The interaction of sexual orientation and provider-patient communication on sexual and reproductive health (SHR) can be tricky to navigate, according to the results of a prospective study of a sample of U.S. women of diverse sexual orientations in the journal Patient Education and Counseling.
“Sexual minority women are known to have poorer SHR outcomes, as well as poorer experiences in health care settings, than sexual majority women,” said principal investigator Ariella Tabaac, PhD, health psychology and instructor in adolescent/young adult medicine at Boston Children’s Hospital in Boston, Massachusetts. “But whether health communication factors relate to SHR outcomes of sexual minority women still needs to be investigated.”
The data for the project, which is part of the larger Sex Education and Reproductive Health study, came from 2 ongoing large cohort studies: the Growing Up Today Study and Nurses’ Health 3 Study. Data were analyzed cross-sectionally from 22,554 women for the follow-up period of 1996 to 2020.
Provider-patient communication was linked to a higher likelihood of using all methods of past-year contraceptive use (relative risks [RRs] ranging from 1.11 to 1.63) and lifetime sexually transmitted infection (STI) diagnosis (RRs ranging from 1.18 to 1.96).
Completely heterosexual women with no same-sex partners (referent) were also 13% more likely than lesbians, but 4% less likely than other groups, to report that a provider ever discussed their SRH.
Sexual minority women whose providers discussed their SRH were also less prone to report contraceptive non-use in the past year compared to sexual majority women (P < .0001).
“I found it surprising that most sexual minority women in our study, aside from lesbian women, were more likely than heterosexual women to have ever had a provider discuss their SRH with them, which in turn was associated with better contraceptive use,” Tabaac told Contemporary OB/GYN®. “Because we only observe this pattern for women who identify as mostly heterosexual or bisexual, and not lesbian, this may reflect provider bias where they expect more sexual risk behaviors from women who are attracted to multiple genders.”
Instead of being part of affirming and comprehensive care, this phenomenon may simply be a way that discriminatory stereotypes like “bisexual women are promiscuous” manifest in clinical settings, according to Tabaac. “Meanwhile, lesbian women were less likely than heterosexual women to report their providers ever discussed their SRH, which indicates that different factors shape these healthcare interactions,” she said.
Sexual minority women are not a homogenous group when it comes to their SRH needs and experiences, noted Tabaac. “Affirming and effective sexual and reproductive healthcare counseling for sexual minority women should account for identity, behavior, and history, while seeking to understand the presenting needs of patients,” she said.
To enhance communication, Tabaac recommends that clinicians be cognizant of stereotypes about the sexual behaviors and health risks of different sexual minority women and being vigilant in avoiding them. “Taking relevant and comprehensive sexual histories that are standard across all patients can be a useful tool in addressing any patient’s current health risks,” she said. “Providing general, sexual minority-inclusive information about contraception and STI risks based on sexual anatomy or practice can also be opportunities to open dialogue with sexual minority patients about their needs.”
The study did not investigate the types of information or services women were receiving from their providers. “Identifying sexual health information content or services that improve SRH outcomes for this population would provide important context for larger health interventions,” Tabaac said.
Tabaac reports no relevant financial disclosures.
Tabaac AR, Sutter ME, Haneuse S, et al. The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations. Patient Educ Couns. Published online May 16, 2021.