Over the last decade, great efforts have been made to improve conversations around LGBT equality. It’s heartening to see the efforts made toward addressing the stigma and discrimination that the community faces. In spite of the growing awareness and visibility, a lot still needs to be done to ensure better healthcare access for LGBT women.
Lesbian, gay, bisexual, and transgender are referred to as LGBT. They are labels used to identify a person’s gender identity or sexual orientation. The Supreme Court ruled on September 6, 2018, in a long-awaited decision, that consensual sexual relations between adults of the same gender are not a crime in India. In spite of this landmark judgment, there is still a whole lot of stigma and non-acceptance that the community faces.
Access to healthcare – The obstacles
It’s crucial to build awareness about some of the medical problems that lesbian and bisexual women can face. Being able to discuss one’s healthcare problems with a doctor requires an individual to be comfortable about accepting their sexual orientation and gender identity. They must be open to ‘coming out’ so that they can discuss any issues without hesitation or the fear of being judged. Furthermore, the health care personnel involved in their care may lack the necessary skills and sensitivity to address their questions and issues effectively. There could be a variety of reasons why they are hesitant to seek healthcare, ranging from discriminatory attitudes to a lack of respect and confidentiality.
Risk of developing cancer
The incidence of breast cancer or endometrial or ovarian cancer is higher in lesbian women as compared to heterosexual women. One of the reasons for this could be fewer pregnancies among lesbian women. Additionally, studies also suggest that reduced use of combined oral contraceptive pills, absence of breastfeeding, and nulliparity as some of the other reasons why lesbian and bisexual women are at a higher risk of developing cancer. Furthermore, lack of regular screenings due to the fear of discrimination or due to not-so-pleasant experiences with their healthcare providers also results in the late detection of cancers.
It is important that health care providers do not make assumptions about their patients’ identities and behaviours. For example, some health care providers may presume that lesbian and bisexual women are heterosexual when discussing their sexual health. It may also be assumed that a woman in a current same-sex relationship has never or will never have sex with a man. It is also important that lesbian and bisexual women be open and honest with their health care providers about their identity so that they receive adequate care. This is especially important when discussing their sexual behaviour, practices, and partners.
Lesbian and bisexual women are not safe from sexually transmitted infections (STIs) and it is important to be tested. Women can catch STIs such as herpes, genital warts, and chlamydia when exchanging bodily fluids. One-on-one contact, such as oral sex or using the same hand when touching yourself and then your partner, can put you at risk. Two women who are both menstruating are at a higher risk too.
Mental and emotional well-being
Lesbians are more likely to suffer from mental health problems, particularly depression. This could be due to chronic stress caused to a lack of emotional support from family members and discrimination from society while growing up. In addition to this, having to hide one’s orientation can contribute to emotional stress that can predispose one to substance abuse, depression, and suicide. Apart from this, some of them also face violence from their partners and this is often unreported. Adolescents are especially vulnerable to substance abuse, suicide, and depression.
CHANGING PERCEPTIONS AND PRACTICES
Sensitising healthcare providers
If you are an obstetrician-gynecologist, you can introduce small changes to make yourself more aware and sensitize your staff on how to better manage lesbian and bisexual patients. Here are a few things to keep in mind
Sensitise your staff: Conduct detailed knowledge sessions with your staff to make them aware of all sexual orientations and gender identities. Inform them that all patients will be treated with the same respect as other patients.
Inclusive language: When a patient’s partner status is unknown, use inclusive language and neutral terms such as “spouse” rather than “boyfriend” or “husband.”
Create a comfortable environment: Make sure you treat them the same way you would any other patient. However, it is also critical to be aware of certain issues that are unique to the LGBT community.
Everyone, regardless of sexual orientation or gender identity, should have easy access to healthcare. Hospitals and doctors should make an effort to address some of the gaps in LGBT care that currently exist.