Homophobia in our healthcare system

While it is outrageous to think that anyone should be excluded or refused treatment on the basis of their sexuality, it ...

While it is outrageous to think that anyone should be excluded or refused treatment on the basis of their sexuality, it is an all-too-common experience for lesbian women. Photo: Getty

It is well known that women who are lesbian can face isolation, exclusion and marginalisation from all areas of society.

But you would hope, in terms of places where they can go to feel safe, supported and listened to, the doctor’s office would rate highly up there.

This is particularly important since lesbian women have a higher morbidity rate for breast, uterine, colon and ovarian cancers, heart disease, mental health problems, obesity and various substance abuse disorders.

Obviously, being a lesbian is not the cause of any of these conditions. But as with things like stress and socio-economic status, it can be a social determinant of health.


But lesbian women in Australia face homophobia in numerous ways when accessing healthcare services and interacting with their doctors, research from the University of Western Sydney has found.

“Fundamentally, the distinctive healthcare needs of lesbian women go unnoticed, are deemed unimportant or are simply ignored,’’ the researchers wrote in the health journal, Contemporary Nurse.

The research, led by Brenda Hayman, who is an associate lecturer within the School of Nursing and Midwifery, found there were four types of homophobia experienced by the women she interviewed; exclusion from services and healthcare; heterosexual assumption; inappropriate questioning and outright refusal of services.

While it is outrageous to think that anyone should be excluded or refused treatment on the basis of their sexuality, it is an all-too-common experience for lesbian women.

Also disturbing was that it wasn’t just the personal choice of doctors that interfered with their ability to access healthcare. In some cases – it was enforced by legislation.

One woman, Phoebe, described to researchers how she and her partner were refused IVF treatment by several hospitals. ‘‘…we were rejected by the first two [hospitals] because they said it was unethical to assist a single woman because they don’t recognise same-sex couples as being a valid couple,’’ she said. The couple were forced to travel interstate to access fertility services not available to them where they lived.

The researchers concluded; “This highlights the need to recognise that homophobia represents a major hazard to lesbian health. Measures need to be taken in order to assist lesbian women to equitably access healthcare.’’

While the study looked specifically at the experiences of lesbian mothers, Dr Julie Mooney-Somers, a Senior Lecturer in Qualitative Research in health at the University of Sydney’s School of Public Health, said lesbian women generally faced challenges when it came to healthcare.

She runs a biennial survey of lesbian health and wellbeing in Sydney for ACON and likens their treatment to casual racism.

“From this survey, we see bisexual and lesbian women in Sydney face some similar health issues to the general population, but there are also some huge disparities,’’ she says.

“They have higher smoking rates across the age categories, and 40 per cent of those under 25 are smoking. That’s pretty horrific.’’

Lesbian women also had higher rates of drinking, she said.

Doctors should be aware of these disparities so that when patients came in identifying as bisexual or a lesbian they could better tailor their care – just as doctors may focus on certain health risks in the elderly, under-25’s or women generally.

While patients should not necessarily feel the need to disclose their sexuality to doctors, Dr Mooney-Somers said it could be helpful information for a trusted doctor to know.

‘’Our survey found 50 per cent of lesbian women are out to their doctor, but when we look at those who see a regular doctor, this jumps to 80 per cent,’’ she said.

‘’Sometimes people will say that if they are going in to discuss a health issue it shouldn’t matter what their sexuality is, but being able to talk to your doctor about the support network you have, including your partner, may be useful in certain circumstances. It also gives the doctor a social context to work with.’’

But it is little wonder that some women feel uncomfortable disclosing their sexuality to their doctor, even in those situations when they feel it may be important. Dr Mooney-Somers said she had been told of some appalling treatment of lesbian women.

“Pap smear rates generally among lesbian women are much lower and that’s not because they do not want to get tested. Some doctors actually don’t realise you don’t need to have had sex with a man to be at risk of cervical cancer, so will say to a lesbian patient that they don’t need to be tested. They also don’t realise some lesbian women may have a history of sex with men.

“Other women have been told they don’t need to take an STI test because they have a female partner, which is not true. That, to me, is refusal of service.’’

There were some positive changes taking place, she said. The Cancer Council in NSW had changed their intake forms for accessing telephone support to make them more language neutral and therefore, remove risk of incidental exclusion.

She believes making access to healthcare easier and more inclusive for lesbian women could be as simple as following the lead of the Cancer Council, as well as educating doctors to be more sensitive about the language they use and to be aware of the unique health issues lesbian women face. Importantly, lesbian women should not be forced to rely on their own resourcefulness to find healthcare, she said, or to have to shop around to find a good GP.

“I think its one of the points this research paper made quite upfront is that lesbian health has generally been seen to be as synonymous with womens health,’’ Dr Mooney-Somers said.

“We don’t seem to have that problem with gay men.

“In lots of ways lesbian health is the same as women’s health, but there are some particular things that need to be looked at for lesbian women requiring extra effort and thinking. It shouldn’t be that hard.’’

Melissa Davey is a health journalist with the Sydney Morning Herald. She is studying her Masters of Public Health at the University of Sydney. Twitter: @MelissaLDavey