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Posted March 27, 2018 by Dante Roulette, M.D.
The medical definition of sexual orientation is “an enduring, emotional, romantic or sexual attraction that one feels toward men or women, or both.” While this definition may suffice for the purposes of education, one truth I have learned is there is no single definition that can encompass all of human sexual orientation, identity or gender identity.
Summa Health is an inclusive healthcare provider whose mission is to provide the right access to the right care for the community we serve. The LGBTQ community faces many healthcare challenges and barriers to the appropriate healthcare for their needs.
We know from research that women who identify as lesbian or bisexual are likely to face barriers to healthcare that include: limited access to care or insurance, concerns about confidentiality, and concerns about discriminatory attitudes and treatment. In addition, there may be additional challenges relating to provider understanding of specific health risks.
Being a lesbian or bisexual does not inherently affect health status, and there are no physiologic differences between lesbian, bisexual and heterosexual women. There are, however, specific issues more common among lesbians and bisexual women that have health consequences. The prevalence of obesity, tobacco use and alcohol use is increased. In turn, these conditions may increase the risk of diabetes, lung cancer and cardiovascular disease. All of these are issues to be discussed and addressed in various ways.
Many patients and healthcare providers incorrectly believe lesbian women do not require routine screening because they are perceived as being at low risk for cervical cancer. This is incorrect. It is incorrect to assume lesbian and bisexual women have, or will, limit their partners to women. Many people experience fluidity in sexual identity and orientation, and may be fluid in the sex of partners they choose. Routine cervical cancer screening is recommended for all women. In fact, cervical dysplasia has been reported in women who have not previously had intercourse with men.
I would be remiss to not mention issues related to mental health and intimate partner violence. Sexual minorities are more likely to have depression and other mental health concerns. This may in part be due to stress caused by isolation, prejudice, stigmatization and a lack of support from peers, family and healthcare providers. These same stressors may contribute to an increase in substance abuse, which should be specifically addressed as part of routine care. Finally, intimate partner violence is a real public health issue, and should be addressed for all patients regardless of sexual identity.
Beyond the issues above, there are a variety of topics that could be discussed, including: how lack of pregnancy affects risk for specific diseases, use of hormonal contraception for reasons other than contraception, and access to fertility services.
I want to express how pleased, and proud, I am to write in support of our call to action supporting National Lesbian, Gay, Bisexual and Transgender Health Awareness. This is a huge topic, and one that can only be incompletely addressed in a setting such as this. More than anything, my hope is that we can start a collective conversation that will lead to quality care for all.
G. Dante Roulette, MD is an obstetrics & gynecology specialist in women’s health. He currently sees patients at our Summa Health Akron Campus and the Park West office. To make an appointment with Dr. Roulette, call 800.23.SUMMA (78662).