said the word “Amurol” to me.  They must have been in the other 25%.

“Minty taste”? Try ammonia breath.

And, um, isn’t Amurol something that you put on your tires?

Oh, wait that’s Armor All.

Ah, tires!

Only 21 days until the Daytona 500.

You knew I was going to fit that in somehow, didn’t ya?

*****

Editrix Jenni of ChronicBabe.com is hosting Grand Rounds this week and her theme/topic is Totally Babelicious: A Focus on Women’s Health Care Issues.”

I wanted to look at women’s health from a different angle.

There are great blogs out there on living with chronic illness, breast health, heart health and women’s sexuality.

What I don’t see are a lot of blogs about health care for lesbian/bisexual women.

So I went to the Gay Lesbian Medical Association. And I downloaded their pdf: “Guidelines for care of Lesbian, Gay, Bisexual and Transgender Patients”.

*****

I honestly thought there was no big deal between the health of lesbian women and heterosexual women. We all face breast, uterine and ovarian cancer. We all face heart disease.

We are all women, after all.

But unlike those of us who are heterosexual, our lesbian sisters, relatives, friends, colleagues and partners have risk factors and face barriers to health care you may not realize.

And what I am about to tell you is pulled right from the GLMA pamphlet.

*****

Did you know…

  • Lesbian/bisexual women are at higher risk for chronic stress, depression, anxiety and other mental health issues because of the stigma, harassment and discrimination (or fear of same) associated with being homosexual. Fear of being judged or discriminated against often prevents a lesbian or bisexual women from seeking health care.

Did you know….

  • A lack of appropriate health care education could cause a lesbian/bisexual woman to forgo necessary screening, perhaps believing that pap smears and other tests are not required for homosexual women. Problems like cancer might not be caught in the early stages. If you don’t access health care personnel, you miss out on health-related education and information.

Did you know…

  • Lesbians have lower health insurance rates than their heterosexual counterparts? Why? Marriage and employment are the two primary routes to healthcare in the United States. (Some states recognize domestic partnerships, some do not). Your patient’s partner is less likely to be insured.  Less insurance means less money for follow-up visits or expensive medications.

Did you know…

  • Lesbian women are more likely to be overweight than heterosexual women. Let me quote directly from page 26 of the pamphlet because the studies behind why this is are interesting (italics mine): “There is evidence that lesbians are more likely to be overweight than their heterosexual counterparts, possibly because of cultural norms within the lesbian community and because lesbians may relate differently to, not accept or not internalize mainstream notions of ideal beauty and thinness. While lesbians as a group tend to have better body image than heterosexual women—a positive health characteristic—they may consequently be  less motivated to avoid being overweight.”

Did you know?

  • That smoking and substance abuse are found more often in lesbian populations, not only because of stress, but because of the “prominent role that bars and clubs have played in lesbian subcultures and as “women-only” spaces.

******

So what can we do to make it easier for our lesbian/bisexual patients?

  • Understand that there is no “unique” lesbian patient; that lesbians are as diverse as the rest of the     patients we care for in race, language, appearance.
  • Be accepting and non-judgmental in your care. An accepting health care environment is likely to lead to willingness to access further health care, leading to further health education. Discussing sexuality is never easy, but don’t be afraid to ask the right questions or just assume that your female patient is heterosexual.
  • Make sure your patients have options – remember that like any patient population, it is possible the lesbian patient may not have insurance. Access to many options is appreciated.
  • Education is key. Lesbian women need to know they are just as likely to develop heart disease, diabetes, COPD, and STDs as any other patient population.

If you provide a warm, welcoming and open environment for your lesbian/bisexual patients you
help promote not only sexual health, but their entire physical health. When they need information, they will gravitate to the health care environment that is most accepting.

And information is power.

The power to make the appropriate decisions for your health care.

Gee.  Maybe we aren’t so different after all.

*****

If you work in a practice with gay, lesbian, bisexual or transgendered patients, I really suggest you download the GLMA pamphlet. It’s full of good information for caregivers on how we can support  our GLBT community.

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12 Comments

  • Braden
    Braden

    January 25, 2009 at 1:12 am

    Kim, I love your blog, but I’m a little surprised to see you supporting crap like this.

    I don’t mean it is crap because it has to do with the LGB community, but because this kind of generalization and stereotyping that embodies so much of the “cultural awareness” education ultimately leads to more prejudice.

    There are certainly considerations to take when caring for patients who are homosexual, but much of the material here actually biases against this group. So we are to assume that all lesbians will be fat, depressed drug addicts? The telling statement comes near the end: “remember that like any patient population…”

    Whether they are trying to get you to understand cultures or religions or now apparently sexuality, all of these kinds of materials have one thing in common: they assume that everybody in that group is exactly the same as everybody else.

    Instead, lets just take our patients one at a time and do our best to support them in all their needs. My lesbian patient may be fat or thin, rich or poor, insured or not, I don’t care, I just give the best care I can – no different than the black guy, Catholic kid, blind woman, or born-again transgendered anorexic diabetic.

    Sorry if this rant seems pointed, this is just a subject that really gets under my skin. Lets just say I barely survived my “cultural nursing” class in college.


  • Kim
    Kim

    January 25, 2009 at 8:12 am

    Hi Braden,

    Thanks for commenting on Emergiblog – and I am going to post this in the “comments” section, too.

    Your comment throws me a little, because I thought I had made the exact point that you did – that lesbians ARE as diverse as any other population, but that certain aspects of being lesbian (ie, less likely to seek health care due to fear of prejudice) could lead to an increase incidence of certain health issues (ie, heart disease, late cancer detection, smoking, etc.).

    I actually agree with you – I don’t care who my patients are or what they do in life, they get care specific to THEM. I chose to focus on this group for this post because women’s health is the focus of Grand Rounds and the host required that we stick to the topic – and I thought it would be an interesting topic to explore.

    So basically, I thought I made the same point you made in your comment! Obviously, it did not come across that way – I’ll have to re-read the post.

    The material actually came from the Gay Lesbian Medical Association, directly, so it never occurred to me it would be stereotypical.

    It will be interesting to get more feedback on this

    And you’re always welcome to rant here! : D

    Kim : )


  • Nurse K
    Nurse K

    January 25, 2009 at 7:14 pm

    Regarding tooth decay—I tell patients who are addicted to methamphetamine that it causes demineralization of the bones which can cause the teeth to rot and “fall right out of your head” and can cause you to “have the bones of a 90 year old lady” in a few years.

    So, if you take up meth and show up in my ER, you’ll have an RN lecture you on tooth decay. A lot of methheads show up with tooth problems to begin with.


  • jennie
    jennie

    January 25, 2009 at 10:39 pm

    Kim- great topic I think. I agree, we need to treat each patient and not assume things about them based on some group they belong to. Stereotypes can be so subtle, we don’t always realize what assumptions we make until someone points it out. The more open discussion about these topics, the better, it can only help. So thanks for opening a discussion and making us reflect.


  • Walter
    Walter

    January 26, 2009 at 5:22 pm

    I have never seen the need to address a person’s health care issues based on their sexuality. HTN, DM, cancer – equal opportunity. Braden really summed things quite well for me. The patient before me is a child of God, no more and no less than any other patient. Kinda screws it all up to say Oh, this person is gay, so _____ fill in the blank. For me, it is, Oh, this patient has HTN. Your sexuality is part of who you are, not the focus.


  • Bardiac
    Bardiac

    January 27, 2009 at 12:39 pm

    I’d like to voice support for your points here, Kim. To those who think the differences aren’t worth discussing, let me give this example. I asked my doctor (family practice) for continual use bcp because I had pms, difficulty traveling, etc. I didn’t need it for conception, but it’s the same drug, so, whatever.

    The first prescription wasn’t working great for me, and at the three month pill check, I was scheduled to see someone else. I explained that this prescription wasn’t working out, and she suggested I use condoms (with that special sneer some people reserve for unmarried women who want access to birth control). I wanted to ask her if I was supposed to staple them to my cervix or something. But of course, I just asked to try a different formulation.

    It’s NOT that people want to be jerks, but they’re sometimes really unaware, and that means they make inappropriate, unhelpful recommendations and comments. I’ve NEVER had a doctor ask me about my sexual preferences, orientation, etc. I can only guess that they think I’m straight.

    I would LOVE to see a rainbow “safe space” symbol at the clinic, but I know until I do that there’s no safe space there. (I’m in the midwest; I hope that things are way better in other areas, but I wouldn’t bet.)


  • Braden
    Braden

    January 27, 2009 at 1:10 pm

    Bardiac, I’d like to respectfully ask “so what?”

    In my experience, people are terrible at reading facial expressions, especially when they can impute evil thoughts to somebody. You went in for birth control pills and they weren’t working, so your doctor recommended another type of birth control. Perhaps the doctor made a mistake in assuming that you were taking birth control pills for their primary purpose, but she didn’t.

    You could try to play the victim at this point, which it appears that you did, or you could simply explain, “I’m not taking the pills for birth control, but for irregular menses.” Then the doctor can say, “okay, then try this” and there is no problem.

    If you want a safe space, try making your own safe space by not over-reacting to things that don’t matter.

    You’ve never had a doctor ask about your sexual preferences because they have very little to do with anything health-related.

    Oh, and by the way, how do you know that your doctor was straight? Did you ask? Why not?


  • Alisha Hampton-Escobedo
    Alisha Hampton-Escobedo

    January 27, 2009 at 1:22 pm

    Hi Kim,
    Not really related to your blog topic, but a thank you.
    I’ve been reading your blog since I was a student nurse – 4-5 years or so and have gotten laughs and encouragement along the way. I’ve always wanted to work in the ED and so as a brand new nurse started on a large (60+) tele unit – as advised. No new grads EVER work in the ED.
    I put in my 2 years on tele and with your advice, tried to transfer w/in my institution but alas no openings. At this point we were in Ohio and my husband decides 12 years is enough and he wants to move home to So Cal and begins HIS job search.
    I elected to just stay on my tele unit until we relocated. I figured I would make the change in practice when I changed hospitals. I got to LA at the end of Oct received my CA RN license in the mail by mid Nov and was finally hired in an Emergency Dept. last week only because I have a good friend working there! Every place I applied, 9 hospitals in all, stated that they were interviewing new grads first, and that I probably wouldn’t be considered because I had no ED experience! I really do think CA is bizarro world. I started applying to other positions (tele, M/S even for PCA positions). Out of 17 or so positions applied for I only got 3 responses – none of those were for interviews. I’m convinced that human resource persons just sit at desks and throw applications in shreaders.
    I am persistant. I start the new grad orientation despite being a nurse with 3 years experience in an acute care setting on Feb 9!
    Thanks for your blogs and encouragement! I’m so excited!
    Alisha


  • Bardiac
    Bardiac

    January 27, 2009 at 3:00 pm

    Braden, I did tell my doctor why I wanted BCP, but apparently the next person didn’t read the chart? Or it didn’t get written down? And so I told the next person again. Her assumption was that a penis is always involved, and it’s just not.

    I think that my doctor is straight because she’s talks about her husband and children on the little video intro for the clinic website. But maybe she’ll change her mind. Some married women do.


  • Harald
    Harald

    January 28, 2009 at 3:41 pm

    I thought this was a very interesting article. On one hand, I think it would be hard to ask people to disclose their sexuality at a doctor’s office to get sexuality-specific care. But it is interesting to see the differences that lesbians have with health problems, and sad to think that some aren’t getting the additional medical treatment they need. Thanks for sharing this fascinating info.


  • Heartstrong
    Heartstrong

    February 3, 2009 at 9:40 am

    Very interesting post. I never saw specific info about lesbian health. My focus is heart disease prevention – we are just starting to learn information about how men and women have different risk factors but this is another area that needs to be investigated further. Thanks for sharing.


  • Kathy Sehm
    Kathy Sehm

    October 5, 2009 at 9:00 am

    So can you imagine being lesbian going to the gynecologist and being asked if you’re pregnant.You say “no” i’m not. Doctor or nurse staff asks you what you use for birth control. You answer that you use the best method-not sleeping with men. Dirty looks, then the foreign trained in muslim country doctor asks you why you aren’t married and if you were molested-all while doing a pelvic exam. Then the doctor asks you if you have ever dated men or what your parents think?/ Sorry-but straighst have no idea the kinda crap we queers deal with when it comes to medical care. I hear my co-workers make all kinds of discriminating ignorant comments about transgendered patients and if those comments were made “in like” to other populations it would be completely intolerable, but queers are still open targets. The medical system and especially as there are more n more foreign trained doctors has gone completely backwards in treatment of women in general and gays/lesbians/transgender population. The stress of oppression has side effects that lead to unhealthy habits. We see this is many minority populations.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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