Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2016

Open Access 01-12-2016 | Research article

Lesbian womens’ access to healthcare, experiences with and expectations towards GPs in German primary care

Authors: Oliver Hirsch, Karina Löltgen, Annette Becker

Published in: BMC Primary Care | Issue 1/2016

Login to get access

Abstract

Background

Lesbian 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.

Methods

A 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).

Results

We 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.

Conclusions

GPs 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.
Appendix
Available only for authorised users
Literature
1.
Addis S, Davies M, Greene G, Macbride-Stewart S, Shepherd M. The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature. Health Soc Care Community. 2009;17(6):647–58.CrossRefPubMed
2.
Diamant AL, Wold C, Spritzer K, Gelberg L. Health behaviors, health status, and access to and use of health care: a population-based study of lesbian, bisexual, and heterosexual women. Arch Fam Med. 2000;9(10):1043–51.CrossRefPubMed
3.
Matthews AK, Brandenburg DL, Johnson TP, Hughes TL. Correlates of underutilization of gynecological cancer screening among lesbian and heterosexual women. Prev Med. 2004;38(1):105–13.CrossRefPubMed
4.
Allen O. Lesbian, Gay & Bisexual Patients: The Issues for General Practice. Dublin: Irish College of General Practitioners; 2008.
5.
Kerr DL, Santurri L, Peters P. A comparison of lesbian, bisexual, and heterosexual college undergraduate women on selected mental health issues. J Am Coll Health. 2013;61(4):185–94.CrossRefPubMed
6.
Austin EL, Irwin JA. Health behaviors and health care utilization of southern lesbians. Womens Health Issues. 2010;20(3):178–84.CrossRefPubMed
7.
Sandfort TG, Bakker F, Schellevis FG, Vanwesenbeeck I. Sexual orientation and mental and physical health status: findings from a Dutch population survey. Am J Public Health. 2006;96(6):1119–25.CrossRefPubMedPubMedCentral
8.
Koh AS, Ross LK. Mental health issues: a comparison of lesbian, bisexual and heterosexual women. J Homosex. 2006;51(1):33–57.CrossRefPubMed
9.
Polek CA, Hardie TL, Crowley EM. Lesbians’ disclosure of sexual orientation and satisfaction with care. J Transcult Nurs. 2008;19(3):243–9.CrossRefPubMed
10.
Steele LS, Tinmouth JM, Lu A. Regular health care use by lesbians: a path analysis of predictive factors. Fam Pract. 2006;23(6):631–6.CrossRefPubMed
11.
Law M, Mathai A, Veinot P, Webster F, Mylopoulos M. Exploring lesbian, gay, bisexual, and queer (LGBQ) people’s experiences with disclosure of sexual identity to primary care physicians: a qualitative study. BMC Fam Pract. 2015;16:175.CrossRefPubMedPubMedCentral
12.
Committee on Health Care for Underserved Women. Health Care for Lesbians and Bisexual Women. Obstet Gynecol. 2012;119(5):1077–80.CrossRef
13.
Davy Z, Siriwardena AN. To be or not to be LGBT in primary health care: health care for lesbian, gay, bisexual, and transgender people. Br J Gen Pract. 2012;62(602):491–2.CrossRefPubMedPubMedCentral
14.
McKay B. Lesbian, Gay, Bisexual, and Transgender Health Issues, Disparities, and Information Resources. Med Ref Serv Q. 2012;30(4):393–401.CrossRef
15.
Reygan FC, D'Alton P. A pilot training programme for health and social care professionals providing oncological and palliative care to lesbian, gay and bisexual patients in Ireland. Psychooncology. 2012;22(5):1050–4.CrossRefPubMed
16.
Rutherford K, McIntyre J, Daley A, Ross LE. Development of expertise in mental health service provision for lesbian, gay, bisexual and transgender communities. Med Educ. 2012;46(9):903–13.CrossRefPubMed
17.
Stott DB. The training needs of general practitioners in the exploration of sexual health matters and providing sexual healthcare to lesbian, gay and bisexual patients. Med Teach. 2013;35(9):752–9.CrossRefPubMed
18.
Smith R. Healthcare experiences of lesbian and bisexual women in Cape Town, South Africa. Cult Health Sex. 2015;17(2):180–93.
19.
Marques AM, Nogueira C, de Oliveira JM. Lesbians on Medical Encounters: Tales of Heteronormativity, Deception, and Expectations. Health Care Women Int. 2015;36(9):988–1006.CrossRefPubMed
20.
Dannecker M. Die Rechtsstellung gleichgeschlechtlicher Lebensgemeinschaften [Legal position of same-sex partnerships]. In: Basedow J, Dopffel K, Kötz H, editors. Sexualwissenschaftliches Gutachten zur Homosexualität [Sexological expertise regarding homosexuality]. Tübingen: Mohr Siebeck; 2000. p. 335–48.
21.
Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.
22.
Lowe B, Kroenke K, Grafe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58(2):163–71.CrossRefPubMed
23.
Welch S, Collings SC, Howden-Chapman P. Lesbians in New Zealand: their mental health and satisfaction with mental health services. Aust N Z J Psychiatry. 2000;34(2):256–63.CrossRefPubMed
24.
Weisz VK. Social justice considerations for lesbian and bisexual women’s health care. J Obstet Gynecol Neonatal Nurs. 2009;38(1):81–7.CrossRefPubMed
25.
Warner J, McKeown E, Griffin M, Johnson K, Ramsay A, Cort C, King M. Rates and predictors of mental illness in gay men, lesbians and bisexual men and women: Results from a survey based in England and Wales. Br J Psychiatry. 2004;185:479–85.CrossRefPubMed
26.
27.
Mravcak SA. Primary care for lesbians and bisexual women. Am Fam Physician. 2006;74(2):279–86.PubMed
28.
Schendera C. Regressionsanalyse mit SPSS [Regression analysis with SPSS]. Munich: Oldenbourg; 2008.CrossRef
29.
Tabachnick BG, Fidell LS. Using Multivariate Statistics. Boston: Pearson; 2007.
30.
Hirsch O, Löltgen K, Becker A. Comparing health survey data from Internet- and paper-based convenience samples of lesbian women in Germany. Sex Health. 2014;11(4):351–8.
31.
Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.
32.
Kerker BD, Mostashari F, Thorpe L. Health Care Access and Utilization among Women Who Have Sex with Women: Sexual Behavior and Identity. J Urban Health. 2006;83(5):970–9.CrossRefPubMedPubMedCentral
33.
Bowen DJ, Bradford JB, Powers D, McMorrow P, Linde R, Murphy BC, Han J, Ellis J. Comparing women of differing sexual orientations using population-based sampling. Women Health. 2004;40(3):19–34.CrossRefPubMed
34.
Mathieson CM, Bailey N, Gurevich M. Health care services for lesbian and bisexual women: some Canadian data. Health Care Women Int. 2002;23(2):185–96.CrossRefPubMed
35.
Durso LE, Meyer IH. Patterns and Predictors of Disclosure of Sexual Orientation to Healthcare Providers among Lesbians, Gay Men, and Bisexuals. Sex Res Social Policy. 2013;10(1):35–42.CrossRefPubMed
36.
Dennert G, Wolf G. Gesundheit lesbischer und bisexueller Frauen. Zugangsbarrieren im Versorgungssystem als gesundheitspolitische Herausforderung [Health status of lesbian and bisexual women. Barriers to healthcare access as a challenge to health policy]. Femina Politica. 2009;1:48–59.
37.
Dennert G. Die gesundheitliche Situation lesbischer Frauen in Deutschland [Health issues in lesbian women in Germany]. Herbolzheim: Centaurus; 2005.CrossRef
38.
St. Pierre M. Under What Conditions do Lesbians Disclose Their Sexual Orientation to Primary Healthcare Providers? A Review of the Literature. J Lesbian Stud. 2012;16:199–219.CrossRefPubMed
39.
Roberts SJ, Patsdaughter CA, Grindel CG, Tarmina MS. Health related behaviors and cancer screening of lesbians: results of the Boston Lesbian Health Project II. Women Health. 2004;39(4):41–55.CrossRefPubMed
40.
European Union Agency for Fundamental Rights. European Union lesbian, gay, bisexual and transgender survey. Luxemburg: Publications Office of the European Union; 2013.
41.
42.
Razzano LA, Cook JA, Hamilton MM, Hughes TL, Matthews AK. Predictors of mental health services use among lesbian and heterosexual women. Psychiatr Rehabil J. 2006;29(4):289–98.CrossRefPubMed
43.
Kerr DL, Ding K, Thompson AJ. A comparison of lesbian, bisexual, and heterosexual female college undergraduate students on selected reproductive health screenings and sexual behaviors. Womens Health Issues. 2013;23(6):e347–355.CrossRefPubMed
44.
Mathy RM, Schillace M, Coleman SM, Berquist BE. Methodological rigor with internet samples: New ways to reach underrepresented populations. Cyberpsychol Behav. 2002;5(3):253–66.
45.
Sanchez DT, Moss-Racusin CA, Phelan JE, Crocker J. Relationship contingency and sexual motivation in women: Implications for sexual satisfaction. Arch Sex Behav. 2011;40(1):99–110.
46.
Malterud K, Bjorkman M, Flatval M, Ohnstad A, Thesen J, Rortveit G. Epidemiological research on marginalized groups implies major validity challenges; Lesbian health as an example. J Clin Epidemiol. 2009;62(7):703–10.
47.
Institute of Medicine (US) Committee on Lesbian G, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People. Building a Foundation for Better Understanding. Washington: The National Academies Press; 2011.
48.
Dannetun E, Tegnell A, Giesecke J. Parents’ attitudes towards hepatitis B vaccination for their children. A survey comparing paper and web questionnaires, Sweden 2005. BMC Public Health. 2007;7:86.CrossRefPubMedPubMedCentral
49.
Warnecke RB, Sudman S, Johnson TP, O'Rourke D, Davis AM, Jobe JB. Cognitive aspects of recalling and reporting health-related events: Papanicolaou smears, clinical breast examinations, and mammograms. Am J Epidemiol. 1997;146(11):982–92.CrossRefPubMed
Metadata
Title
Lesbian womens’ access to healthcare, experiences with and expectations towards GPs in German primary care
Authors
Oliver Hirsch
Karina Löltgen
Annette Becker
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2016
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-016-0562-4

Other articles of this Issue 1/2016

BMC Primary Care 1/2016 Go to the issue

Research article

Classifying patients with lumbar spinal stenosis using painDETECT: a cross-sectional study

Research article

Medically unexplained physical symptoms and work functioning over 2 years: their association and the influence of depressive and anxiety disorders and job characteristics

Research article

Low use of statins for secondary prevention in primary care: a survey in a northern Swedish population

Research article

Associations between patients’ risk attitude and their adherence to statin treatment – a population based questionnaire and register study

Research article

Factors influencing general practitioners’ decisions about cardiovascular disease risk reassessment: findings from experimental and interview studies

Research article

Disenrollment from general practitioners among chronic patients: a register-based longitudinal study of Norwegian claims data