Healthcare for Lesbians: attitudes and experiences

Introduction

This article reviews the literature relating to healthcare provision for lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals.. The author discusses the attitudes of healthcare providers to this client group and the experiences of these women in a prejudiced healthcare system.

Table of Contents

by Doreen Kimura.

The incidence of homosexuality in women has been reported to be from 2 to 12 per cent of the femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). population (Hall 1978, Olesker and Walsh 1984, Robertson 1992). The true incidence may be underestimated due to the ‘invisibility’ of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. in society: women may be forced to hide their sexuality out of necessity for fear of losing family and friends or employment.

LesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. face a homophobic reaction from healthcare providers, are anxious about the consequences of revealing their sexual orientationPatterns of emotional, romantic, and/or sexual attractions to groups of people (e.g. men, women, trans people), a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions; for example pansexual, bisexual, LGB, heterosexual., worried about breaches of confidentiality and concerned that they may face hostility or physical harm. Negative experiences can also lead lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. to delay seeking health care.

It is, therefore, reasonable to assume that healthcare providers have always taken care of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. but usually without the providers’ knowledge of the woman’s sexuality. This is problematic because in order to provide, for example, appropriate gynaecological diagnosis and treatment, accurate information regarding a woman’s sexual activity and orientation is important.

Attitudes of healthcare providers

The healthcare system is one part of a predominantly heterosexual society into which most homosexuals• Men and women who form their primary loving relationships with people of the same gender. Many gay people prefer that the terms “gay men and lesbians” or “gay people” be used to describe homosexuals as a group rather than the term “homosexuals”.
• An outdated term that was historically used to describe people who were attracted to other people of the same gender; replaced by the more inclusive and respectful term, ‘gay’ or ‘lesbian’, which are not considered offensive by many.
will at some time enter, but ignorance about homosexuality has led to exaggerated stereotyping of them by society.

All healthcare providers come to their profession with pre-formed values and opinions and when a subject as sensitive as homosexuality is involved there is certainly the potential for bias and prejudice (Olesker and Walsh 1984). Nurses are not immune from the prejudices prevalent in mainstream society (Wright 1988), and it is perhaps not surprising that they share negative images of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. and gay menMen who form their primary loving and sexual relationships with other men..

From the studies that have explored healthcare provider’s attitudes towards lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals., it is clear that fear and prejudice are still present in current practice. Significant numbers of doctors and nurses in the research were uncomfortable providing care for lesbian clients, some even refusing services to women who were lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. (Bond et al 1990, Harvey et al 1989, Rose 1993, Smith et al 1985).

Many healthcare provider’s attitudes are based on assumptions that people are heterosexual. Lack of knowledge about different lifestyles and how these affect health can lead healthcare professionals to ask inappropriate questions and to form incorrect judgements.

One of the predictive factors in positive attitudes is familiarity. In Eliason et al’s sample (1992) nursing students who reported knowing a lesbian had more accepting attitudes.

According to Eliason et al (1992), academic research, imbued with the values of the dominant heterosexual culture, has contributed to lesbian invisibility in several ways. Earlier studies on the topic of homosexuality sometimes included lesbian women as though men and women could be compared equally. Research that did address lesbianism specifically often examined questions of psychopathology rather than exploring the reasons why society does not accept lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals..

Also, science is not objective, but is biased by the same heterosexist values as the non-scientific culture. Thus, any research concerning lesbain issues may be tainted with the same faulty assumptions that patriarchal society holds for women in general and lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. in particular – the ‘double jeopardy’ of belonging to two minority groups (Potter and Darty 1981).

In studies, healthcare providers have usually assumed that their femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). clients were heterosexual, had maleA sex, usually assigned at birth, and based on chromosomes (e.g. XY), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. penis, testicles). sexual partners and performed within normative social roles as wives and mothers in traditional family units (Olesker and Walsh 1984, Rose and Platzer 1993, Zeidenstein 1990). Participants felt that simply rephrasing common questions asked during healthcare interviews, would eliminate inaccurate assumptions, thereby allowing the womanA human being who self-identifies as a woman, based on elements of importance to the individual, such as gender roles, behaviour, expression, identity, and/or physiology. to be more open about her sexual orientationPatterns of emotional, romantic, and/or sexual attractions to groups of people (e.g. men, women, trans people), a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions; for example pansexual, bisexual, LGB, heterosexual..

For example, questions regarding contraception such as ‘What type of contraception are you using?’, could be rephrased as ‘Do you have a need for contraception?’ (Olesker and Walsh 1984).

The majority of respondents in Harvey et al’s study (1989) felt that the overall quality of care and the providers’ ability to meet the healthcare needs of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. were adequate to excellent. Conversely, over half of these women rated healthcare providers as inadequate to poor on their practical knowledge of, and sensitivity to, lesbian health concerns, their awareness of homophobia and their ability to comfort lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals..

In addition, a majority rated providers as inadequate to poor in their support of lesbian relationships or lesbian parenting. The emotions evoked by healthcare providers interactions with lesbian clients included pity, disgust, unease, embarrassment and fear (Stevens 1992).

Smith et al (1985) categorised the negative reactions from healthcare professionals. The respondents described various reactions, including:

‘Cool’ (12 per cent)
‘Embarrassed’ (30 per cent)
‘Inappropriate’ (25 per cent), such as suggesting a referral to a mental health professional
‘Overt rejection’ (22 per cent) for example: He got up, left the room and had a nurse finish the questioning”.

MaleA sex, usually assigned at birth, and based on chromosomes (e.g. XY), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. penis, testicles). and femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). healthcare providers were found to respond equally in a negative manner.

These negative attitudes are thought to be deeply rooted in religious, legal, political and psychological institutions of Western civilisation (Zeidenstein 1990). Thirteen per cent of the study participants in Eliason et al’s study (1992) objected to lesbianism on moral, ethical or religious grounds.

Lesbian stereotypes

Damaging stereotypes that are widespread in the general public are also apparent in the way that doctors and nurses think about, and thus interact with, lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals.. Stereotypes are, for the most part, demeaning and offensive and deny the recognition of individual differences among members of a group. Eliason et al (1992) identified the common stereotypes held by femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). nursing students.

The most prevalent theme was that lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. aim to seduce heterosexual women, with 38% of the sample suggesting that heterosexual women should be wary of sexual advances made by lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals.. They recommended ‘keeping a distance’ from all lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. to ‘protect’ themselves from those ‘overly friendly’ lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. who will ‘make eyes at you’.

Other common stereotypical reactions include that ‘lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. hate men’, ‘lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. are anti-family’ and ‘lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. hate children’ (Olesker and Walsh 1984). Brossart (1979) said femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). nurses were particularly threatened by a lesbian because ‘they’d be afraid of what others might suspect if they appeared to be accepting of her’.

In response to the question asked by Eliason et al (1992) – ‘How would you know if a co-worker was a lesbian?’ – 26% said lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. were identifiable only through self-disclosure. However, 31% suggested that lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. may be picked out of a crowd based on their ‘aura of masculinity’.

In a heterosexist society, sexuality is a dichotomous variable; there is maleA sex, usually assigned at birth, and based on chromosomes (e.g. XY), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. penis, testicles). sexuality and there is femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). sexuality. If a lesbian is not perceived as fitting within femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). sexuality as defined by the culture, then, according to the sexual dichotomy, she must be considered as representing maleA sex, usually assigned at birth, and based on chromosomes (e.g. XY), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. penis, testicles). sexuality.

Sexual health and lesbians

Some healthcare providers inappropriately associate high rates of HIV infection and transmission with lesbian clients (Gentry 1992, Lucas 1992, Olesker and Walsh 1984) presumably because the heterosexual society tends to consider gay menMen who form their primary loving and sexual relationships with other men. and lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. as a homogenous group. AIDS has been stereotyped as a ‘gay disease’, which has led to lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. being labelled as a high-risk group. In some countries, for example, lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. have been refused as blood donors on the grounds of their homosexuality (Richardson 1994).

LesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. are largely absent from the literature on AIDS, health education usually ignores them and lesbian sexual behaviour has never been studied as a separate and distinct group in terms of incidence, rate and modes of transmission of HIV (Richardson 1994, Zeidenstein 1990). Thus, lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. are both implicated in popular conceptions of AIDS which link homosexuality and disease and neglected in the healthcare system’s response to AIDS.

The implications of this lack of information are twofold. By thinking AIDS is an issue which does not affect them, some lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. may be putting themselves at risk of HIV infection. Equally, some lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. who are ill-informed may be worrying unnecessarily about HIV infection or AIDS.

LesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. are less likely to engage in unsafe sexual practices than gay menMen who form their primary loving and sexual relationships with other men. or heterosexual couples. Risk of HIV infection is created by certain kinds of behaviour, not by social group or sexual identity and Elaison et al (1992) argued that HIV and AIDS education needs to focus on high-risk behaviours and not on groups of people. As this goal is accomplished, perceptions of risk groups may change.

More generally, AIDS has stimulated public debate on sexuality, sexual practice and sexual values which has prompted and encouraged attempts to impose new forms of social control over sexuality. These affect lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. as well as other groups.

An example of this in the UK was Section 28 of the Local Government Act 1988, which makes it illegal for a local authority to intentionally ‘promote’ homosexuality and forbids the teaching of the ‘acceptability of homosexuality as a pretended family relationship’ (Rose 1993).

Richardson (1994) stated that policies like these reinforce negative meanings of lesbianism. Differences in legislation between the age of consent for heterosexuals and homosexual men has also reinforced homophobic attitudes (Rose 1993, Taylor and Robinson 1994).

Studies have shown however, that lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. have one of the lowest rates of sexually transmitted diseases, such as gonorrhoea, chlamydia and syphilis, but are still at risk from other sexually transmitted diseases such as bacterial vaginosis and herpes (Zeidenstein 1990).

Disclosure of lesbian identity

Some lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. believe that disclosure of sexual orientationPatterns of emotional, romantic, and/or sexual attractions to groups of people (e.g. men, women, trans people), a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions; for example pansexual, bisexual, LGB, heterosexual. can affect negatively the quality of care they receive. Upon disclosure, some experienced mistreatment, ranging from refusal to treat, demeaning jokes, avoidance of physical contact, insults to them and to their lesbian partners and friends, rough physical handling and breaches of confidentiality (Harvey et al 1989, McGhee and Owen 1980, Rose 1993, Smith et al 1985).

Due to these negative reactions, many women did not feel free to disclose that they were lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. in healthcare contexts, even when they would have preferred to do so. One study participant (Zeidenstein 1990) stated: ‘Once I was fitted for a diaphragm which I didn’t need rather than having to come out’. Due to non-disclosure, they were subjected to health providers’ heterosexual assumptions. Many of the women in Zeidenstein’s study (1990) who chose to come out did so to dispute the healthcare provider’s heterosexual assumptions.

Lesbian clients tended to be vigilant for behavioural and verbal clues from healthcare providers that conveyed their openness toward or discomfort with lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals.. Deevy (1990) summarised this: ‘Because lesbians…….negotiate their daily lives in environments that range from hostile to friendly, they are acutely aware of subtleties in language and manner that suggest danger or safety’.

The assumption of heterosexuality is so pervasive within health care that most lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. report never being asked their sexual preference. The finding by Smith et al (1985) that only 9% of their total sample had ever been asked about sexual preference confirms the fact that healthcare providers rarely ask for such information.

One area in which the assumption of heterosexuality occurs is birth control. This assumption was a dominant theme throughout the interviews carried out by Robertson (1992). Not surprisingly, the most common area in regard to this was contraceptive needs and sexual activity.

Lesbian and gay menMen who form their primary loving and sexual relationships with other men. who are healthcare providers are rarely mentioned in the literature and the very existence of lesbian nurses is largely hidden. Rose (1993) conducted a research project to examine lesbian nurses’ experiences of homophobic attitudes, discrimination and oppression. Silence dominated the subject of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. in nursing. One nurse commented: ‘Anti-lesbianism I experienced came in the form of complete silence on the subject, as if the other nurses felt okay about me as an individual but not about my lesbianism.’ The study suggested that while some lesbian nurses experienced discrimination, others felt that they must live a lie to avoid it.

There are many risks to homosexuals• Men and women who form their primary loving relationships with people of the same gender. Many gay people prefer that the terms “gay men and lesbians” or “gay people” be used to describe homosexuals as a group rather than the term “homosexuals”.
• An outdated term that was historically used to describe people who were attracted to other people of the same gender; replaced by the more inclusive and respectful term, ‘gay’ or ‘lesbian’, which are not considered offensive by many.
disclosing their sexuality in society as well (Gentry, 1992). By disclosing their homosexuality, lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. may experience rejection, shame and humiliation from family members and friends who do not understand the homosexual lifestyle.

For some lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. who believe they can conceal their lesbian identity, comprehensive management of that information involves not only keeping silent about being lesbian, but also being vigilant about the intimate details of who they are, how they act, how they look, what they say, who they are with and where they go. Such a task is extremely complex and is not paralleled in the experiences of non-lesbian women (Stevens, 1992).

Delays in seeking health care

Studies have demonstrated that lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. avoid or delay seeking care because of the insensitivity of healthcare personnel and poor healthcare experiences (Deevy 1990, Smith et al 1985, Zeidenstein 1990). In Reagan’s study (1981), 24 per cent of the sample had at one time delayed care because of concerns regarding negative responses to their sexual preference. In some cases they were more likely to seek help from lesbian friends rather than healthcare providers.

Trippet and Bain (1992) highlighted gaps in care provision which deterred lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. from seeking healthcare from traditional sources: lack of holistic care; little preventive care and education; lack of communication and respect; and few women-managed clinics. Negative healthcare experiences have also contributed to lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. choosing Eastern and ancient healthcare practices rather than Western practices (Buenting 1992).

Fear and the unpleasantness associated with coming out• The process of a queer person becoming aware of his/her sexual orientation, gender identity, and/or intersex identity, and of letting other people know. This is a life- long, continual process because we live in a hetero-normative, gender-normative society. It is not uncommon for non-heterosexual people to be “out” to some people (e.g., certain friends, family) and not “out” to others (e.g., a boss, work colleagues). The decision to disclose one’s sexual orientation or gender identity should always be a personal decision – you should never out another person.
• The process of becoming aware of one’s trans identity, accepting it, and/or telling others about it; coming out is also used to refer to disclosing one’s non-heterosexual sexual orientation.
influenced the majority of respondents in Zeidenstein’s study (1990) to postpone gynaecological care or to seek lesbian-sensitive providers. Study findings have shown that lesbian clients have an overwhelming preference for femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). healthcare providers (Olesker and Walsh 1984, Robertson 1992, Smith et al 1985, Trippet and Bain 1992).

Although some lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. would prefer a lesbian healthcare provider, the gender• However gender is far more complicated. It is the complex interrelationship between an individual’s sex (gender biology), one’s internal sense of self as male, female, both or neither (gender identity) as well as one’s outward presentations and behaviours (gender expression) related to that perception, including their gender role. Together, the intersection of these three dimensions produces one’s authentic sense of gender, both in how people experience their own gender as well as how others perceive it.
• Gender is expressed in terms of masculinity and femininity. It is largely culturally determined and is assigned at birth based on the sex of the individual. It affects how people perceive themselves and how they expect others to behave.
• Socially and culturally constructed roles, behaviours, expressions and identities of girls, women, boys, men, and trans people.
of the provider was more important than the sexual orientationPatterns of emotional, romantic, and/or sexual attractions to groups of people (e.g. men, women, trans people), a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions; for example pansexual, bisexual, LGB, heterosexual.. LesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. felt more comfortable, perceived more kindness and openness, and believed that they were less vulnerable to harm with a femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). practitioner, as do many women regardless of sexual orientationPatterns of emotional, romantic, and/or sexual attractions to groups of people (e.g. men, women, trans people), a person’s sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions; for example pansexual, bisexual, LGB, heterosexual.. If healthcare providers who were gay felt more comfortable to come out then lesbian women would seek out their care.

Discussion

This review of the literature suggests that lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. have a range of concerns in relation to their healthcare needs. They fear homophobia from healthcare providers; the consequences of being open about their sexuality and that if they are not, they may not receive relevant care; physical harm; and breach of confidentiality leading to negative consequences for family and friends, as well as for their own employment, housing and future health care. Consequently, they may delay seeking care or avoid healthcare professionals entirely, adversely affecting their health.

The silence about lesbian issues in healthcare training, whether due to lack of knowledge or to homophobia, perpetuates the invisibility of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals.. It may also contribute to lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. receiving poorer quality care by neglecting to inform healthcare providers of their unique needs.

Social conditioning regarding sexuality can be countered by appropriate educational preparation, helping to dismantle the traditional views on the subject and improve both health care and the personal development of healthcare providers. Values regarding sexuality develop over years and it takes time, experience and the opportunity for pen discussion to learn to handle the subject sensitively. The RCN (1994) suggested the designing of pre- and post-registration training and education strategies to ensure the profession is better informed.

The healthcare concerns of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. differ from those of heterosexual women and health professionals must recognise this. Although lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. are no more nor less likely to require health care for general medical reasons than heterosexuals, gynaecological concerns or the desire for children focus attention on sexuality. In Zeidenstein’s study (1990) 70% of participants wanted to have children.

Healthcare providers, especially midwives, are being faced with several moral, ethical and legal issues in regard to this, including the benefits and risks of using known or unknown donor insemination or coitus, along with maleA sex, usually assigned at birth, and based on chromosomes (e.g. XY), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. penis, testicles). parental involvement and possible custody battles.

One health visitor described how a lesbian mother had hidden the existence of her partner from two previous health visitors because of fears that child protection proceedings might have been started (Rose and Platzer 1993).

There are signs that the concerns of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. are beginning to be addressed. The launch of the Sandra Bernhard Clinic at Charing Cross Hospital in 1992 was a recognition of the special health needs of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals.. The RCN also announced it’s commitment to developing and promoting good nursing practice to this group of clients by supporting the Lesbian and Gay Nursing Needs Working Party (RCN 1994). Health professionals are also beginning to conduct research on the health needs of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. but studies are few.

The problem with lesbian studies is that they sample only those women who are accessible, those who have come out, and who are white, middle-class and well educated. The majority of respondents were also identified in gay-sensitive areas such as women’s cultural events. A lack of women from ethnic backgrounds was also evident.

Trippet and Bain (1992) argued that as long as homophobia exists or is perceived, methodological problems in lesbian healthcare research will continue to exist.

A more fundamental analysis of the relationship between gender• However gender is far more complicated. It is the complex interrelationship between an individual’s sex (gender biology), one’s internal sense of self as male, female, both or neither (gender identity) as well as one’s outward presentations and behaviours (gender expression) related to that perception, including their gender role. Together, the intersection of these three dimensions produces one’s authentic sense of gender, both in how people experience their own gender as well as how others perceive it.
• Gender is expressed in terms of masculinity and femininity. It is largely culturally determined and is assigned at birth based on the sex of the individual. It affects how people perceive themselves and how they expect others to behave.
• Socially and culturally constructed roles, behaviours, expressions and identities of girls, women, boys, men, and trans people.
and health care and research that focuses specifically on the concerns of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. is urgently needed. Major knowledge deficits remain regarding lesbian experiences with healthcare providers across a full range of contexts, such as hospital nursing staff, mental health professionals and alternative medical practitioners, and how healthcare providers’ attitudes correspond with their actual behaviour toward lesbian clients (Stevens 1992). New studies also need to include lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. representative of minority socio-economic groups.

Evidence based care

If healthcare providers and educators are to have a positive impact on the health status of the lesbian population, they need to incorporate information from research into their practice and teaching. It is relevant that all participants in one study stated that characteristics such as insensitivity and ability to approach clients in a non-judgemental manner were important (Olesker and Walsh 1984).

However, they also stated that these characteristics were lacking in much of the traditional medical system and for this reason recommended evaluation and improvement of health services to women in general. Perhaps health professionals need to open themselves to the concept that they can learn from their clients.

Conclusion

The World Health Organization outlined the fundamental rights of the individual, including the right to sexual health (WHO 1975). This right includes freedom from fear, shame guilt, false beliefs and other factors inhibiting sexual response and impairing sexual relationships. LesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. are an overlooked and underserved population and have historically been excluded from research. Until healthcare providers looking after women and healthcare educators examine their own views and values about homosexuality among the femaleA sex, usually assigned at birth, and based on chromosomes (e.g. XX), gene expression, hormone levels and function, and reproductive/sexual anatomy (e.g. vagina, uterus). population, they will be unable to provide the humanistic, non-judgemental, non-heterosexist and sensitive care lesbian women want and have the right to expect.

References

Bond S, Rhodes T, Philips P (1990) HIV infection and AIDS in England: the experience, knowledge and intentions of community nursing staff. Journal of Advanced Nursing. 15, 249-255.
Brossart G (1979) The gay patient: what you should be doing. Registered Nurse. 42, 4, 50-52.
Buenting J (1992) Health life-styles of lesbian and heterosexual women. Health Care for Women International. 13, 2, 165-171.
Deevy S (1990) Older lesbian women: an invisible minority. Journal of Gerontological Nursing. 16, 5, 37-39.
Eliason M, Donelan C, Randall C (1992) Lesbian stereotypes. Health Care for Women International. 13, 2, 131-144.
Gentry S (1992) Caring for lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. in homophobic society. Health Care for Women International. 13, 2, 173-180.
Hall M (1978) Lesbian families: cultural and clinical issues. Social Work. 23, 5, 380-385.
Harvey S, Carr C, Betheine S (1989) Lesbian mothers – health care experiences. Journal of Nurse-Midwifery. 34, 3, 115-119.
Lucas V (1992) An investigation into the health care preferences of the lesbian population. Health Care for Women International. 13, 2, 221-228.
McGhee R, Owen W (1980) Medical aspects of homosexuality. New England Journal of Medicine. 303, 50-51.
Olesker E, Walsh L (1984) Childbearing among lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals.: are we meeting their needs? Journal of Nurse-Midwifery. 29, 5, 322-326.
Potter S, Darty T (1981) Social work and the invisible minority: an exploration of lesbianism. Social Work. 26, 3, 187-191.
Royal College of Nursing (1994) Nursing care for gay menMen who form their primary loving and sexual relationships with other men. and lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals.. Nursing Standard. 8, 48, 32.
Reagan P (1981) The interaction of health professionals and their lesbian clients. Patient Counselling and Health Education. 3, 21-25.
Richardson D (1994) Inclusions and exclusions: lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. HIV and AIDS. In Doyal L, Naido J, Wilton T (eds) AIDS: Setting a Feminist Agenda. London, Taylor & Francis.
Robertson M (1992) LesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. as an invisible minority in the health services arena. Health Care for Women International. 13, 2, 155-163.
Rose P (1993) Out in the open? Nursing Times. 89, 31, 52-54.
Smith E, Johnson S, Guenther S (1985) Health care attitudes and experiences during gynaecologic care among lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. and bisexualsPeople who are physically and/or romantically attracted to other-and same-gender individuals. This does not mean that bisexuals must have relationships with more than one gender or that they are equally attracted to all genders, but simply that the potential exists to be attracted to more than one gender.. American Journal of Public Health. 75, 9, 1085-1087.
Stevens P (1992) Lesbian health care research: a review of the literature from 1970 to 1990. Health Care for Women International. 13, 2, 91-120.
Taylor I, Robinson A (1994) A sensitive question. Nursing Times. 90, 51, 31-32.
Trippet S, Bain J (1992) Reasons American lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals. fail to seek traditional health care. Health Care for Women International. 13, 2, 145-153.
World Health Organisation (1975) Education and Treatment in Human Sexuality: The Training of Health Professionals. Technical Report 57. Geneva, WHO.
Wright S (1988) Prejudice? Not me. Nursing Standard. 2, 51, 42.
Zeidenstein L (1990) Gynaecological and childbearing needs of lesbiansWomen who form their primary loving and sexual relationships with other women. Some lesbians prefer to call themselves “lesbians” and use the term “gay” to refer to gay men. Others use the term “gay” to refer to all homosexuals.. Journal of Nurse-Midwifery. 35, 1, 10-18.