“Are you married? Do you have children? Do you and your husband plan to have children?” My doctor asked without taking a breath. I cringed. Do I look like I have a husband? “My wife and I plan on having children someday,” I replied. He immediately asked, “When was the last time you were screened for STDs?” I wonder if he asks that question to all his patients, or did he ask that because I am a lesbian? “I have been screened for STDs, but it’s been a while since I am low risk,” I replied. Even as a physician myself, I can’t remember a time when I did not feel nervous going to the doctor’s office. As someone who is young and generally healthy, I admit that I sometimes want to skip my annual physical. It’s not only because I get asked uncomfortable questions, but also because when assumptions are made, I sometimes feel judged or completely unseen. It’s also because going to the doctor’s office is already extremely invasive and means coming out to another stranger, again, and this time, in a very vulnerable setting.
As a physician, I think it is extremely important to understand why marginalized communities such as the LGBTQ+ community have numerous health disparities and what health care providers can do to help bridge those gaps and alleviate this burden on LGBTQ+ patients.
LGBTQ+ communities are at higher risk of certain physical, mental, and social health conditions, have less access to health care, and have worse health outcomes compared to the general population1.
What does LGBTQ+/LGBTQQI stand for?
L = Lesbian
G = Gay
B = Bisexual
T = Transgender
Q = Queer
Q = Questioning
I = Intersex
What is the difference between gender, sex, gender identity, and sexual orientation?
Sex = Biological attributes assigned in humans at birth. It is associated with physical and physiological features including genes (chromosomes, gene expression), hormone levels and function, and reproductive/sexual anatomy21.
Gender = Socially constructed roles, behaviors, characteristics, thoughts, and expression of identities of girls, boys, females, or males.
Gender identity = A person’s basic and innermost concept/sense of being male or female, both, neither, or something else3; it is how you feel inside and how you express your gender through clothing, behavior, and personal appearance. It’s a feeling that begins very early in life. It is how one perceives themselves and what they call themselves. One’s gender identity can be the same or different from their sex assigned at birth3.
Sexual orientation = An inherent emotional, romantic, or sexual attraction to other people3.
What is minority stress theory and how does that pertain to LGBTQ+ health?
Courtesy of Michelle Forcier, MD, MPH and Johanna Olson-Kennedy, MD and www.uptodate.com4
What are some unique health disparities that LGBTQ+ communities face?
There are many health concerns that are unique to the LGBTQ+ community. These include physical, mental/behavioral, and health care access issues.
Physical health:
LGBTQ+ patients are more likely to develop certain diseases and infections such as:
- STIs such as HIV/AIDS9 and HPV7
- Breast6, cervical7, and anal cancer7
- Obesity7
Behavioral health and psychosocial issues:
LGBTQ+ patients are more likely to develop certain behavioral/mental health and psychosocial issues such as:
- Depression and mood disorders5
- Suicide5
- Alcohol, tobacco, and substance abuse5
- Eating disorders5
- Victimization and violence10
- Homelessness10
- Fertility issues10
- Anabolic abuse10
Access to health care:
LGBTQ+ patients have less access to the health care they need because:
- They are less likely to have health insurance and fill prescription5
- They are more likely to use the ER or delay getting care5
- They are more likely to be refused health care services5
What makes an accessible, safe, and successful medical environment?
For many patients, going to the doctor can be a stressful experience. For LGBTQ+ patients, it can be an even more stressful experience because of:
- The minority status of LGBTQ+ patients1
- Judgment
- Discrimination and harrassment1
- Stigma1
- Systemic bias in the health care system and restrictive health benefits1
- Limited role models and representation in health care1
At Comprehensive Primary Care, we understand the importance of addressing health care disparities in the LGBTQ+ community and are working towards making our health care as accessible as possible and providing a safe, welcoming, and open environment for our patients.
We believe in:
- Asking every patient their sexual identity, orientation, and behaviors and asking specific questions based on each patient’s answers
- Avoiding assumptions about sexual identity, orientation, and behaviors; prevents missed opportunities for preventative screening (such as screening for mental health disorders, substance abuse disorders, STIs, etc) and counseling for risk reduction (such as discussion about PrEP therapy and safe sex practices)
- Providing a safe and non-judgmental environment for all patients to address their concerns and health care needs
- Normalizing the process to make every patient feel comfortable talking about any health care concerns related to sexual orientation and identity and avoiding imposing personal biases
- Acknowledging that every patient is different and not defined only by their sexual identity, orientation, and behaviors and advocating for every patients’ health, wellness, and goals
- Providing adequate resources and a multidisciplinary approach tailored towards each patient’s unique health care needs
This article was written by Dr. Tanya Tan, who is a full-time provider at our Silver Spring and Woodley Park office locations. She is accepting new patients. Dr. Tan is passionate about LGBTQ+ health care. As part of the LGBTQ+ community herself, she is aware of
the unique medical, mental, and social challenges her community faces and is committed to providing inclusive, non-judgmental, compassionate, and quality patient-centered care for all her patients. At Comprehensive Primary Care, her philosophy is providing a comfortable and safe environment, working towards closing health care disparity gaps, and becoming an advocate for her patients to ensure better continuity of care and ultimately better health care outcomes.
References:
- https://www.cigna.com/individuals-families/health-wellness/lgbt-disparities#:~:text =LGBT%20people%20are%20more%20likely,and%20report%20more%20chroni c%20conditions.&text=Lesbian%20and%20bisexual%20women%20have,women %20are%20at%20greater%20risk.&text=LGBT%20people%20have%20higher% 20rates%20of%20HPV%20infection.
- https://cihr-irsc.gc.ca/e/48642.html
- https://www.hrc.org/resources/sexual-orientation-and-gender-identity-terminology -and-definitions
- https://www.uptodate.com/contents/lesbian-gay-bisexual-and-other-sexual-minori tized-youth-epidemiology-and-health-concerns?search=lgbtq&source=search_re sult&selectedTitle=1~150&usage_type=default&display_rank=1
- Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey.Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.
http://www.transequality.org/issues/resources/national-transgender-discriminati on-survey-full-report - Dibble, S.L., Roberts, S.A., and Nussey, B. (2004) Comparing breast cancer risk between lesbians and their heterosexual sisters. Women’s Health Issues March-April 2004 Volume 14(2)60-68 http://www.whijournal.com/article/S1049-3867(04)00018-0/abstract
- National LGBT Cancer Network. Electronic article HPV and Cancer. (2013) https://cancer-network.org/cancer-information/hpv-and-cancer/
- Centers for Disease Control and Prevention, National Health Statistics Reports (July 2014) Sexual Orientation and Health Among U.S. Adults: National Health Interview Survey, 2013.
- Centers for Disease Control and Prevention. (2013). HIV Among Gay, Bisexual, and Other Men Who Have Sex With Men
- https://www.uptodate.com/contents/lesbian-gay-bisexual-and-other-sexual-mino ritized-youth-epidemiology-and-health-concerns?search=lgbtq&source=search_re sult&selectedTitle=1~150&usage_type=default&display_rank=1
