Sexual Minority Women's Experiences Research Articles

Health Care Utilization and Care-seeking Behavior Among Vulnerabilized Sexual Minority Women: A Social-ecological Approach

Abstract: Sexual minority women (SMW) experience worse health than their heterosexual counterparts but have largely been omitted from health services research. To address this gap, we conducted 25 semi-structured, in-depth interviews with SMW. Transcripts were analyzed using thematic analysis, and findings were organized using a modified socioecological framework. Key themes at each socioecological level include (1) structural: stigma, sociocultural norms, health infrastructure; (2) organizational: stigma, patient-provider relationship, hours and location, linkage to care and co-location of services; (3) interpersonal: stigma and social support; (4) individual: internalized stigma, self-efficacy, socioeconomic status, health literacy, and intersecting identities. Stigma is the central theme affecting vulnerabilized SMW's experiences accessing care. Anti-stigma initiatives and factors that lead to personal resilience and can mitigate care access barriers were identified at each level. Interventions should focus on building inclusive policies/infrastructure and using SMW's unique social networks to empower and improve care access and health outcomes among vulnerabilized SMW.

Minority Stress and Microaggression Experiences among Sexual Minority Women in Sweden

In the present article we explore when, where, and how Swedish sexual minority women experience minority stress and microaggression. Drawing on deductive thematic analysis of forty-eight interviews, we show that minority stress and microaggressions were experienced in a wide range of everyday life areas. Exposure was described in the forms of physical violence, threats and verbal abuse, ignorance and prejudice, discrimination, micro, microinsults microinvalidations, excessive focus, exotification, and silence. The exposure was described to cause negative emotions, hypervigilance, a feeling of being different, internalized homo- or biphobia, and mental health problems. Despite the Swedish population being among the most accepting towards sexual minorities, theories of minority stress and microaggressions are still useful for highlighting the lived experiences of sexual minority women. Focusing on lived experiences of minority stress and microaggressions provides us with a visualization of the texture of the experiences that helps us understand what various aspects of the theories mean in everyday life.

Multivariate Patterns of Substance Use, Minority Stress and Environmental Violence Associated with Sexual Revictimization of Lesbian and Bisexual Emerging Adult Women

This study documented between-group differences in factors associated with sexual revictimization histories in a sample of young sexual minority women. Diverse samples of lesbian (N = 204, ageM = 23.55 years) and bisexual (N = 249, ageM = 23.35 years) women from the United States were recruited using the CloudResearch platform to assess factors associated with recent experiences of intimate partner violence (IPV). Participants were categorized into four groups based on self-reports of sexual victimization (a) during childhood and (b) during adulthood in intimate relationships. Multivariate Analysis of Variance (MANOVA) was used to model between-group differences in three variable domains: Past-year substance use involvement, minority stress, and violence in relationship and community settings. Lesbian women reporting sexual revictimization in adulthood reported significantly higher scores for measures of past-year substance use involvement and negative consequences, daily discrimination experiences, relational victimization, and criminal victimization, compared to their counterparts with no history of sexual victimization. Among bisexual women, sexual revictimization was associated with a similar pattern of between-group differences. The sexual revictimization experiences of sexual minority women appear to occur in the context of multivariate patterns of harmful substance use, minority stress, and violence in both relationship and community settings. Our findings have implications for how intervention services are provided to emerging adult sexual minority women who experience multiple episodes of sexual abuse during their lifespans. Recommendations include specialized training for counseling or intervention service providers, integrated trauma-informed services that address both substance use and sexual assault issues, and affirmative services for sexual minority women.

Vulnerability and resilience to the harmful health consequences of weight discrimination in Black, Latina, and sexual minority women

Background and objectiveBecause they deviate from societal expectations regarding thinness, women with high body weight or large body size frequently experience social devaluation and discrimination and such experiences can negatively affect health. Yet relatively little is known about experiences of weight discrimination among people impacted by overlapping forms of oppression such as racism, sexism, and heterosexism or how high body weight may intersect with other marginalized identities to contribute to health disparities. Guided by an intersectional lens, the purpose of the current study was to assess Black, Latina, and sexual minority women's experiences with weight discrimination and to identify factors associated with vulnerability or resilience to the harmful health consequences of weight discrimination in these women. MethodsSemi-structured interviews were conducted with thirty-two cisgender women from the United States who identified as Black, Latina, and/or a sexual minority (e.g., lesbian, bisexual) to assess their experiences with and responses to weight discrimination. All participants had a body mass index ≥30 kg/m2 and had previously experienced weight discrimination. Data collection took place from June to August of 2020. ResultsFive factors associated with vulnerability or resilience to experiencing or being negatively affected by weight discrimination were identified: 1) sociocultural norms about weight and perceived acceptance of high body weight, 2) perceived links among weight, perceived femininity, and attractiveness, 3) childhood experiences, 4) internalized weight stigma, and 5) coping strategies. The intersectional nature of women's experiences with weight discrimination was apparent in each theme. ConclusionsThis study identified key factors that may amplify or mitigate the negative health consequences of weight discrimination in socially marginalized women with high body weight. Findings highlight novel research questions to be explored in future research. Such research will be critical for guiding future interventions aimed at reducing the harmful health consequences of weight discrimination.

Sexual Orientation Disparities in Experiences of Male-Perpetrated Intimate Partner Violence: A Focus on the Preconception and Perinatal Period.

Compared with their heterosexual counterparts, sexual minority women (SMW), especially those with male partners, are at increased risk for intimate partner violence (IPV). IPV has been linked to a variety of adverse maternal, infant, and child health outcomes. However, to date, no research has examined SMW's experiences of IPV in the context of pregnancy. This study explored whether SMW were more likely than exclusively heterosexual women with only male sexual partners (WSM) to report a variety of forms of IPV perpetrated by their male partner before or during pregnancy. Data are from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Our sample size ranged from 10,081 to 10,328 pregnancies, matched with their male pregnancy partner, reported by 3,828 to 3,873 women. Logistic regression results indicated that compared with heterosexual-WSM, mostly heterosexual women and heterosexual-women who have sex with women (WSW) were more likely to report any IPV, mostly heterosexual women were more likely to report an IPV-related injury, and heterosexual-WSW were more likely to report sexual assault. Results suggest that mostly heterosexual and heterosexual-WSW are at increased risk of experiencing multiple forms of IPV with their male pregnancy partners, highlighting the need for additional screening and prevention efforts to reduce IPV and its negative sequelae.

Fertility health information seeking among sexual minority women

To qualitatively explore and describe fertility information-seeking experiences of sexual minority women (SMW) couples using assisted reproduction. Qualitative thematic analysis of 30 semistructured, in-depth individual and dyadic interviews with SMW couples. Video conferencing. Twenty self-identified lesbian, bisexual, and queer women comprising 10 same-sex cisfemale couples (10 gestational and 10 nongestational partners) using assisted reproduction technology in the United States. Not applicable. We describe how SMW came to learn about ways to achieve pregnancy through information seeking, acquisition, appraisal, and use. Analysis revealed three primary themes. First, uncertainty and information scarcity: SMW have basic knowledge about how to conceive but uncertainty persists due to information scarcity regarding how same-sex couples navigate assisted reproduction. Second, women attempt to collect fragmented information from disparate sources. The participants discussed a mixture of formal and informal, online, textual (books), and in-person seeking, finding, and synthesizing information that ranged from reliable to unreliable and from accurate to inaccurate. Finally, persistent heteronormative communication focused on the needs and conditions of male-female couples who experienced subfertility or infertility, rather than barriers related to social constraints and the absence of gametes that SMW sought to overcome. These findings support and extend existing evidence that has focused primarily on online fertility information seeking. Our findings suggest that shifts in fundamental assumptions about who seeks assisted reproductive support and why, together with improvements in fertility-related health communication, may result in more inclusive care for this population.

Development and psychometric evaluation of the Sexual Minority Women's Sexual Objectification Experiences Scale.

Research has linked experiences of sexual objectification to body image and eating problems among women. Existing measures of sexual objectification were grounded in heterosexual women's experiences. The present research extends this prior work by centering sexual minority women's experiences to develop and evaluate the Sexual Minority Women's Sexual Objectification Experiences Scale (SMW-SOE). In Study 1, an initial 51 items were developed, drawing on prior qualitative research with sexual minority women and existing measures of sexual objectification experiences. Exploratory factor analysis of 217 sexual minority women's responses to the initial item set suggested an underlying structure of three interrelated factors. In Study 2, data were collected from an independent sample of 201 sexual minority women to conduct confirmatory factor analysis and evaluate validity evidence. Findings from the confirmatory factor analysis supported a higher order solution with three first-order factors. The final scale comprised 17 items: six items assessing Sexualization of Sexual Identity, five items assessing Intrusive and Explicit Sexual Advances, and six items assessing Body Evaluation. In terms of validity, SMW-SOE overall scale scores yielded expected small-to-large positive correlations with heterosexist experiences, internalization of sociocultural appearance standards, and disordered eating; SMW-SOE subscale scores yielded distinctive patterns of correlations. SMW-SOE scale and subscale items yielded acceptable Cronbach's alphas in both samples. Implications for future research and clinical work are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nonvoluntary or Forced Sex Among Women, by Sexual Identity, Attraction, and Behavior — National Survey of Family Growth, United States, 2011–2017

Nonheterosexual (sexual minority) women report experiencing more sexual violence than heterosexual (sexual majority) women (1,2). Sexual minority women are often categorized as a collective whole, which fails to capture the nuances in sexual violence among subgroups of sexual minority women, such as bisexual and lesbian women (3). To estimate the prevalence of lifetime forced vaginal intercourse (forced sex) and of nonvoluntary first vaginal intercourse among women aged 18-44 years in the United States, CDC analyzed data from female respondents who were interviewed during 2011-2017 for the National Survey of Family Growth (NSFG); respondents were stratified by self-reported sexual identity, attraction, and behavior. Log-binomial regressions and analyses of variance (ANOVAs) were performed to compare experiences across each dimension of sexual orientation, controlling for demographic characteristics. Compared with sexual majority women,* prevalence of any male-perpetrated nonvoluntary first vaginal intercourse or forced sex (nonvoluntary or forced sex) was higher among women who identified as bisexual (36.1% versus 17.5%), reported attraction to the opposite and same sex (30.3% versus 15.8%), and reported sexual behavior with the opposite and same sex (35.7% versus 15.9%). These sexual minority women reported that their earliest experience of nonvoluntary or forced sex occurred at younger ages than did that of sexual majority women. Among women who were unsure of their sexual attraction, the prevalence of nonvoluntary first vaginal intercourse was also higher than among sexual majority women. These findings underscore the need for comprehensive prevention approaches tailored for sexual minority women and prevention of child sexual abuse, given the average ages at earliest nonvoluntary or forced sex experience among sexual minority women (range = 12.5-16.3 years). Additional research is needed into the circumstances of and norms or attitudes that influence perpetration of nonvoluntary or forced sex and broader sexual violence against sexual minority women. Prevention of nonvoluntary or forced sex victimization among sexual minority women will require comprehensive approaches to prevent sexual violence and child sexual abuse. Engaging sexual minority women in the development of sexual violence prevention efforts and research would help ensure that the experiences of sexual minority women across the spectrum are represented.

The support that partners or caregivers provide sexual minority women who have cancer: A systematic review.

Intimate partners and other informal caregivers provide unpaid tangible, emotional, and decision-making support for patients with cancer, but relatively little research has investigated the cancer experiences of sexual minority women (SMW) with cancer and their partners/caregivers. This review addressed 4 central questions: 1) What social support do SMW with cancer receive from partners/caregivers? 2) What effect does cancer have on intimate partnerships or caregiving relationships of SMW with cancer? 3) What effects does cancer have on partners/caregivers of SMW with cancer? 4) What interventions exist to support partners/caregivers of SMW or to strengthen the patient-caregiver relationship? This systematic review, conducted in 2018 and updated in 2020, was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent coders screened abstracts and articles. In total, 550 unique records were screened; 42 articles were assessed for eligibility, and 18 were included in a qualitative synthesis. Most studies were U.S.-based, involved breast cancer, included intimate partners, had primarily white/Caucasian samples, and were cross-sectional. Sexual minority female participants reported that partners/caregivers often provide important social support, including emotional support, decision-making support, and tangible support. Effects of cancer on relationships with partners/caregivers were mixed, with some studies finding relationships remained stable and others finding cancer either increased closeness or disrupted relationships. Participants reported partners/caregivers often experience distress and may experience discrimination, discomfort disclosing sexual orientation, and a lack of sexual minority-friendly services. No studies involved an intervention targeting partners/caregivers or the dyadic relationship. More work is needed to understand SMW with cancers other than breast cancer, and future work should include more racially, ethnically, and economically diverse samples. Longitudinal research will allow an examination of patterns of mutual influence and change in relationships. These steps will enable the development of interventions to support SMW with cancer and people close to them.

Objectification of sexual minority women: Responses, consequences, and resistance.

This study investigates responses to, consequences of, and resistance against objectification from the perspectives of sexual minority women in the United States. Data from 5 focus groups with 33 sexual minority women were analyzed using thematic analysis. Results revealed 13 themes and 49 subthemes. First, sexual minority women's responses to objectification included those described in prior research with heterosexual women, as well as novel responses not routinely assessed in prior research (e.g., critical examination), and the complex co-occurrence of responses (e.g., indignation and internalization). Second, participants identified deleterious consequences that were consistent with prior theory and research as well as consequences that reflected resilience and growth from working through objectification. Finally, participants articulated personal, relational, and identity-related forms of resistance against objectification. Sexual and gender identity processes were interwoven with resistance. These results highlight how centering sexual minority women's experiences can both corroborate and advance prior understanding of responses to and consequences of objectification. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Systematic Review of Sexual Minority Women's Experiences of Health Care in the UK.

Sexual minority women (SMW) experience worse health and disproportionate behavioural risks to health than heterosexual women. This mixed-methods systematic review evaluated recent studies on health experiences of UK SMW, published 2010–2018. Analysis was through narrative thematic description and synthesis. Identified were 23,103 citations, 26 studies included, of which 22 provided qualitative and nine quantitative results. SMW had worse health experiences that might impact negatively on access, service uptake and health outcomes. Findings highlighted significant barriers facing SMW, including heteronormative assumptions, perceptions and experiences of negative responses to coming out, ignorance and prejudice from healthcare professionals, and barriers to raising concerns or complaints. Little information was available about bisexual and trans women’s issues. Findings highlighted the need for explicit and consistent education for healthcare professionals on SMW issues, and stronger application of non-discrimination policies in clinical settings.

Online health community experiences of sexual minority women with cancer.

The study sought to explore online health communities (OHCs) for sexual minority women (SMW) with cancer by conducting computational text analysis on posts. Eight moderated OHCs were hosted by the National LGBT Cancer Network from 2013 to 2015. Forty-six SMW wrote a total of 885 posts across the OHCs, which were analyzed using Linguistic Inquiry and Word Count and latent Dirichlet allocation. Pearson correlation was calculated between Linguistic Inquiry and Word Count word categories and participant engagement in the OHCs. Latent Dirichlet allocation was used to derive main topics. Participants (average age 46 years; 89% white/non-Hispanic) who used more sadness, female-reference, drives, and religion-related words were more likely to post in the OHCs. Ten topics emerged: coping, holidays and vacation, cancer diagnosis and treatment, structure of day-to-day life, self-care, loved ones, physical recovery, support systems, body image, and symptom management. Coping was the most common topic; symptom management was the least common topic. Highly engaged SMW in the OHCs connected to others via their shared female gender identity. Topics discussed in these OHCs were similar to OHCs for heterosexual women, and sexual identity was not a dominant topic. The presence of OHC moderators may have driven participation. Formal comparison between sexual minority and heterosexual women's OHCs are needed. Our findings contribute to a better understanding of the experiences of SMW cancer survivors and can inform the development of tailored OHC-based interventions for SMW who are survivors of cancer.

Teen Pregnancy Experiences of Sexual Minority Women.

Sexual minority women are more likely than heterosexual peers to have a teen pregnancy, though little is known about origins of this disparity. Our objective was to describe teen pregnancy experiences among sexual minority women and elucidate potential risk factors. As a part of the SexuaL Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) study, in-depth semistructured interviews and surveys were conducted. Across the United States. Interviews were conducted with 10 sexual minority cisgender women, ages 21-66years, who experienced a teen pregnancy. Interview transcripts were analyzed using immersion/crystallization and template organizing style approaches. The themes were contextualized using survey data and organized into a conceptual model. Participants first became pregnant between ages 12 and 19years; all pregnancies were described as unintentional. Half of the pregnancies resulted from sexual assault. Most of the remaining pregnancies resulted from consensual sex with a boyfriend or regular partner with whom the participant reported inconsistent or no contraceptive use. Five primary themes emerged from participants' interviews: (1) sexuality; (2) life history and contextual factors before pregnancy; (3) abuse and assault; (4) reactions to the pregnancy; and (5) pregnancy outcomes. Future research should assess each theme to explore its contribution to the higher burden of teen pregnancies among sexual minority compared with heterosexual women; such data can inform public health prevention campaigns and evidenced-based curricula for health care providers who care for adolescents.

Sexual Minority Women's Experiences With Sexual Identity Disclosure in Contraceptive Care.

To describe a group of young sexual minority women's experiences with and preferences for sexual identity disclosure in the context of contraceptive care. In Chicago, Illinois, Salt Lake City, Utah, and Madison, Wisconsin, investigators conducted five focus groups (n=22) and 11 interviews with women aged 20-30 years who identified as something other than heterosexual. Focus groups explored social norms regarding contraceptive care; interviews documented individual experiences with contraceptive care. Using a qualitative descriptive approach and combined deductive and inductive content analysis, investigators coded transcripts for themes related to disclosing sexual orientation to contraceptive providers. Participants described the process of sexual identity disclosure in contraceptive care in three stages: 1) listening for whether, when, and how health care providers asked about sexual orientation, 2) deciding whether or not to disclose sexual identity to providers, and 3) evaluating responses from providers after disclosure. Participants wanted providers to: avoid assumptions and ask about both sexual identity and sexual behaviors, signal their openness and competence around the health of sexual minority women during contraceptive encounters, and focus discussions on the individual patient's priorities and needs for contraceptive care. Decisions made by sexual minority women about sexual identity disclosure in contraceptive contexts are influenced by previous and current interactions with health care providers. Contraceptive providers should ask all patients about sexual identity and sexual behavior, avoid assumptions about use of and need for contraception, and acknowledge the prevalence of marginalization, discrimination, and stigma experienced by sexual minority women and their communities in health care contexts.

Patient-Provider Sexually Transmitted Infection Prevention Communication among Young Adult Sexual Minority Cisgender Women and Nonbinary Assigned Female at Birth Individuals.

Health care providers are an important source of sexually transmitted infection (STI) prevention information for young adult sexual minority women (SMW). However, very few studies have described patient-provider STI communication in this understudied and underserved population. We explore sexual minority women's experiences communicating with health care providers about sexual health, with particular attention to STI prevention, to inform programs and practices that address their unique needs and concerns. We conducted 29 in-depth interviews with sexual minority cisgender women and nonbinary assigned female at birth (AFAB) individuals aged 18-36years. The sample included White (55%), Asian (31%), Black (17.2%), and Latina (3.4%) participants. We used thematic analysis with deductive and inductive coding to identify themes related to patient-provider STI prevention communication. Heteronormative health care provider assumptions inhibited participants' willingness to disclose their sexual orientation and discuss sexual health issues with providers. Most sexual health conversations focused on pregnancy and contraception, which many felt was irrelevant to them, and limited STI prevention recommendations to condom use. Participants reported that some providers lacked medical knowledge on AFAB-to-AFAB STI transmission and were not able to provide relevant STI prevention information. Providers' bias related to gender identity and race/ethnicity furthered some participants' mistrust generated from providers' heteronormative assumptions. Our study describes several barriers that AFAB sexual minorities felt inhibited their patient-provider sexual health communication. Interventions are needed to improve patient-provider STI prevention conversations with AFAB sexual minorities so they can access the sexual health information they need to effectively protect themselves from STIs.

Impacts of Marriage Legalization on the Experiences of Sexual Minority Women in Work and Community Contexts

ABSTRACTThe extension of marriage rights to same-sex couples in the United States provides an opportunity to examine how legalization of same-sex marriage has impacted the experiences of sexual minority women (SMW) in interactions within their extended social networks and local communities. Interviews were conducted with 20 SMW ranging in age from 23 to 75, with varying relationship statuses, and in different regions of the United States. Inductive thematic analysis of responses revealed both positive and negative/neutral impacts in 3 broad thematic areas: workplace dynamics and interpersonal interactions in the workplace, social interactions in extended social networks and local communities, and community climate and queer communities. Findings of the study underscore the importance of evaluating the impact of same-sex marriage legalization in the context of local social and political climates.

"I don't care about you as a person": Sexual minority women objectified.

This study investigates sexual minority women's experiences of objectification in the United States. Data from 5 focus groups with 33 sexual minority women were analyzed using thematic analysis (Braun & Clarke, 2006, 2012). Results revealed 6 themes and 34 subthemes grouped into "manifestations of objectification: general and explicit intersections," "immediate context of relational and situational characteristics," and "broader context of oppression and privilege along gender and sexualities." First, sexual minority women's experiences of objectification included both general manifestations described in prior research with heterosexual women and manifestations of objectification that reflected intersections of systems of inequality based on sexual orientation, gender identity, race, ethnicity, culture, and age. Second, participants identified novel relational and situational characteristics of objectification. Finally, participants included experiences of stereotyping, discrimination, and dehumanization in their conceptualizations of objectification, connecting their experiences of objectification with broader dynamics of power related to gender and sexuality. Centralizing sexual minority women's experiences, this study produced a fuller understanding of objectification experiences in general and of sexual minority women's experiences in particular. (PsycINFO Database Record

Are mainstream support services meeting the needs of sexual minority women with breast cancer? An exploration of the perspectives and experiences of users of an online support forum

ABSTRACTWe conducted an inductive content analysis of messages posted to the lesbian-specific discussion board forum found on breastcancer.org for the purpose of examining sexual minority women's experiences of and perspectives on mainstream cancer support services. Our analysis indicated that currently available support services might not be adequately addressing sexual minority women's unique needs. Individuals posting to the lesbian-specific forum reported the presence of homophobia, heterosexual bias, and feelings of exclusion in mainstream breast cancer support services. In contrast, forum users generally perceived nonspecific cancer support groups to be beneficial, yet the majority preferred lesbian-specific support.

Perceived health concerns among sexual minority women in Mumbai, India: an exploratory qualitative study

The experiences of sexual minority women (i.e., women who do not identify as ‘heterosexual’) in India have largely been absent in scientific literature. In partnership with India’s oldest and largest sexual and gender minority-advocacy organisation, the Humsafar Trust, our study used community-based participatory research principles to explore the lived experiences and health concerns of sexual minority women in Mumbai. Study methodologies included interviews with key informants, a focus group comprised of six women, and an additional 12 in-person interviews with sexual minority women to identify important physical, mental, social and other health priorities from these women’s perspectives. Thematic data are organised within the framework offered by the social ecological model, including individual, interpersonal, micro and macro levels. Findings from this study are important in providing the groundwork for future research and intervention involving sexual minority women in India, a dramatically underserved population.

Coping Styles and Suicide in Racially and Ethnically Diverse Lesbian, Bisexual, and Queer Women.

The purpose of the current study was to examine whether coping strategies are associated with past suicidal ideation and history of suicide attempts among sexual minority women (SMW). Participants were 150 racially and ethnically diverse lesbian, bisexual, queer, or "other" nonheterosexual-identified cisgender women who were recruited as part of a national online survey on the experiences of SMW. Simultaneous multiple regressions suggested that coping styles significantly explained 20.3% of the variance in past suicidal ideation and 30.4% of the variance in lifetime history of suicide attempts. Within these regressions, self-blame coping positively predicted past suicidal ideation, and religious coping and venting coping were associated with a higher lifetime history of suicide attempts. Based on these findings, directions for future research and interventions to reduce suicide risk among SMW are discussed.