Lesbian Health: Historic Results

This historical legacy has informed the policies and practices of health care and continues to influence lesbians' experiences with the medical system. Indeed, research on lesbians' experiences with health care providers demonstrates the unique struggles that lesbians face (Denenberg, 1995; Rosser, 1992; Stevens, 1995). Most fundamental is the question of being “out” or disclosing one's lesbian identity. While it is assumed that honesty, respect and confidentiality are the cornerstones of the patient-health care provider relationship; this is often not the case for lesbians, for whom the disclosure of a lesbian identity may have negative consequences.

A study of nurse educators in the United States found that 25 percent of participants saw lesbianism as “immoral” and “wrong” and 52 percent believed that lesbians should undergo treatment to become heterosexual (Rankow, 1995). These attitudes are not left at the doors of operating rooms or clinics, but affect the quality of care that lesbians receive. Discrimination impacts every aspect of health care interactions, from a woman's decision to access care through to the health care provider's diagnosis and treatment. A survey of the American Association of Physicians for Human Rights found that 67 percent reported knowing of instances where lesbian, bisexual or gay patients had been refused care or had received substandard care because of their sexual orientation (Rankow, 1995).

In Canada , a 1997 Ontario study reported that 51 percent of lesbian patients had not “come out” to their health care providers even though 91 percent of the lesbian patients believed that this knowledge was important for their providers to have ( Davis , 2000). Another recent study looked at the impact of the anti-lesbian/anti-gay social climate on lesbians living in northern British Columbia (Anderson et al., 2001). This study found that the anti-lesbian/anti-gay social climate in the north had permeated health care services and that significant changes were needed in services, and in the community at large, to increase and encourage lesbians' access to health care.

Too often, the presumption that all women partner with men guides the policies and practices of health care and renders lesbians invisible (Simkin, 1998; Luce et al., 2000). This invisibility directly affects the health of lesbians and the care they receive. To ensure that adequate care is provided lesbians must often make a declaration of their sexual identity or sexual practices. This disclosure may be met with disgust, fear, hostility or misunderstanding and the anticipation of such a reaction may discourage a woman from being out. The fear of receiving homophobic treatment means that some lesbians pass as heterosexual in health care settings, providing incomplete or inaccurate information, in an effort to camouflage their lesbian identity. This carefully constructed charade often results in misdiagnosis and improper treatment, as well as discomfort and anxiety for the patient. The irony of disclosure is great, as a Vancouver woman noted, “If I allow the presumption of heterosexuality to go unchallenged, I risk receiving inappropriate care due to misinformation. Yet if I am out, I fear antagonism, disgust or potential medical mistreatment.” In an effort to avoid this negotiation of identity, many lesbians simply go without medical care: including routine check-ups, pap smears, mammograms and breast exams (Mautner, 1998; Davis, 2000; Anderson et al., 2001).

Source: The Lesbian and Bisexual Women's Health Project was funded by Health Canada and Status of Women Canada, and co-coordinated by the British Columbia Centre of Excellence for Women's Health.

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