Abstract
BackgroundLesbian 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.MethodsA 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).ResultsWe 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 non-gatekeeping 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.ConclusionsGPs 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0562-4) contains supplementary material, which is available to authorized users.
Highlights
Lesbian women have higher rates of physical and psychiatric disorders associated with experiences of discrimination, homophobia and difficulties with coming out
To measure discrimination experiences we included five questions to be answered “yes” or “no”: “Have you ever refrained from a necessary examination or treatment because you were afraid of being discriminated because of your sexual orientation?”, “Have you ever felt discriminated against by physicians, in hospitals or in other areas of the healthcare system because of your sexual orientation?”, “Have you ever been refused an examination or treatment because of your sexual orientation?”, “Have you ever felt that your physician should know about your sexual orientation prior to an examination or treatment, but you did not disclose it for fear of negative consequences?”, and “Did you ever feel the need to talk about your sexual orientation with your medical contact person, but he/she dismissed it?” [23,24,25]
We asked for the demographic characteristics of age, sexual orientation, residence, secondary education level, professional education, employment status, monthly income, marital status, living with partner and being a parent or co-parent
Summary
Lesbian women have higher rates of physical and psychiatric disorders associated with experiences of discrimination, homophobia and difficulties with coming out. Authors have found an increased risk for cardiovascular disorders and cancer, compared to non-lesbian women [1,2,3], and for mood disorders, anxiety disorders, substance use and self-injuring or suicidal behaviour [4, 5]. This seems to be associated with minority stress based on discrimination, homophobia and difficulties with coming out [6, 7]. The better the integration in their social environment, the more comprehensive their coming out, which leads to a higher openness to physicians who in turn are better able to adapt to their needs [9]
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