It’s good for their health!

It’s time healthcare facilities are diversified and made more inclusive for the LGBT community, writes Dr Prathima Reddy

LGBT stands for lesbian, gay, bisexual and transgender. They are terms used to describe people’s sexual orientation or gender identity. Despite the decriminalisation of gay sex among consenting adults in private, the LGBT community continues to face social stigma and non-acceptance in society.

Health care for this group of people can pose a problem as it involves “coming out” to discuss their problems adequately. Added to this, doctors and healthcare personnel may not have the skills and sensitivity required to deal with them.

The barriers to adequate healthcare for this group are concerns about confidentiality and discriminatory attitudes of the healthcare personnel. So what are the medical problems that this particular group of women face?

Psychological

Mental health issues, specifically depression, tends to be more common in lesbians. This may be due to a lack of familial and societal support when growing up. In some societies, a sense of isolation with a hidden lifestyle may contribute to emotional stress that can predispose to substance abuse, depression and suicide. Lesbians are more likely to abuse alcohol and drugs compared to heterosexual women. Intimate partner violence is also common although under-reported by the sufferer. Adolescents are at high risk of depression, eating disorders, suicide and substance abuse.

Cancers

When compared to heterosexual women, lesbian women have fewer pregnancies. This may put them at risk of cancers, such as breast or endometrial or ovarian cancer. This may be due to, as studies suggest, nulliparity, late childbearing and absence of breastfeeding and reduced use of combined oral contraceptive pills. In women who have only homosexual contact, the risk of cervical cancer may be reduced. However, screening for cervical cancer should follow national guidelines in this group as well.

General health

Several studies have reported a higher prevalence of obesity, tobacco use, and alcohol in this group. These factors may increase the risk of diabetes, lung cancer and heart attacks. So women should be counselled about this and appropriately screened.

How doctors can help

There are numerous ways obstetrician-gynaecologists can better meet the needs of lesbian and bisexual patients in their practices.

Specific suggestions for changes in the clinic setting include the following (Healthcare for Lesbians and Bisexual Women — Committee Opinion ACOG May 2012 Reaffirmed 2018):

Inform receptionists and other office staff that patients of all sexual orientations and gender identities are welcome in the practice and should be treated with the same respect as other patients.

Modify office registration forms and questionnaires that require patients to identify their relationship and behavioural status to obtain more accurate and useful information. Examples include the following:

• Are you single, married, widowed, or divorced, or do you have a domestic partner?

• Are you or have you been sexually active with anyone — male, female, or both male and female partners — or are you not sexually active?

• Who are you sexually attracted to — men, women, or both men and women?

The form can state that response to these questions is optional. If the patient does not answer these questions, she can be asked in person.

Have a non-discrimination policy for your office posted in the reception area.

For example: “This office appreciates diversity and does not discriminate based on race, age, religion, disability, marital status, sexual orientation, or perceived gender.”

Use inclusive language with all patients and neutral terms such as “partner” or “spouse” rather than “boyfriend” or “husband” when a
patient’s partner status is unknown.

(The author is director, OB/GYN, Fortis La Femme Hospital, Richmond Road Bengaluru)