para>Have a nondiscrimination policy visible to patients.
Provide reading materials (magazines, health education pamphlets) that address the specific needs of lesbian patients.
Ensure that the staff is comfortable with lesbian patients and their families.
Ensure confidentiality.
Make sure intake forms include options for nonmarried partners.
Interviewing
Use gender-neutral language:
Use language free of heterosexist assumptions. Avoid questions like:
Ask about prior heterosexual intercourse and assess safe sex behavior.
"Have you ever been sexually active with men, women, or both? "
"Are you presently in a sexual relationship with a woman or a man or both? "
Ask with whom the patient lives, who is important to them, and who would care for them if they were sick.
Ask the patient how they would like to be referred to and/or how to refer to their partner.
Encourage lesbians to have legal documents regarding who can make medical and/or legal decisions for them (durable power of attorney for health care and finances).
LEGAL ISSUES
- Lesbians in committed relationships are not granted the same legal and financial protection the US laws confer to heterosexual couples:
- Civil marriage contracts exist only in 6 states (CT, IA, MA, NH, NY, VT) plus Washington, DC.
- Civil unions exist in only 3 states (IL, NJ, RI) with domestic partnerships in 8 states (CA, MD, ME, NM, NV, OR, WA, WI).
- 34 states have passed laws to prohibit recognition of same-sex marriages.
- Without legal recognition, same-sex partners are not entitled to many state and over 1,100 federal laws that protect married couples.
- Despite legally sanctioned inequality:
- Approximately 75% of Americans support laws to protect lesbians from prejudice and discrimination in employment and housing and to provide them with employment benefits, inheritance rights, employer-provided health insurance, and social security benefits.
- The Kaiser Foundation survey found that 66% of Americans believe that homosexual behavior is a normal part of an individual 's sexuality.
References
1Bailey JV, Farquhar C, Owen C. Sexual behavior of lesbians and bisexual women. Sex Transm Infect. 2003;79:147 " 150. [View Abstract]2Marrazzo JM, Stine K, Koutsky LA. Genital human papillomavirus infection in women who have sex with women. Am J Obstet Gynecol. 2000;183:770 " 774. [View Abstract]3Valanis BG, Bowen DJ, Bassford T. Sexual orientation and health. Arch Fam Med. 2000;9:843 " 853. [View Abstract]4Gartrell N, Bos H. US national longitudinal lesbian family study: Psychological adjustment of 17-year-old adolescents. Pediatrics. 2010;126(1):1 " 9. [View Abstract]5Eliason MJ, Schope R. Does "Don 't ask don 't tell " apply to health care? Lesbian, gay and bisexual people 's disclosure to health care providers. J Gay Lesbian Med Assoc. 2001;5:125 " 134.6Westerstahl A, Segesten K, Bjorkelung C. GPs and lesbian women in the consultation: Issues of awareness and knowledge. Scand J Prim Health Care. 2002;20:203 " 207. [View Abstract]7Hinchliff S, Gott M, Galena E. " I daresay I might find it embarrassing ': General practitioners ' perspectives on discussing sexual health issues with lesbian and gay patients. Health Soc Care Community. 2005;13:345 " 353. [View Abstract]
Additional Reading
1 Health care needs of gay men and lesbians in the United States. JAMA. 1996;275:1354 " 1359. [View Abstract]2 Organization for health care professionals providing information about lesbian and gay health research, public policy, advocacy, and patient information. Available at www.glma.org3 Lesbian health: current assessment and directions for the future. Washington, DC: National Academy Press, 1999.4 The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academy Press, 2011.
Clinical Pearls
- Health care providers must avoid assuming heterosexuality.
- Health care providers need to be aware that some of their patients will identify as lesbians. Some patients may be engaging in same-sex relationships but will not want to identify as a lesbian.
- Create a safe health care environment for all patients by using gender-neutral language.
- Employ the same screening guidelines and lifestyle advice for lesbians as for heterosexual women (i.e., appropriate PAP smear, mammogram, and colonoscopy screening, exercise, diet, and alcohol moderation).
- Because same-sex partners are not legally recognized in most states, health care providers should discuss durable power of attorney for health care and finances with their lesbian patients.
Codes
ICD9
V65.49 Other specified counseling
ICD10
- Z70.9 Sex counseling, unspecified
- Z71.9 Counseling, unspecified
SNOMED
- 89217008 female homosexual (finding)
- 313079007 counseling for homosexuality (procedure)