As I was scrolling through my newsfeed on Facebook today, a College Humour video popped up providing a wonderful "POV" (Point of View) take on a woman's experience visiting the Gynecologist for a routine checkup. The video does a great job of covering some of the key concerns that women have about these kinds of sexual health exams:
- Do I have an STI?
- Am I pregnant?
- Have I delayed the appointment too long?
- What should I wear? Should I have waxed?
- What IS THAT THING? What are they going to do with it?
- Ouch! That hurts! It's cold!
According to a recent paper that our lab published, the video, although intended to be entertaining, does a pretty good job of covering some of the primary concerns that women have about a sexual health exam - but with one major caveat: the women in question need to be cisgender, heterosexual women for this video to apply!
In our paper, we discuss not only the key concerns that people have about visiting the doctor for a sexual health exam, but we also investigated how these concerns differ as a function of gender, gender identity, and sexual orientation. What we found was a little bit disturbing.
Although it makes sense to have concerns about your health when visiting the doctor (after all, that's why we visit the doctor in the first place), many of our minority-identified participants had different kinds of concerns. Instead of being worried about whether they had HPV or another STI, our sexual and gender minority participants were more concerned with whether the doctor would treat them respectfully, whether they would face discrimination as a result of their sexual or gender identity, and whether the doctor would be comfortable and knowledgeable in terms of providing care to someone with their sexual and/or gender identity.
In the College Humour video above, one of the common experiences for women was laid bare in this exchange:
Doctor: Are you sexually active?
Doctor: Do you always use condoms?
Pretty typical. But, not all people who are sexually active engage in sex that necessarily requires a condom for either contraceptive or protective purposes. This rather simple question lets the patient know that the doctor is operating from a heteronormative perspective where sex = penile-vaginal intercourse between a man and a woman. Many of our lesbian participants made reference to an exchange just like this one as being the first hint that their doctor was ill-informed about the sexual health needs of sexual minorities.
The key finding in our study of 926 participants was that while many cisgender, heterosexual men and women have concerns related to their health, including serious concerns about the potential for cancer, HIV, or unwanted pregnancies, our sexual and gender minority participants were primarily concerned about issues of safety and basic human dignity. That isn't to say that our sexual and gender minority participants had no health concerns, but rather, that their PRIMARY concerns were about whether they would be treated with respect and whether their doctors would understand their bodies and relationships. For some participants, the concerns were so overwhelming that it led them to avoid visiting the doctor for a sexual health exam, and indeed, some participants had never had a sexual health exam, despite knowing that they should have one.
While it isn't good news that sexual and gender minorities face discrimination (and/or fear of discrimination) when visiting the doctor for a sexual health exam, there is a silver lining to our findings. The vast majority of the concerns that sexual and gender minority participants expressed can be overcome through improved education for healthcare professionals as well as small, inexpensive steps to help make doctors' offices more inclusive and welcoming. For example, having alternate gender options on an intake form at a gynecologist office lets patients immediately know that the office understands that not all bodies in need of a gynecologist belong to cisgender, heterosexual women. Similarly, altering the script for asking questions about sexual activity can go a long way in letting a patient know that the doctor is not heteronormative. For example, following the "are you sexually active?" question with "are you sexually active with men, women, or both?" can help to avoid awkward miscommunications.
Sexual health exams play a very important role in the early detection of cancer and in ensuring optimal health and well-being. It's important that sexual and gender minority patients feel safe accessing theses services. Hopefully, some of the suggestions that we make in our paper will be useful for healthcare professionals looking for tips on how to make their practices more LGBTQ-friendly. A more detailed summary of our paper, along with a link to the publication can be found below.
Dignity vs. Diagnosis: Sexual Orientation & Gender Identity Differences in Reports of One's Greatest Concern About Receiving A Sexual Health Exam
Hoskin, R.A., Blair, K.L. & Jenson, K.E.
Psychology & Sexuality, Volume 7, Issue 4, 2016.
- N = 926
- Average Age: 30
- Country: 46.5% USA; 38.1% Canada
- 579 women, including 8 trans women
- 344 men, including 15 trans men
- 13 Gender Queer participants
- 58% identified as LGBTQ
- 88.7% White
- As part of a larger online survey, participants were asked to describe their greatest concern about visiting the doctor for a sexual health exam.
- We used thematic qualitative analysis to assess the common themes emerging from participants' answers and then analyzed the frequency of each theme occurring based on sexual identity, gender identity, and gender.
- Cisgender women and trans men were more likely to report concerns related to painful examinations than were cisgender men
- Concerns over the embarrassing nature of sexual health exams were common across all sexual and gender identities, but were most common in heterosexual cisgender women and least common in heterosexual cisgender men.
- LGBTQ participants were primarily concerned with embarrassment related to having to 'out themselves' to the doctor, an experience also associated with fear of the doctor's reaction to this revelation.
- The most common concern for cisgender heterosexual men and women was related to the possibility of receiving negative news about their health (diagnosis, etc.). Sexual and gender minorities were most commonly concerned with how their minority identity changed their experience of accessing healthcare services.
- Participants expressed concern over not knowing what doctor they would see, and this was more common for individuals without access to a regular healthcare provider. Many participants expressed a desire to choose or know the gender or sexual identity of their provider, but there were no clear patterns for preferences (i.e., some men preferred a female doctor, others preferred a male doctor, etc.). For sexual minority participants, many were concerned that their preference for a doctor of a specific gender would not be received well by the doctors, for example, one lesbian participant indicated that she would prefer to have a female physician over a male physician, but that she also worried that a female doctor would not want to examine a lesbian patient.
Article Citation: Hoskin, R. A., Blair, K. L., & Jenson, K. E. (2016). Dignity versus diagnosis: sexual orientation and gender identity differences in reports of one’s greatest concern about receiving a sexual health exam. Psychology & Sexuality, 7(4), 279-293.
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