As the world celebrates Pride Month, this month’s Nana Chat will focus on the health of women who identify as LGBTQ+. In The Peacock Roundtable, we will discuss unique issues facing sexual and gender minorities when it comes to health care. Sexual and gender minorities include lesbian, bisexual, and transgender people. Barriers to health care for sexual minority women include lack of access due to being uninsured and fear of discrimination and marginalization.
Sexual and gender minority women have unique social experiences and needs. This group is more likely to live in poverty and lack health insurance. Interestingly, lesbian females were found to be less likely to have health insurance than their heterosexual peers despite reporting higher annual incomes. Transgender poverty rates are statistically significantly higher than for heterosexual women for the 35–44 and 55–64 age groups.
Lesbian and transgender people have higher rates of smoking, alcohol dependence and recreational drug abuse. Compared to heterosexual women, lesbian women experience elevated rates of mental disorders, substance use, violence, self-harm, and suicidal thoughts. Transgender people experience high levels of stigma and discrimination leading to persistent psychological distress. The long-term impact of these chronic stressors may manifest in various ways later in life including in medical conditions like diabetes and heart disease.
While sexual and gender minorities may have unique needs, most gynecologic health recommendations are the same for all women. Lesbians and transgender people should get annual gynecological checkups. And they should get screening for STDs and gynecologic cancers. Sexual and gender minority individuals are less likely to receive preventative care and more likely to delay treatment. Lesbians are less likely than heterosexual women to receive cancer screenings like Pap smears and mammograms. Unfortunately, lesbian women also have a higher prevalence of risk factors for breast cancer including being overweight and not bearing children. Interestingly, the highest rates of gynecological cancer screening among lesbians are in those over the age of 50. Transgender individuals assigned female at birth are at a disproportionately higher risk of contracting STDs including HPV - the virus that causes cervical cancer.
The American College of Obstetricians and Gynecologists endorses equitable treatment for lesbians and their families, but one study found that less than half of board-certified obstetrician-gynecologists report having training in care for sexual and gender minorities. Studies show the lack of well-informed health care professionals serves as a significant barrier to care for transgender individuals. In the 2015 U. S. Transgender Survey, patients reported negative experiences when seeking care including harassment, assault, refusal of care or needing to explain their needs to the provider.
Rather than forgoing important health care, sexual and gender minority women should seek out medical practices where they feel safe. It is important for patients’ to be open about their sexual history so the physician can understand and address specific risk factors. While this may require some extra legwork, it is an important step to maintaining overall good health.
Glossary of Terms