A lesbian patient recently asked if she needed to see me less often than straight women since she was at a lower risk for sexually transmitted infections. She figured she needed fewer Pap smears.
Lesbians and bisexual women need to see their doctor with the same frequency as heterosexual women. The Pap smear, breast and pelvic exams, and mammogram screenings are done at the same interval regardless of your sexual orientation.
The medical community needs to lead the way with sensitivity.
In speaking with many lesbian and bisexual women in my 22 years as an ob-gyn, I've learned that some have felt apprehensive about getting health care because of discriminatory attitudes, concerns about confidentiality, and uncertainty about their specific health care needs.
The medical community should take the lead by learning sensitive ways of asking necessary medical questions and building trust with all patients. Unfortunately (and understandably), it’s rare for a doctor to ask if someone is straight or gay. While doctors do ask patients if they're sexually active, a lesbian may say yes without disclosing the gender of her partner. She might not feel ready to come out to her doctor.
From a medical standpoint, if a doctor knows whether a patient is gay, straight, or bisexual, the doctor can be more sensitive and thorough with follow-up questions.
For example, if the doctor knows you're a lesbian, she won't ask if your boyfriend wore a condom during sexual intercourse. In that case, the conversation might shift to questions like “Do you share sex toys? Do you use dental dams for protection against STIs?”
If a patient discloses that she is sexually active, it's important that the doctor's next question be, “Is it with a male or female?” Hopefully, everyone will feel comfortable disclosing her sexual preference even if she's not 100% sure of what that is.
Barriers to health care and fertility treatments
Seventeen states (plus Washington, D.C.) have legalized same-sex marriage, and employment rights and benefits have never been so inclusive of gay couples. Last December, CNN reported that 67% of Fortune 500 companies offer health care benefits to same-sex couples.
That said, many states and employers still don’t extend health care benefits to gay partners or spouses. Also, some health care providers will not offer fertility services to women who identify themselves as lesbian. Sadly this could reflect personal prejudices that adversely affect their responsibilities as a physician.
Regardless of sexual orientation, the first step in the lengthy, confusing and costly process of IUI treatments is finding the right doctor who will deliver equitable and complete health care.
The issues of having fertility treatments covered by insurance companies vary between countries, states and different health plans. Some insurance companies, for example, will only define "infertility" as "unprotected sex for at least six months," which excludes lesbians. Others will cover insemination but not the sperm, which can cost around $500. In Arkansas, health insurers are only required to pay for IUI treatments with a spouse's sperm after two years of unprotected sex, which also discriminates against lesbians.
Lesbians do have some higher risks than heterosexual women
While the American Congress of Obstetricians and Gynecologists acknowledges that there are "no known physiologic differences between lesbian and straight women," research shows that lesbians are more likely to engage in some behaviors with negative health consequences: