The authors conducted in-depth interviews with lesbians from rural communities in the midwest about their interactions with health care professionals and how they decided whether to disclose their sexual orientation to them. They described the protective strategies they used when seeking health care and the responses they received to the disclosure of their sexual orientation. The four primary protective strategies included screening, planned disclosure, unplanned disclosure and non-disclosure. Participants voiced concerns over rejection or retaliation by health care professionals and by other community residents if their sexual orientation became known, and that they would be unable to obtain safe, appropriate care given the limited availability of health care service providers in their region.

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