End LGBT Invisibility in Health Care Now! Do Ask, Do Tell

Published: February 25, 2013

Lesbians are less likely than heterosexual women to have health insurance or get preventive health care such as mammograms, and they may be at greater risk for breast cancer and ovarian cancer. Some studies indicate higher prevalence of these cancers among lesbians, yet we don’t know for sure, because we don’t gather enough data systematically. What we do know is that while lesbians are as likely as straight women to get cervical cancer, they are up to 10 times less likely to be screened for it.

Until very recently, lesbian, gay, bisexual and transgender (LGBT) people have been invisible in health care. Most providers do not ask about sexual orientation or gender identity, nor are they trained in the unique health care needs of LGBT people or the health disparities they experience. Many LGBT patients are not "out" to their providers; as a result, they are not screened for issues that may disproportionately affect LGBT people. Moreover, sexual orientation isn’t just about identity. For example, a recent study found that nearly 10 percent of men who identified as straight had had sex with another man in the past year — and these men were less likely to use condoms than men who identified as gay. This underscores the need to ask questions about sexual behavior as well as sexual identity.

Thankfully, the Obama administration has taken significant steps to end LGBT invisibility in health care. Healthy People 2020, the federal government’s blueprint for improving our nation’s health over the next decade, includes a groundbreaking call to action to eliminate LGBT health disparities. The Institute of Medicine published its first-ever report on LGBT health in 2011. The National Health Interview Survey has added a question regarding sexual orientation. And last fall, the Institute of Medicine held a practice-oriented workshop on gathering data on sexual orientation and gender identity in electronic health records.

Asking about sexual orientation and gender identity in clinical settings is a critical step that will enhance our knowledge of LGBT population health and improve patient-provider interactions. There are important health reasons to ask about sexual orientation and gender identity. For example, providers who know that a patient is a sexually active gay man can warn him about a recent syphilis outbreak and test him for sexually transmitted infections more common among gay men. Doctors who know that a woman is a lesbian can screen her for obesity and cardiovascular disease, conditions more prevalent among lesbians. Providers who don’t know that a female patient is transgender may not know to test her for prostate cancer.

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