Sexual minority women’s experiences of health care

Researchers have undertaken a systematic review of how sexual minority women (SMW) experience health care in the UK and the results suggest a need for explicit and consistent education for health care professionals there. (SMW included lesbians, bisexual women, women who have sex with women, women who have sex with men and women, same-sex married or cohabiting women or other non-defined non-heterosexual women and transwomen.) The findings may be helpful to ob/gyns in the United States because insights from patients suggest ways to make clinical settings and interactions more positive for women who are not heterosexual.

Published in The International Journal of Environmental Research and Public Health, the mixed-methods systematic review evaluated recent studies on health experiences of UK SMW that were published between 2010 and 2018. Twenty-six studies-qualitative and quantitative and some providing both types of information-ultimately were assessed via narrative thematic description and synthesis.

Overall, the authors found, the SMW included in the studies had worse health experiences than heterosexual women, which could have negatively impacted their access to care, use of health care services, and health outcomes. The barriers the SMW faced encompassed heteronormative assumptions, perceptions and experiences of negative responses to coming out, ignorance and prejudice from healthcare professionals, and barriers to expressing concerns or complaints.

The SMW women were from the general community and they ranged from young children to women older than age 50. The studies involved both self-reports and objectively measured health experiences from published research as well as “grey literature” reports on lesbian, gay, bisexual, transgender organization websites.

Common themes in the qualitative study results were the following:

• Heteronormative expectations throughout the patient “journey,” starting with information and forms in waiting rooms

• Exclusive language used by office staff, which forced SMW to contradict assumptions

• Assumptions on the part of providers about what it meant to be a lesbian or a woman who has sex with a woman

• Differences in the way providers spoke with partners of SMW, even when the partners were present

• Reluctance of SMW to come out to providers because they felt safer not doing so or were uncomfortable challenging false assumptions

• Medical ignorance about SMW health, such as lack of agreement on the part of healthcare professionals about whether a SMW needed a Pap smear

The four studies in which results for SMW and for heterosexual women were compared showed that SMW had worse experiences in the healthcare setting. In one report, 5.3% of lesbians and 5.3% of bisexual women reported no trust or confidence in their doctor, versus 3.9% of heterosexual women.

The authors noted that little research exists on SMW health or on the experiences of that population with healthcare. “While the current status quo continues, SMW continue to receive poor and inappropriate care in many situations,” the researchers said. “It is unclear how long it will take for equality and diversity messages to filter through to front line healthcare staff resulting in practice change.”