Ok, the title might be a little tongue in cheek, but from the stories that I have heard over and over again, one might think that sexual health professionals have forgotten that lesbians have cervixes and other sexual organs. I have run out of the fingers to count the number of times I have heard the same story. “My doctor/gynecologist told me that I don’t need pap smears because I told her I was a lesbian.” Or “My doctor told me that I don’t need to worry about sexually transmitted infections because I’m a lesbian.”
I heard this same tale last week, and I recently read yet another account in POZ, so I felt compelled to bring it up. The biggest issue here are the barrier that lesbians face trying to access care. Clearly, there are doctors who aren’t trained and doctors who are homophobic and heterosexist. And to quote the Lesbian Health Research Center:
Many groups encounter barriers when trying access the healthcare system. Race, ethnicity, socioeconomic status, disability, and sexual minorities have all been marginalized and are often “hidden.” This means that lesbians who also identify with other marginalized groups such as being African American face even greater barriers when trying to access the healthcare system.
I probably sound like a broken record, but no one’s identity makes them less likely to get a sexually transmitted infection and no one’s identity precludes them from sexual health care. Behaviors, not identities put a person a risk, and unprotected sexual contact is a risky behavior. Contrary to much popular belief, oral sex between women can pass sexually transmitted infections, as can naked body rubbing (think scissoring), and sex toys that are shared with more than one partner. Additionally, non-heterosexual women are not immune to issues of addiction, meaning women who use injection drugs are a risk for blood-born infections like HIV and Hepititis. And we all know that alcohol and drug use of any sort can impair our judgments. (Unplanned and unprotected hook-ups anyone?)
That being said, self-identified lesbians frequently do avoid health care, especially sexual health care. Frequently women-loving-women report not seeking STI tests, cancer screenings, and pap smears because they have faced homophobia and discrimination, or they fear the judgment they might face. Of course, this is in addition to the standard concerns about cost and access to care. Lesbians also avoid care out of personal insecurity be that rooted gender discrimination and bias, concerns about body image, internalized homophobia, experiences of violence, and other common sources of insecurity.
And to add one more layer of complexity, one Guttmacher study recently found that 77% of self-identified lesbians have had a male partner. (Again, identity doesn’t define behavior.) With this in mind lesbians who have had or do have male sex partners are at additional risks not only for STIs but also for unplanned pregnancy (if there is penile-vaginal intercourse). This is yet another reason for lesbian women to be honest about their sexual histories and on top of sexual health exams. It’s also a reason why women who identify as lesbians need to know about condoms, birth control, and emergency contraception.
So, what’s a girl-loving-girl to do to get good sexual health care? I’m again going to leave you with the advice of some experts, again from the Lesbian Health Research Center:
1. You do not have to have anyone in the room that you do not want there. This means that if you want a female doctor, you cannot be forced to see a man, and vice versa. You also do not have to agree to have a specific person assisting the doctor or clinician. You can refuse to have any particular person in the room for any reason.
2. None of the clinic staff should be present while you are undressing or while you’re putting your clothes back on.
3. You may watch what is happening through a mirror, if you want to, and you are not required to keep a sheet over your legs so that you cannot see what is happening.
4. Anyone who touches your genitals must wear gloves. If you are allergic to latex, you need to inform the clinician so that they can use latex-free gloves.
5. You may ask the clinician to tell you exactly what he or she is doing throughout the exam. If it is your first visit, the clinician must do this.
6. You are free to ask questions at any time.
7. The staff must do any tests on you that you ask for, as long as they are capable of performing these tests.
8. You may bring a family member, partner, or friend to support you during the exam.
9. You do not have to do anything you don’t want to do.
10. You deserve to be listened to, and are free to tell the staff what would make you most comfortable. (i.e. you can ask that they take more time, go more slowly, stop to allow you to relax, etc.)
11. You can stop the exam at any time.
12. If at any time the staff does anything that makes you uncomfortable, you can leave.
Take care! And please share your comments or questions.