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Juno Obedin-Maliver, MD, MPH, MAS

Patricia A. Robertson, MD

Comprising roughly 4% of adult women in the United States, lesbian and bisexual women are considered a medically underserved population in the United States by the National Academy of Medicine. Furthermore, since 2016, lesbian and bisexual women—as sexual minorities—are considered a health disparity population by the US National Institutes of Health. Professional medical organizations, such as the American College of Physicians, have published position papers to educate and make recommendations on achieving equity for lesbian, gay, bisexual, and transgender (LGBT) individuals in the health care system. Barriers to care include both personal and structural. Personal barriers may include the patient’s experience of disrespectful behavior and discrimination by health care providers and staff members and feeling threatened or experiencing a refusal of treatment due to sexual orientation, which may cause delay or avoidance of care. Structural barriers may include social stigma and even abject violence, financial challenges caused by decreased prevalence of insurance coverage (eg, many employers do not provide same-sex partner benefits), and the lack of trained providers to care for lesbian and bisexual women. Even when lesbian and bisexual women do seek medical care, it may not be appropriately targeted to the unique issues of this underserved population and therefore less effective. In the United States, women in same-sex couples are less likely to get nonurgent medical care when needed, see a specialist, and feel that doctors spent enough time with them. Lesbian and bisexual women in the United States are also less likely to have primary care providers. A study in Lebanon noted that significantly more sexual minority women reported having trouble accessing health care than heterosexual women, and a meta-analysis of southern African countries outlined the unique health challenges faced by sexual minority women, including social exclusion and invisibility, criminalization, and systematic homophobic sexual assault. There is a lack of systematic medical knowledge, however, about the care and understanding of lesbian and bisexual women. The World Health Organization (WHO) recognized this dificiency, stating that the limitation in available data “points to the fact that LGBT people often experience poorer health outcomes than the general population and face barriers to health care that profoundly affect their overall health and well-being.”

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