presenters suggested that rather than asking a woman whether she is married and what birth control she uses, it is preferable to ask whether she is in a sexual relationship, whether her partner is a man or a woman, if she and her partner are monogamous, and when she last had unprotected sex with a man (Waitkevicz, 1997). It is also important that questions be developmentally appropriate in the case of adolescents.

Homophobic Attitudes of Providers. It has been suggested that negative attitudes and responses by some health care providers may lead lesbians to avoid seeking health care (Turner et al., 1992; White and Levinson, 1993). Surveys indicate that like members of society at large, medical faculty have widely divergent views regarding homosexuality (Black and Underwood, 1998). Thus, it is not surprising that discrimination and prejudice against lesbians by both physical and mental health care providers have been reported (Denenberg, 1995; Roberts and Sorensen, 1995). This discrimination and prejudice can take many forms, including reluctance or refusal to treat, negative comments during treatment, or rough handling during examination (Smith et al., 1985).

It should be noted that a number of provider professional associations have developed statements regarding the care of people of all sexual orientations and have task forces, committees, or other initiatives in place to increase the visibility of lesbian and gay health concerns to their members and to the general public.4

Fear of Coming Out to Health Providers. In order to provide high-quality primary care it is important to know a patient's sexual orientation (Geddes, 1994; White and Levinson, 1995). However, the need to disclose one's sexual orientation to a health care provider can present a special barrier to care for lesbians. Fear or embarrassment may make the lesbian patient reluctant to disclose her sexuality, possibly compromising her care (Geddes, 1994; Turner et al., 1992; White and Dull, 1997).5


These groups include (but are not limited to) the American Psychological Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Medical Association, and the National Association of Social Workers.


Of course, disclosing behaviors that might be perceived as shameful is an issue not just with respect to a person's sexual behavior, but also in other realms of sensitive or stigmatized behavior, such as drug use or domestic violence, irrespective of a patient's sexual orientation.

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