Health Care Needs in the LGBT Community

Are the healthcare needs of patients who identify as lesbian, gay, bisexual and transgender (LGBT)different than those of patients who identify as heterosexual? Are we asking the important questions, providing the appropriate education in our treatment environments? Fortunately, these questions have been asked by researchers and medical providers, and there are increased resources to provide excellent educational content for those of us working in pelvic rehabilitation. There are some important distinctions among definitions and health care issues for lesbian, gay, bisexual and transgender (LGBT) individuals, and the references and resources are helpful in describing those differences. The following points represent some common health issues in the LGBT community:

• Screening for cervical cancer occurs less often in women who identify as lesbian, thereby increasing the risk of missing an early diagnosis. In a survey of more than 1000 women, only 62% were routinely screened according to Tracy et al., 2013, with participants citing lack of primary care physician or lack of physician referral for screening as barriers

Healthy People 2020 cites health disparities of those in the LGBT community to include the following: societal stigma, discrimination, denial of basic human rights, having high rates of psychiatric disorders, substance abuse, violence, victimization, and suicide

• Medical providers assume heterosexuality, this is often referred to as "heteronormative" behavior, and this is not conducive to useful communication. In a summary of a large survey of men and women in the UK, Fish & Bewley describe homophobic behaviors or lack of knowledge (about societal marginalization or sexual practices, for example) in healthcare providers. The referenced article emphasizes improving access to healthcare for all and improving knowledge of GLBT needs among providers

Now for the excellent and convenient resources we have that can assist our own educational process:

Heck & colleagues describe positive intake interview techniques and the importance of "starting from a place of positive affirmation" as many patients who have experienced discrimination or bias will not open up about personal health history unless the interviewer establishes an unbiased approach. While the article is written from the psychotherapy approach, the information is relevant for any health provider

ACOG May 2012 Bulletin titled "Health Care for Lesbians and Bisexual Women" is an excellent tool and states that women should be provided with quality care regardless of sexual orientation. Understanding the barriers as well as the importance of routine care and providing a patient with an overall positive clinic experience are outlined.

The Center of Excellence for Transgender Health has an excellent "Learning Center" complete with guidelines for patient care has a page devoted to lesbian and bisexual health issues, and there is a link to a PDF that you can freely download and use in patient education (or peer and community education) about the topics

As healthcare providers, we have a responsibility to serve our patients in a nondiscriminatory way. Often, we are not even aware of our own belief systems because they are developed at such a young age and influenced by our experiences and those around us. Providing the most comprehensive pelvic rehabilitation requires understanding of the health needs of various populations, including our patients who identify as LGBT. The more we improve our awareness of "heteronormative" behaviors and the value of avoiding such habits, the more empowered we can be as health care advocates and providers.
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