When I became Director of Mautner Project: The National Lesbian Health Organization, I heard a fair number of smart smart aleck jokes about why lesbians need a health organization: Allergic reactions to flannel shirts? Heel inflammation from those Birkenstocks? (You get the picture.)
The reality is there are important health issues for women who identify as lesbian, bisexual or queer.
Most of these issues are created by the stigma and discrimination we experience. This stigma contributes to ill health and prevents lesbians from getting the health screenings and health care we need.
Let’s start with mental health: Depression and anxiety are reported at higher rates among lesbians and bisexuals than among heterosexual women. It is possible that depression and anxiety rates differences may not be as large as reported, since queer women are more likely to seek psychological care than their heterosexual counterparts. (And that’s the good news: if you’re feeling depressed or anxious, do seek counseling!)
Why the depression and anxiety? It’s an illness we catch from our families and our society:
Researchers describe a syndrome of “minority stress” that’s experienced by members of any group who experience a cumulative, chronic, and additive stress stemming from repeated small and large scale social discrimination and alienation.
In LGBT populations this theory has been supported by research demonstrating that when people perceive that they lack the support of family, friends, and coworkers, they are more likely to experience mental health difficulties. Indeed, rejection by one’s family is strongly associated with mental illness in LGBT individuals.
Reactions to stigma create physical problems, too: Queer women are more likely than heterosexual women to abuse alcohol and drugs. And, as a group, we are more likely to be obese or overweight than the heterosexual population. The reasons are many: our culture is more sympathetic to large body size than the normative heterosexual culture. But feeling bad about ourselves may also play a role. The fact is, we’re just not sure. But we do know that obesity is a health risk, and we know that it’s healthier to exercise more and make healthier food choices.
Another barrier to good health is violence. Queer women – especially those who look “butch,” or masculine, experience more violence from strangers than their heterosexual peers. Violence is particularly prevalent among male to female transgender people, particularly transwomen of color.
We know that lesbians also experience partner violence, but at lower reported rates than heterosexual women. Still, the real rates may be higher; embarrassment and unwillingness to deal with the authorities when reporting lesbian partner violence may well account for limited reporting.
Another effect of stigma is that queer women tend to avoid regular medical checkups and screenings. Why? Too many have experienced doctors or nurses who have a negative reaction (subtle or not-so-subtle) to the news of one’s queerness. Or, women are afraid they’re going to get that hostile reaction and have a lot of explaining to do, which is the the last thing they want to deal with. Pretty much every lesbian with a stomach ache has been asked if she could be pregnant. A perfectly reasonable question, but many practitioners just won’t take “no” for an answer. A transwoman friend who went to the emergency room fearing a broken ankle recently told me that although she had already explained that she had been born male, she still was interrogated about how she could be SURE she wasn’t pregnant. Right.
But because we avoid those regular checkups, we avoid getting the screenings we need: pap tests and mammograms, blood pressure, blood sugar, colonoscopies. Every woman, no matter what her sexual preference or practices, needs these tests.
Finally, lesbians are less likely than heterosexual women to have health insurance. Why? Self-employment and low-paying jobs (“pink collar” jobs) both play a role. So too does not being married to a man: the best predictor of whether a woman has health insurance is if she’s married, to a man, who’s more likely to hold a job that includes health insurance.
Mautner Project can help you find doctors, nurses, and clinics who welcome and understand the issues faced by queer women and who you can afford to see. Please call us at 202.332.5536 if your anxiety about seeking medical care, or insurance or income issues, are preventing you from getting the care you need and deserve.
To your good health!
Leslie Calman is the Executive Director of Mautner Project, the national lesbian health organization.