To launch Pride Month, Dr Leila Frodsham, a consultant gynaecologist, discusses the need to ensure all healthcare is inclusive and accessible to all.
LGBTQ+ people face health inequalities across the board, and the RCOG is committed to improving their access to, and experience of obstetric and gynaecological (O&G) care.
For example, lesbian and bisexual women are more likely to suffer from certain sexually transmitted infections, but are less likely to ever get tested. Nearly one in five have never attended a cervical screening. They are also less likely to disclose sexual orientation when in healthcare environments.
Trans men and non binary people with a cervix are similarly less likely to access cervical screening, and when it comes to accessing fertility treatment, LGBTQ+ people face more challenges starting a family.
When it comes to cancer diagnosis and treatment, a study by De Montfort University found clear evidence that LGBTQ+ people have poorer experiences of care compared with heterosexual people. The main issue for LGBTQ+ cancer patients was the added layer of stress caused by deciding whether or not to disclose their sexuality to their healthcare professionals. Some people also experienced subtle discrimination within the hospital environment during their cancer treatment and important questions were often not asked by participants because they were too anxious.
It is clear from these statistics that lesbian and bisexual women, and trans and non-binary people are not getting the care they need. The question is—why? And more importantly—what can be done to ensure that LGBTQ+ individuals’ healthcare needs are being met?
How can healthcare professionals build trust?
The answer to ‘why’ this disparity in gynaecological healthcare exists is complex and is almost certainly a combination of factors. Conscious and unconscious bias against LGBTQ+ individuals is pervasive in most fields; O&G is no exception. Where bias is present or anticipated, trust is often absent, which could explain the discomfort lesbian and bisexual women feel when disclosing their sexuality. There are, however, steps that O&G professionals can take to increase trust and help LGBTQ+ individuals get the care they need.
Healthcare professionals can take steps to put people at ease by beginning conversations in an open and inclusive way. Respecting pronouns and using gender neutral language when appropriate and when desired by the person in their care is an essential part of this process.
It is also important to help patients feel in-control. Healthcare professionals should always obtain informed and explicit consent before any kind of procedure, and should regularly remind patients that they can stop at any time. This is especially important for LGBTQ+ individuals who may not have undergone the procedures or be familiar with them.
Another step that clinicians can take is to ensure that they are providing women and people with accurate and comprehensive information about why procedures are necessary. For example, there is a common misconception among lesbian and bisexual women that if they haven’t had sexual intercourse with a man, certain tests may not be necessary.
Clearly explaining tests and screenings such as cervical screenings as well as their importance can help dispel myths, and encourage bisexual and lesbian women, and trans and non-binary people with a cervix to attend cervical screening appointments.
There are also practical measures that O&G professionals can take to help LGBTQ+ patients feel more comfortable and at ease. For example, offering transmen a topical vaginal oestrogen as they can develop thinning and drying of the vaginal walls from testosterone supplementation which would improve their experience of smear tests.
The RCOG is committed to ensuring that ALL individuals have equal and adequate access to gynaecological healthcare. The suggestions here are only some of many steps that can be taken to help reduce the current inequity between heterosexual or cis and LGBTQ+ individuals. If there is one piece of advice for all clinicians, it is to stay informed. This post is far from comprehensive and taking the time to research further can advance your understanding of best practice when it comes to the LGBTQ+ community.