Written by:
Susan C. Ball, M.D., M.P.H.
When I was pregnant with my first son I went to see the obstetrician that had delivered the children of two of my colleagues. At my first visit as a new obstetrical patient I was asked to complete the usual paperwork. In the lines looking for information on "Father" I crossed out the word and wrote "Mother" and filled in my partner's age, address, place of work, etc. Despite it being my first pregnancy, we had spent a lot of time and effort to get here. Our baby was conceived with donor sperm and the parenting roles ahead involved two mothers, not a father and a mother. Yet, the questions on the form didn't reflect this reality.
When I met with the doctor in her consultation room she greeted me warmly and said she was always flattered to get referrals from colleagues. She asked me a bit about my work and then asked if my husband was also a doctor. I said I didn't have a husband. She glanced down at my paperwork, apologized graciously and we went on from there. She asked the necessary questions about our donor and the insemination process.
I don't blame my obstetrician for making an assumption. When a pregnant woman comes for obstetrical care the assumption is that there is a father. Biologically speaking, the male component is necessary. But unless the patient is Melissa Etheridge the doctor is unlikely to start asking the more open-ended questions that pregnant lesbians should hear. I hope that my obstetrician now takes the briefest of glances at that standard, completed form before launching into questions about husbands.
The Larger Issue
In a sense it's only semantics. So what if we had a donor? Plenty of straight women have donors. Sperm donation has been going on for more decades than is publicized. Obstetrically it doesn't matter where the sperm comes from, it's just a detail in the care and management of a pregnant woman trying to have a healthy pregnancy.
The larger issue is for the non-pregnant lesbian going for routine care -- be it GYN or for treatment of her cold. Too often the physician's history includes questions that have not the slightest opening for the issue of sexuality. Questions like: Have you ever used birth control pills? Have you ever had gonorrhea or syphilis? Have you ever had pain with intercourse? Sure the information is important but there is no window for a patient to poke her head through and ask "I have sex with women, do I need an HIV test?"
HIV is the most notorious of sexually transmitted diseases (STDs) these days. Oral sex is a poor vector for the transmission of HIV although a couple of cohort studies of gay men have demonstrated that it can, in fact, occur. For lesbians there have been no cohort studies although there have been rare, anecdotal reports of HIV transmission between lesbian partners. While HIV is significantly less of a risk factor for lesbians, there are a number of sexually transmitted diseases, including herpes, syphilis, HPV, gonorrhea and chlamydia, that can pass back and forth between sexually active lesbians. When a healthcare provider only asks, "are you sexually active?" the answer is not always the whole story.
Too many women, gay or straight, believe that if they are not having penetrative intercourse then they do not need to see their GYN on a regular basis. All women should have a yearly PAP, according to the American College of Obstetrics and Gynecology (ACOG), regardless of sexual activity.
Just as it is recommended that sexually active gay men have a rectal PAP smear, lesbians need to know that they are not immune to contracting and spreading various STDs despite the lack of contact with a penis. Barriers such as dental dams, cellophane and finger gloves are among the methods recommended and available for practicing "safer" sex. These methods are especially encouraged in women who are bisexual and/or who are having multiple partners.
Finding A Lesbian and Gay Friendly Provider
For providers, the assumption that all women are straight leads not only to a failure to appreciate the subtleties of medical risk but it leads to a loss of confidence on the part of the patient. When taking your medical history, does your doctor ask questions like: Are you intimate with men? Are you intimate with women? Do you have a sexual partner? Is your partner a man or a woman? Is your partner sexually active with anyone else? These types of questions provide an opportunity for your sexuality to be manifest in a non-judgemental, non-aggressive way. The overt, "are you a homosexual?" is unacceptable. It should be your choice to disclose your sexuality. But your doctor can offer a safe environment where you can share important information about your sexual and general health. If your doctor doesn't do these things, you may want to look for health care elsewhere.
To find a lesbian-friendly healthcare provider in your area, you can check out the "provider listing" on GayHealth.com. Also, the Mautner Project for Lesbians with Cancer makes the following recommendations:
Use word-of-mouth.
Call and ask questions: Do you have other LGBT patients? Is your staff trained in LGBT health?
Check out the waiting room for any gay-friendly symbols or literature.
Do the forms you fill out use words like "partner" instead of "husband"?
brought to you by http://www.gayhealth.com
Dr. Susan C. Ball, MD, M.P.H.
Co-Medical Director of GayHealth.com
Dr. Susan C. Ball, M.D., M.P.H., is the assistant director of the Birnbaum Unit HIV Care Center at New York Presbyterian Hospital. She is an associate professor at Cornell University's Wiell Medical College and a regular columnist for The AIDS Reader. She has published numerous articles related to HIV care. Dr. Ball is at the forefront of gay and lesbian health. She resides in New York City with her partner and their two sons.
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