On National Lesbian Visibility Day, learn how lack of data, underreporting and bias are negatively impacting this population
August marks Lesbian Visibility Month, a time not only to celebrate people with this sexual orientation, but to strengthen the fight for equality, rights and inclusion. One of the most delicate points of this battle is the sexual health of lesbian women, starting with the precariousness of the data relating to this population.
“There are very few studies in the medical literature and those available have small samples. But, in general, what is known is that lesbian women go to the doctor less and delay consulting the gynecologist by about three years,” informs the gynecologist and the sexologist Lucia Alves da Silva Lara, teacher and doctor at the University of São Paulo (USP) and president of the National Commission of Sexology of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo).
According to data from the survey “Expectations of Brazilian women regarding their sexual and reproductive life: the relationships of gynecologists and obstetricians with their patients” (2019), carried out by Febrasgo, 76% of women (regardless of their sexual orientation ) undergoes annual gynecological consultations. If only women who have sex with women (MSM) are considered, the percentage drops to 47%, according to the report Comprehensive Healthcare for Lesbian and Bisexual Women, by the Ministry of Health (MS).
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These are the most conclusive statistics on the health of lesbian women. It is essential, however, to take account of the under-reporting aspect, as self-declaration is key to gathering information and there is a whole contingent of women who do not speak openly about their sexual orientation – especially, sadly, within the walls of the domestic walls. an office doctor. “And when we include lesbian women as patients, we also have to think about barriers to access such as race and social class. Which patients are we talking about? and peripherals,” comments gynecologist and obstetrician Vitor Henrique Oliveira, Maga, very active in health of teenagers and the LGBTQIA+ public and host of the podcast “Fala, mas faz”.
heteronormative consultation
It is common, in a society still based on the binary, for heteronormative standards to influence medical care. From the moment a woman walks into the office, there is a preconception that she is in a heterosexual relationship. It is not thought that she may be lesbian or bisexual. The questions, therefore, range from the contraceptive method she uses to questions about possible pain during sex and condom use. “These are statements that embarrass lesbian women and can lead them to take a defensive attitude, hiding their sexual orientation,” says Lúcia.
“I have heard more than one complaint from a patient considered ‘virgin’ by another professional, before coming to me, for sharing her sexual orientation with the doctor and explaining that she had never had penetrative sex with men,” he says the gynecologist and obstetrician Karen Rocha De Pauw, specialist in Human Reproduction at the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC/FMUSP).
Also according to sexologist and clinical sexologist Dani Fontinele, presenter of the “Clitcast” podcast and member of the Brazilian Association of Health, Education and Sex Therapy Professionals (Abrasex), it is not uncommon to see professionals despise or minimize the sexuality of lesbians women, as if only relationships with men could indicate an active sex life.
For Vitor Maga, the main reason why lesbian women avoid gynecological consultations is the fear of being prejudiced combined with the fear of not being understood during the consultation. “Often, due to lack of training and even intolerance, some gynecologists do not know how to accommodate sexual diversity. There is still a very outdated view according to which female sexual health is reduced precisely to patients at risk of colon cancer, for example through the Penis-to-vagina intercourse. And that’s a big mistake,” he warns. Also, there is a myth that lesbians are not at risk of sexually transmitted infections (STIs) because they are not in relationships with men, which is a fallacy.
Dani also draws attention to the fact that, contrary to what happens with straight teenagers, lesbian girls see no “reason” to start taking care of their intimate health early. “The primary motivation of younger heterosexual girls is the initiation of sex life and the consequent need to be prescribed a contraceptive pill, which is not the case with lesbians. That is why the usual consultations and preventive examinations end up being done late”, observe her.
Risks and needs
One of the few documents on the subject in Brazil, the dossier “Lesbian Women’s Health – Promotion of Equity and Integrity” (2006) was conducted by anthropologist Regina Facchini and produced by the National Feminist Network for Health, Rights Sexual and Reproductive Rights. Though nearly two decades have passed since the study, the warning information about the risks of neglecting lesbian women’s health is still relevant today.
The research warns of the need for cervical cancer prevention and detection, especially through the Papanicolaou test – and evidence of a higher prevalence of risk factors for breast cancer among lesbian women, such as smoking, low frequency of preventive examinations and nulliparity (condition of those who have never been pregnant).
The dossier already listed the reasons for the lower demand for health services by the lesbian population, highlighting the existence of discrimination and the unpreparedness of professionals to deal with the specificities of this population group.
This unpreparedness, according to professionals interviewed by Earth US, can only be reversed with some basic work. “One of the ways to improve public health policies, in general, is through proper medical education. Creating a structured curriculum for teaching sexual health in health care courses gives students a different perspective on these issues. When we talk about a minority, such as lesbian women, this importance becomes even more relevant, because we know that social minorities run the risk of being affected by the phenomenon of minority stress, i.e. they are more likely to develop mental health problems and even malpractice in health services cause to social vulnerability,” says Vitor.
From the point of view of Lúcia, from Febrasgo, adequate training for different sexual orientations and gender identities is essential. “This must happen at the time of graduation, not in the form of a specialization, for example. To speak of ‘specialization’ is again to discriminate,” she attests. “But there must also be interest on the part of the medical profession in seeking information and understanding how to provide efficient and humanised care to different people and their needs”, completes Dani.
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Source: Terra
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