Lesbian womens’ access to healthcare, experiences with and expectations towards GPs in German primary care

Abstract

Background: Lesbian women have higher rates of physical and psychiatric disorders associated with experiences of discrimination, homophobia and difficulties with coming out. Therefore, easy access to specialized healthcare in an open atmosphere is needed. We aimed to describe women's access to and experiences with healthcare in Germany, and to assess the responsibility of the general practitioner (GP) compared to other specialities providing primary health care. Methods: A questionnaire study was conducted via internet and paper-based sampling. Using current literature, we designed a questionnaire consisting of sociodemographic data, sexual orientation, access to care and reasons for encounter, disclosure of sexual orientation, experience with the German health system (discrimination, homophobia), and psychological burden. Depression was assessed using the depression screening from the Patient Health Questionnaire (PHQ-2). Results: We obtained responses from 766 lesbian women. Although 89% had a primary care physician, only 40% had revealed their sexual orientation to their doctor. The main medical contacts were GPs (66%), gynaecologists (10%) or psychiatrists (6%). Twenty-three percent claimed they were unable to find a primary care physician. Another 12.4% had experienced discrimination. Younger lesbian women with higher education levels and who were less likely to be out to other physicians were more likely to disclose their sexual orientation to their primary care physician. GPs play an important role in healthcare for lesbian women, even in a nongatekeeping healthcare system like Germany. Study participants suggested improvements regarding gender neutral language, flyers on homosexuality in waiting areas, involvement of partners, training of physicians, directories of homosexual physicians and labelling as a lesbian-friendly practice. Conclusions: GPs should create an open atmosphere and acquire the respective knowledge to provide adequate treatment. Caring for marginal groups should be incorporated in medical training and further education. Ideally, physicians address patients' sexual orientation pro-actively in order to address individual needs accordingly.

Sexual orientation disclosure in health care: a systematic review

“…They do include, however, important information on the effects of patient sex, age, ethnicity, and SO on disclosure. For example, LGBT people who are from ethnic minorities, [52][53][54][55] or identify as bisexual, 52,53,[55][56][57] or do not have a college education, 53,54,58 or have a low income 53,54 are less likely to disclose their SO to a healthcare professional. There is mixed evidence for the effect of patient age 53,54,58 and sex 16,52,59 on disclosure.…”

Experiences of individuals with various sexual orientations with healthcare professionals

“…Many LGBT individuals report avoiding healthcare services due to fear of discrimination and homophobia (Müller, 2017), which is not the case with the majority population. Just under one in ten respondents say that they decided not to receive the necessary check-ups or treatment due to fear of discrimination (Hirsch, et al, 2016).…”

“…Thus, healthcare professionals should have enough cultural competencies to address specific issues related to the LGBT health. Just over one in five respondents assessed their physician's knowledge of specific topics positively (Hirsch, et al, 2016). Lack of information hinders educated decision-making (Hoffkling, et al, 2017), which in turn may compromise the quality of healthcare provision.…”

“…In general, LGBT individuals have positive experiences with healthcare professionals (Katz, 2009;Riggs, et al, 2014;Marques, et al, 2015;Westerbotn, et al, 2017), but this could also be because some do not come out with their sexual orientation or gender identity, or even purposefully conceal it. In one study 60.6 % of respondents had not informed their primary care provider about their sexual orientation (Hirsch, et al, 2016). Nevertheless, most respondents reported receiving the same healthcare provision as others and said their gender identity was not unnecessarily emphasised (Westerbotn, et al, 2017), they also mainly had positive experiences with general practitioners (Riggs, et al, 2014) and characterised school nurses as being open and caring (Rasberry, et al, 2015).…”

“…Other examples of negative experiences include non-acceptance, prejudice, dichotomy, nonunderstanding, sexualisation (Duffy, 2011;Victor & Nel, 2016), and sometimes they were connected to offensive questions (Riggs, et al, 2014), respondents also described a lack of caring and understanding (Hoyt, et al, 2017). There was evidence of transphobia experienced by some LGBT individuals with healthcare professionals openness, non-judgment, acceptance, awareness of lack of knowledge, appropriate provision of healthcare services, LGBT-friendly physician, protection of privacy / confidentiality, respect, inclusion of partner, support, consideration, absence of direct disapproval, honesty, warmth, caring, professionalism, compassion, equality, confirmation of identity, absence of irritating questions, calmness, kindness, listening, sensitivity, empathy Katz, 2009;Duffy, 2011;Eady, et al, 2011;Vanden-Langenberg, et al, 2012;Riggs, et al, 2014;Lyons, et al, 2015;Marques, et al, 2015;Rasberry, et al, 2015;Hirsch, et al, 2016;Victor & Nel, 2016;Hoffkling, et al, 2017;Westerbotn, et al, 2017; Negative experiences of…”