42-02: Health Care for Lesbian & Bisexual Women

Cisgender lesbian and bisexual women are addressed together in this section since most medical literature does not delineate clearly enough between lesbian and bisexual cisgender women. Current medical literature also does not consider the intersection of sexual orientation and gender identity explicitly enough to evaluate the specific health needs and concerns of lesbian and bisexual women who are of transgender experience. In the United States, women in same-sex couples are less likely to have primary care providers, get nonurgent medical care when needed, see a specialist, and feel that doctors spent enough time with them. This is true worldwide with variability depending on the local sociopolitical climate. In countries with more restrictive laws and policies, health disparities are likely greater. 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. Limited clinician training likely exacerbates the lack of preparedness to care for sexual minority women.

HEALTH DISPARITIES AFFECTING LESBIAN & BISEXUAL WOMEN

Health disparities exist across the life span for lesbian and bisexual women compared to heterosexual women. The following are increased among lesbian and bisexual women: childhood physical abuse in the home, childhood sexual abuse, substance use including alcohol and tobacco, chlamydial infection as teens and young adults, sexual assault, depression, disabilities, increased body mass index (BMI), intimate partner violence, threats and violence outside the home, asthma, and cardiovascular disease (CVD). Sexual dysfunction for lesbian and bisexual women is seen less often or as often as heterosexual women but is under-studied and likely assessed at rates lower than among heterosexual women. A high risk of sexual dysfunction can be detected by a single question regarding sexual function: “Do you have any questions or concerns about your sexuality or sexual health?” Studies of Irish SGM elders reveal concerns about residential care outside of their own home as well as respect by health professionals; similarly, there are concerns about home services for lesbian and bisexual women in Canada and the United States. Lesbian and bisexual women have fewer children available to help them as they age compared to heterosexual women. Therefore, it is critical that health care providers identify health decision makers for all patients, including lesbian and bisexual women, who may have more “family of choice” members versus “family of ...