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 is an all-too-common experience for lesbian women.

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.

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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 

40 comments

  • “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. - where are these doctors?! Hiding under a rock? Seriously?!

    Commenter
    Charlie
    Location
    Hampton
    Date and time
    June 21, 2013, 2:42AM
    • I can't speak to whether such a statement is cause by homophobia, but any doctor who actually said that is displaying gross incompetence.

      Commenter
      DM
      Date and time
      June 21, 2013, 9:05AM
    • Actually, it is possible that lesbian women would not need a pap smear. AFAIK the HPV virus has to make contact with the epithelial cells of the cervix so if a woman does not have any kind of penetrative sex (including a dildo) then she probably isn't at risk of cervical cancer. And the article supports this as it says lesbians have fewer pap smears but only the other female cancer rates are higher.

      Commenter
      les
      Date and time
      June 21, 2013, 10:21AM
    • This is VERY concerning if true... all doctors must complete a certain amount of Continuing Professional Development credits every year in order to continue practicing and this includes being up to date on this sort of stuff... very distressing.

      Commenter
      Adrian
      Location
      Sydney
      Date and time
      June 21, 2013, 10:47AM
    • Those sorts of doctors are out there.

      My doctor is a clueless moron who wouldn't know a sick patient from a piece of aluminium foil. I have no idea how he became a registered doctor.

      I've had a transplant and he has no idea of what he is doing. He tried to prescribe antibiotics to me when I am on a cocktail of antibiotics, heart medication, transplant medication etc. Even experienced transplant physicians consult a proper pharmacist before prescribing things to me. The fact that he did not consult my specialist first speaks volumes of his incompetence.

      I'm male. If I were a lesbian he would have even less of an idea.

      As a service to the community he has a note on his door stating he cannot prescribe opiates. If you see this it is a warning to choose another doctor.

      Commenter
      Anon
      Date and time
      June 21, 2013, 12:36PM
    • Actually, Les, while HPV is the major cause of cervical cancer, it is not the only cause. And so it is entirely possibly to develop cervical cancer even though a woman may have never had sex with a man. Furthermore, HPV can be contracted in ways that do not directly involve a penis, so a woman who has never had sex with a man can still contract HPV-associated cervical cancer.

      Commenter
      Honey Badger
      Date and time
      June 21, 2013, 12:48PM
    • Doctors prescribe tests based on their risk assesment, so scientifically speaking lesbian women have a low rate of HPV infections. In the same way, you dont get a MRI scan immediately if you turn up at your GP complaining about gas.

      This is just commonsense.

      Commenter
      Regh
      Date and time
      June 21, 2013, 2:28PM
  • I can honestly say that I am one of those lesbians who has not had a pap smear after three doctors all told me I don't need to as I have not had sex with a man. I even got it confirmed with the pap smear agency.

    My current doctor is great, she followed it up and is comfortable with my sexuality (and she is straight).

    What seems to be the issue, is a lack of information on the subject. When you search, there is little information...and now, based on one comment here, I'm not sure if I need to go back and get a pap smear.....?!?

    Commenter
    nopapsmear
    Location
    Melbourne
    Date and time
    June 21, 2013, 9:04AM
    • Be safe have a test.

      Commenter
      Rusty Strodes
      Location
      Mooroolbark
      Date and time
      June 21, 2013, 11:01AM
  • I am hetero but have been refused an STI test and birth control by a doctor because my "partner isn't here and it's his business too". Doctors are human and bring their own prejudices and personal beliefs with them. I have had too many negative experiences with GPs to have much respect for them anymore.

    Commenter
    T
    Date and time
    June 21, 2013, 9:24AM

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