Lesbians and Health Care Survey

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Lesbians and Health Care Survey

• Conducted in the UK by
• Dr. Julie Fish
• De Montfort University.

2
Why lesbian health?

• When lesbian health is seen as different to that
  of heterosexual women, it is viewed as pathology.
• When lesbian health is seen as the same as that
  of heterosexual women, it is invisible.
• This research aims to represent some of the ways
  in which lesbian health is unique and identify
  some of the barriers in their access to health
  care services.

3
What are (some of) the key issues in lesbian
health?

• Risks for cervical cancer
• Reduced uptake of cervical screening
• Lesbians breast cancer risk
• Experiences of health care
• Disclosure/ coming out to health professionals

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Lesbians and Health Care Survey(LHCS)

• Multiple sampling methods included
• 1066 lesbian participants in survey
• They lived throughout the UK - from Cornwall to
  Outer Hebrides
• Survey collected qualitative and quantitative
  data
• Combined methods of
• Focus groups- survey- focus groups.

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Lesbians risks for cervical cancer

• Believed to be at low risk of cervical cancer by
  health professionals and lesbians themselves
• Evidence for transmission by lesbian sex
• Greatest risk factor - not being screened
• Lesbians may be more likely to smoke than
  heterosexual women
• One study found no differences in risk factors
  (sex with men, age at first intercourse, number
  of sexual partners).

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Dispute about refusal of smears

• Some health professionals argue that lesbians are
  not refused smear tests.
• Findings from the survey suggested that lesbians
  had been refused cervical screening.

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Dispute about refusal of smears (survey findings)

• Had one approx 4 years ago, when doctor
  realised I was a lesbian he told me I shouldnt
  have bothered no need.
• She questioned the need for me to have a
  smear. She said that having sex with women did
  not count I was not sexually active and
  therefore didnt really need a smear.
• (Lesbians and Health Care Survey)

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LHCS survey results

• 12 (N128) had never had a smear test
• Reasons for never having a smear
• 40 Because I dont need one
• 38 Negative aspects of procedure
• 15 No longer attended for smears
• 54 Attended every 3-5 years
• 13 Just one
• Of those who had been screened, 15 reported
  abnormal smears.

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Lesbians risks for breast cancer

• Less likely to have children and more likely to
  delay childbirth beyond the age of 30
• More likely to drink alcohol
• Higher BMI (body mass index)
• Fewer breast health checks
• US population-based study found higher prevalence
  rates of breast cancer among lesbians than
  heterosexual women
• (Findings from other studies)

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Perceptions of breast cancer risk (quantitative
data)

• How do you see lesbians risk of breast cancer -
  relative to heterosexual women?
• Lesbians said
• 3 said lesbians risk is lower
• 77 said lesbians risk is the same
• 18 said lesbians risk is higher. (LHCS)

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Perceptions of breast cancer risk (qualitative
data)

• If you dont have children youre more likely
  to develop breast cancer. Lesbians are less
  likely to have kids.
• Lesbians drink slightly more, have more
  stressful lives in some ways.
• I think, in many ways, lesbians are more
  likely to be overweight not so pressured by
  fashion etc. (LHCS)

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Breast screening

• Breast self-exam and mammograms
• Proportion of lesbians who never practise BSE
  same as population as a whole
• But, much less likely to regularly practise BSE
• (13 vs 41) (lesbians vs heterosexuals)
• Similar proportions of lesbians attend for
  mammograms (as heterosexual women) but they are
  less likely to re-attend

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Experiences of health care (1)

• Lesbians delay attending for routine health care
  because they anticipate adverse reactions from
  professionals
• Poor explanations, heterosexist attitudes,
  negative aspects of the procedure, experiences of
  pain.
• 44 reported bad experiences of smears
• More likely to report bad experiences than
  lesbians in US studies.

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Experiences of health care (2)

• 46 reported good experiences
• In the qualitative data, lesbians gave examples
  of good experiences of screening the absence of
  heterosexism and a safe environment in which
  their sexual identity was acknowledged
• In comparison to heterosexual women, lesbians
  less likely to report good experiences of smears
  and mammograms
• Good experiences were found to correlate with
  regular attendance for smears.

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Disclosure to health professionals

• Conflicting results from previous studies
• 28-84 of lesbians bisexuals have come out to
  health professionals
• Disclosure linked to improved mental health
• Those who disclose are more satisfied with care
  and use more routine care.

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For more information about this research

• Fish, J. (in press) Exploring Lesbians Health
  Behaviours and Risk Perceptions, Diversity in
  Health Social Care.
• Fish, J. Anthony, D. (2005) UK National
  Lesbians and Health Care Survey, Women and
  Health, 41 (3) 27-45.
• Fish, J. Wilkinson, S. (2003) Explaining
  Lesbians Practise of Breast Self-Examination
  Results from a UK Survey of Lesbian Health,
  Health Education Journal, 62 (4) 304-315.
• Fish, J. Wilkinson, S. (2003) Understanding
  Lesbians Healthcare Behaviour The Case of
  Breast Self-examination, Social Science and
  Medicine, 56 (2) 235-245.

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Heterosexism in Health and Social Care Dr Julie
Fish (2006) For a free downloadable
chapter http//www.palgrave.com/newsearch/Catalo
gue.aspx?is1403941238