Lesbian health research: a review and recommendations for future research

'The Wild Women of the West (Midlands)': how LesBeWell imagined queer women's health and its obstacles in the 1990s through the pages of Dykenosis

In 1994, the Birmingham based lesbian health activism group LesBeWell began to produce a newsletter titled Dykenosis. Variously describing itself as 'for women who have sex with women', 'health information for dykes' and 'the national bi-monthly newsletter about lesbian health', the newsletter offers a window into how one activist group imagined the health and ill health of women who had sex with women in the 1990s. By analysing Dykenosis, this article illuminates how LesBeWell identified and attempted to eliminate social and institutional obstacles to 'dyke' health. The article focuses on Dykenosis' collation of experiences of invisibility and hypervisibility within Britain's National Health Service, and the mobilisation of research, complaint, and community self-help within its pages and beyond as remedy to NHS shortcomings.

Scholarly literature in HIV-related lesbian, gay, bisexual, and transgender studies: A bibliometric analysis

Introduction

Lesbian, gay, bisexual, and transgendered (LGBT) people are marginalized and understudied. Analyzing research activity worldwide is vital to better understand their needs in confronting the HIV epidemic. This study aimed to evaluate the global literature to identify the research collaboration, content, and tendency in HIV-related issues among the LGBT populations.

Methods

Peer-reviewed original articles and reviews were achieved from the Web of Science Core Collection database. Country's collaborations and co-occurrence of most frequent terms were illustrated by VOSviewer software. The Latent Dirichlet Allocation (LDA) and the linear regression model were utilized to uncover the hidden topics and examine the research trend.

Results

From 1990 to 2019, a total of 13,096 publications were found. Stigma, sexual risk behaviors and HIV testing were the major topics in the LGBT research during the study period. Among 15 topics, topics about HIV/Sexually transmitted infections (STIs) prevalence, Outcomes of HIV/AIDS care and treatment, and Opportunistic infections in HIV-positive LGBT people showed decreasing attention over years, while other topics had a slight to moderate increase.

Discussion

Our study underlined the exponential growth of publications on the LGBT population in HIV research, and suggested the importance of performing regional collaborations in improving research capacity. Moreover, further research should focus on examining the manner to increase the coverage of HIV testing and treatment, as well as implement HIV-interventions with low cost and easy to scale-up.

Health and identity-related interactions between lesbian, bisexual, queer and pansexual women and their healthcare providers

Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women's experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the different barriers, stigma and health outcomes that exist between them. This paper presents factors influencing identity disclosure and describes the characteristics of interactions that sexual minority women have with their healthcare providers around sexual identity and health. Using a mixed-methods approach, both qualitative and quantitative data were gathered using an online survey. The sample included lesbian, bisexual, queer and pansexual women from across the USA. Qualitative and quantitative data were analysed concurrently, and qualitative themes were quantified and integrated into quantitative analyses. Identity disclosure, reasons for disclosing identity and characteristics of interactions with providers varied by identity, but often overlapped. Bisexual and pansexual participants were significantly less likely to disclose identity than lesbian participants. There were no significant differences related to age or ethnicity. Findings from this study have the potential to inform ethical medical practices and improve healthcare quality among sexual minority women.

Lesbian and bisexual women's gynaecological conditions: a systematic review and exploratory meta-analysis

BACKGROUND

Little is known about the gynaecological health of lesbian and bisexual (LB) women.

OBJECTIVES

To examine differences in incidence and/or prevalence of gynaecological conditions in LB compared with heterosexual women.

SEARCH STRATEGY

The systematic review protocol was prospectively registered (PROSPERO-CRD42015027091) and searches conducted in seven databases.

SELECTION CRITERIA

Comparative studies published 2000-2015, reporting any benign (non-infectious) and/or malignant gynaecological conditions with no language or setting restrictions.

DATA COLLECTION AND ANALYSIS

Inclusions, data extraction and quality assessment were conducted in duplicate. Meta-analyses of condition prevalence rates were conducted where ≥3 studies reported results.

MAIN RESULTS

From 567 records, 47 full papers were examined and 11 studies of mixed designs included. No studies directly addressing the question were found. Two chronic pelvic pain studies reported higher rates in bisexual compared with heterosexual women (38.5 versus 28.2% and 18.6 versus 6.4%). Meta-analyses showed no statistically significant differences in polycystic ovarian syndrome, endometriosis and fibroids. There was a higher rate of cervical cancer in bisexual than heterosexual women [odds ratio (OR) = 1.94; 95% CI 1.46-2.59] but no difference overall (OR = 0.76; 95% CI 0.15-3.92). There was a lower rate of uterine cancer in lesbian than heterosexual women (OR = 0.28; 95% CI 0.11-0.73) and overall (OR = 0.36; 95% CI 0.13-0.97), but no difference in bisexual women (OR = 0.43; 95% CI 0.06-3.07).

CONCLUSIONS

More bisexual women may experience chronic pelvic pain and cervical cancer than heterosexual women. There is no information on potential confounders. Better evidence is required, preferably monitoring sexual orientation in research using the existing validated measure and fully reporting results.

TWEETABLE ABSTRACT

Lesbians have less uterine cancer than heterosexual women; bisexuals have more pelvic pain and cervical cancer.

Examining Sexual Orientation Disparities in Unmet Medical Needs among Men and Women

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen's health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen's model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.

Lesbians on Medical Encounters: Tales of Heteronormativity, Deception, and Expectations

The experiences of lesbian women in medical encounters prove particularly relevant for understanding their difficulties in their relationship with professionals and health services. We carried out semistructured interviews with 30 women aged 21 to 63 years, who define themselves as lesbian. The analysis highlights the difficulties experienced in disclosure of sexuality in medical encounters, the tendency for doctors to come across as heteronormative, and also medical practices experienced as appropriate by interviewees. Analysis of participant experiences demonstrates the need for reflection and decision making to promote the recognition of the sexual citizenship of lesbian women and their empowerment.

Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature

Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature was undertaken to answer this question and to provide insight into the ways healthcare professionals can play an active role assisting their lesbian patients in "coming out." Thirty empirical studies met the inclusion criteria and were reviewed. Collectively, these separate studies have found that a myriad of internal (patient attributes) and external (healthcare context, patient-provider relationship) factors influence disclosure. The discussion highlights the critical role of healthcare professionals in supporting disclosure.

Epidemiological research on marginalized groups implies major validity challenges; lesbian health as an example

OBJECTIVE

Several studies have suggested an increased risk of health problems among lesbian women. Evidence-based practice calls for knowledge about risks and prevalences of diseases deserving special awareness. However, research on marginalized groups raises ethical challenges from normative assumptions underlying analysis, because models are drawn from the cultural context where marginalization itself is created and recreated. Several methodological problems consequently appear.

STUDY DESIGN AND SETTING

In this article, we aim to explicate some challenges related to validity in epidemiological research on minority groups where members can conceal their identity -- lesbian health being our case. Our approach is a case study drawing on analytic induction.

RESULTS

We demonstrate challenges related to conceptual indistinctness, internal and external validity, confounders, cultural context, type II error, and the issue of small population subgroups. As women with a lesbian orientation constitute a relatively small fraction of the population, modest measurement problems can lead to serious errors in inference about health in "lesbians."

CONCLUSION

Generalization of the findings about health to "all lesbians," and comparison between "all lesbians" and "women in general," should be undertaken with great caution. Similar awareness should be exercised in studies on any minority group where members can conceal their identity.

Nobody was out back then: a grounded theory study of midlife and older lesbians with alcohol problems

This explorative study used grounded theory methodology (GTM) to develop a substantive theory regarding the life experience of the misuse of alcohol among midlife and older lesbians. The core category in this study is represented by the overarching process of "Disconnecting from their Authentic Selves." Professional health care providers may better be able to understand and assist midlife and older lesbians who misuse alcohol by being aware of their life experience with alcohol problems and the concepts they have described. A theoretical model is presented as a visual representation of the key concepts described in this paper and their interrelationships.

Health care access and utilization among women who have sex with women: sexual behavior and identity

Past research has shown that women who either have sex with women or who identify as lesbian access less preventive health care than other women. However, previous studies have generally relied on convenience samples and have not examined the multiple associations of sexual identity, behavior and health care access/utilization. Unlike other studies, we used a multi-lingual population-based survey in New York City to examine the use of Pap tests and mammograms, as well as health care coverage and the use of primary care providers, among women who have sex with women and by sexual identity status. We found that women who had sex with women (WSW) were less likely to have had a Pap test in the past 3 years (66 vs. 80%, p<0.0001) or a mammogram in the past 2 years (53 vs. 73%, p=0.0009) than other women. After adjusting for health insurance coverage and other factors, WSW were ten times [adjusted odds ratio (AOR), 9.8, 95% confidence interval (CI), 4.2, 22.9] and four times (AOR, 4.0, 95% CI 1.3, 12.0) more likely than non-WSW to not have received a timely Pap test or mammogram, respectively. Women whose behavior and identity were concordant were more likely to access Pap tests and mammograms than those whose behavior and identity were discordant. For example, WSW who identified as lesbians were more likely to have received timely Pap tests (97 vs. 48%, p<0.0001) and mammograms (86 vs. 42%, p=0.0007) than those who identified as heterosexual. Given the current screening recommendations for Pap tests and mammograms, provider counseling and public health messages should be inclusive of women who have sex with women, including those who have sex with women but identify as heterosexual.

Effects of Breast Cancer Risk Counseling for Sexual Minority Women

Sexual minority women (lesbian and bisexual) represent a vulnerable group regarding their breast health. The participants in this study were 150 women aged 18-74 recruited via public announcements in mainstream and sexual minority communities in the greater Seattle metropolitan area. Potential participants were recruited to participate in a randomized trial of a breast cancer risk counseling intervention for sexual minority women. The counseling intervention produced significant reductions in perceived risk of breast cancer, anxieties and fears about breast cancer at 6 and 24 months, and increases in breast screening rates at 24 months in the intervention arm, compared with the control arm participants. These data add to the growing body of knowledge on sexual minority women's health and point to areas of community action and future research.

Complementary medicine practices in a community-based sample of lesbian and heterosexual women

While researchers have examined the established the foundation for understanding the correlates of complementary and alternative medicine (CAM) use among some medical populations, less is known about the correlates of CAM use in nonclinical samples of women, and particularly according to sexual orientation. Information on CAM modalities was collected as part of a survey of lesbian and heterosexual women's health. Eighty-two percent of the sample reported CAM use. Predictors of CAM use included a lesbian sexual orientation, less health-related worry, and perceived discrimination in health care settings. Additional research is warranted to better understand how sexual orientation relates to use of CAM. Future studies should also examine the relationships between and experiences with discrimination in traditional medical settings and increased use of complementary and alternative medicine.

Australian lesbian and bisexual women's health and social experiences of living with hepatitis C

We recruited women in two Australian locations to complete a questionnaire on their health and social experiences of living with the hepatitis C virus (HCV). Among 462 respondents 9% identified themselves as lesbian and 14% as bisexual. Bisexuals were more disadvantaged than lesbians or heterosexuals on income, work status, home ownership, and level of education. Lesbians and bisexuals were less likely to be referred for HCV treatment and were more likely to report being treated negatively by any health professional. Lesbians and bisexuals experience HCV differently from one another and from heterosexuals. Their needs are not being met by women's health and HCV-specific services.

Predicting, understanding and changing: three research paradigms regarding alcohol use among lesbians

The author presents a paradigmatic categorization and review of the literature that is available regarding lesbians and alcohol. She illuminates the characteristics, shortcomings, and strengths of Empirical Post Positivist, Interpretive, and Critical Social research paradigms. Results of the various studies are presented while research and funding directions are proposed.

Risks and prevention of sexually transmissible infections among women who have sex with women

Health care providers working with women who have sex with women (WSW) have been ill-informed about a range of sexual health issues for these women. Pertinent issues include sexual behaviours that carry risks of sexually transmissible infection (STI), prevention strategies for safer sex and understanding experiences of abuse. A relative silence continues in all of these areas within the mainstream medical literature, textbooks, research and policy documents, which perpetuates medical ignorance. There is evidence that the prevalence of STIs among WSW is at least as high as among heterosexual women, if not higher among some sub-groups. Risk factors include the sex and number of sexual partners, minimal use of protected sexual behaviours and low levels of knowledge of STI prevention among WSW. Importantly, marginalisation leading to poorer mental health and experiences of abuse can combine to influence risk taking including substance abuse and risky sexual behaviours. Safe-sex guidelines and the need to recognise the impact of sexual abuse are presented.

[Non heterosexual patients in gynaecology]

Visible or invisible? Despite a growing tolerance of homosexuality over the past 30 years, little research on lesbian health or lesbian healthcare behaviour has been conducted in France. We have reviewed American studies in an attempt to investigate the relationship between sexual orientation and general and gynaecological health. In this paper, we stress the importance of trust in the doctor-patient relationship.

Challenging heteronormativity in the consultation: a focus group study among general practitioners

OBJECTIVE

To reflect on and further understand mechanisms of heteronormativity in the consultation, with special focus on the relative invisibility of lesbian women.

DESIGN

Tape-recorded focus group interviews transcribed verbatim and analysed using qualitative methods.

SETTING

General practitioners (GPs) from the city of Göteborg, Sweden, who had formerly answered a postal questionnaire about lesbian women in the consultation, were invited to take part in subsequent focus groups.

SUBJECTS

Ten GPs from the questionnaire who accepted the invitation and volunteered to participate in focus groups.

MAIN OUTCOME MEASURES

A discourse analytical approach using interaction regarding consensus and disagreement between informants in creating major and minor themes.

RESULTS

Consultation skills were forwarded as a major tool in receiving optimal information from patients. However, traditional concepts of family and sexuality restricted information and hampered an accepting attitude. Bringing up issues of sexual identity/orientation was left to the lesbian patient and strongly related to her reason for attending.

CONCLUSION

Consultation skills are a useful but not sufficient means of making lesbian women visible in the doctor-patient relationship. Doctors also need to transcend traditional concepts of family and sexuality and reflect on what is a relevant issue from the patient's perspective.

Lesbian health inequalities: a cultural minority issue for health professionals

Health inequalities exist for lesbian and bisexual women, largely related to experiences of discrimination, homophobia and heterosexism. These issues can lead to avoidance of routine healthcare and screening and reduced disclosure of sexual orientation within consultations. Lesbian and bisexual women have specific healthcare needs in areas of sexual and cervical health, reproductive health and parenting, mental health, substance use, and ageing. Facilitation of disclosure of sexual orientation, identity and behaviour within the consultation is desired by most lesbians and important for addressing specific health needs. Healthcare providers should develop "cultural competence" in lesbian issues to enhance their care of lesbian and bisexual women. Healthcare providers have a role in promoting awareness of lesbian health issues and inequalities in the arenas of healthcare provider education, research and health policy.