Introduction
The National LGBT Partnership works to reduce health inequalities and tackle homophobia, biphobia and transphobia within the public sector.
The Partnership brings together the expertise of ten key LGBT organisations across England. It acts as a bridge, bringing the issues facing LGBT people to the attention of decision-makers. The Partnership’s aim is to improve access to healthcare services and ensure that the voices of the LGBT community are heard.
This year’s theme for LBT Women’s Health Week is ‘Breaking the Silence’. It aims to highlight issues that are often considered difficult to discuss or taboo. We are focusing on areas such as racial inequality, mental health, poverty, menstruation, pregnancy, the menopause, weight, cervical screening, disability, as well as domestic and sexual violence.
Although many of these topics can be complex for everyone, there are specific nuances for lesbians, bisexual and trans women (or people associated with femininity). Healthcare professionals need to understand these specificities.
Examples of barriers:
- Lesbians (who do not have sex with men) are asked to take a pregnancy test when being prescribed treatment, despite the physical impossibility of pregnancy.
- Lesbians or bisexual women who have conceived with a partner through a clinic are asked about contraception.
- Trans women are not given accurate advice on necessary examinations.
- For people who have experienced childhood abuse, questions about sexual orientation can be a trigger if doctors link orientation to trauma.
The aim of this guide is to provide information on key areas where the voices of LBT women are rarely heard, and to present facts and statistics regarding the community’s needs. This guide is written for all healthcare and social services professionals, as well as for LBT women themselves.
Health inequalities affecting LBT women
LBT women are more likely to experience poor physical and mental health compared to heterosexual women. Furthermore, they experience disproportionately high levels of discrimination and face barriers when seeking support.
Here are some facts about inequality:
- 27% of lesbians and 42% of bisexual women report having a long-term mental health condition (NHS, 2019).
- Patients with frailty syndrome are more likely than average to identify as LGB or select the ‘other’ option.
- Teenage pregnancy rates are higher among lesbians and bisexual women than among heterosexual women. Furthermore, the likelihood of becoming pregnant is twice as high for bisexual teenage girls as for their heterosexual peers (Barker et al., 2012).
- 19.2% of lesbians and 30.5% of bisexual women report having an eating disorder (Hunt and Fish, 2008).
- The prevalence of all types of cancer is higher among lesbians (4.4%) and bisexual women (4.2%) than among heterosexual women (3.6%) (Saunders et al., 2017).
A national LGBT survey conducted in the UK (Government Equalities Office, 2018) revealed:
- Among those who sought public healthcare, 16% reported a negative experience due to their sexual orientation, and 38% due to their gender identity.
- 80% of trans respondents who had visited gender identity clinics described the process as difficult (mainly due to long waiting times).
- 40% of trans respondents had faced negative treatment in public institutions because of their gender identity.
Inequality extends beyond poor-quality treatment. LBT women are more likely to smoke, abuse alcohol and be less physically active, which is often a consequence of minority stress. Furthermore, due to a lack of monitoring of gender identity, there is a dearth of research into the health of trans women.
Experiences of interacting with doctors
The experience of receiving care depends largely on the individual healthcare professional. Research shows that lesbian and bisexual women often face negative experiences in hospitals, with GPs and in sexual health clinics, but have more positive experiences in dental and fertility clinics.
One of the most common issues is the automatic assumption that a patient is heterosexual. Healthcare professionals often ignore coming-out or feel uncomfortable discussing sexual orientation. This leads to LBT women receiving incorrect medical advice.
Intersectionality
Negative experiences are unevenly distributed:
- Black women, women of Asian descent and members of other ethnic minorities face this more frequently.
- Lesbian and bisexual women who are perceived as heterosexual face the problem of ‘invisibility’ and the need to constantly come out.
- LBT women who are also transgender face additional discrimination, such as misgendering.
All of this discourages LBT women from seeking help in the future, which puts their health at risk.
What can help?
Confidence among healthcare workers when discussing the needs of LBT women will be supportive. To achieve this, the following is necessary:
- Training staff in appropriate questioning and terminology.
- Knowledge of local resources for the LBT community.
- Monitoring services with regard to clients’ sexual orientation and gender identity (to better understand the audience).
- Displaying information in waiting areas that reflects LBT women sends a signal that they are welcome here and their needs are taken into account.
References: Barker, M., Richards, C., Jones, R., Bowes-Catton, H., Plowman, T., Yockney, J. and Morgan, M., 2012. The Bisexuality Report: Bisexual inclusion in LGBT equality and diversity. Centre for Citizenship, Identity and Governance, The Open University. Government Equalities Office, 2018. National LGBT Survey: Summary Report. Government Equalities Office. Hunt, R. and Fish, J., 2008. Prescription for Change: Lesbian and bisexual women’s health check. Stonewall. National LGBT Partnership, 2017. Best practice in providing healthcare to lesbian, bisexual and other women who have sex with women. NHS, 2019. GP Patient Survey National Results. Ipsos MORI. Saunders, C., Meads, C., Abel, G. and Lyratzopoulos, G., 2017. Associations Between Sexual Orientation and Overall and Site-Specific Diagnosis of Cancer: Evidence From Two National Patient Surveys in England. Journal of Clinical Oncology, 35(32), pp.3654-3661.
Mental health
British and international studies show a higher prevalence of stress, anxiety and depression among lesbians and bisexual women compared to heterosexual women.
At the same time, bisexual women often have poorer mental health outcomes than lesbians. The Bisexuality Report (2012) links this to experiences of biphobia and bi-erasure — when those around them ignore or deny the existence of bisexual people.
Minority stress
It is important to understand that belonging to the LBT community does not in itself cause mental health problems. The cause lies in minority stress. This is chronic stress caused by living in a hostile environment: facing discrimination, expecting rejection, and fearing homophobia and transphobia.
For those with intersecting identities (intersectionality) — for example, belonging to ethnic minorities or having a disability — this stress is exacerbated.
