Being lesbian, but also bisexual, pansexual, being a woman with a dissenting gender identity or sexual orientation, on many occasions, implies suffering discrimination also in the health world. The practices that come out of heterosexuality are often invisible, with consequences on the sexual health of women. We take advantage of the Lesbian Visibility Day this April 26 to tell the stories of the women who suffer this discrimination in the first person.
– Do you have an active sex life?
– Yes.
– Do you use contraceptive methods?
– Do not.
– Are you planning to get pregnant?
– Do not.
– Then why don’t you use birth control?
– I’m a lesbian.”
This conversation with her gynecologist told by Laura Arenas, a Colombian woman who identifies as a lesbian, is the beginning of the consultations of many women around the world. In a society that presupposes heterosexuality, the moment of discussing contraception with health professionals often becomes the delicate moment of having to come out of the closet for anyone with a dissenting sexual orientation and sexual practices.
After revealing that she was a lesbian, Laura received this response from the doctor: “Oh, but you don’t have sex.” “It made me feel very uncomfortable, it was as if what we did was not part of sexual interactions,” she recalls.
Lesbian, bisexual women, and especially trans women, suffer discrimination and invisibility on a daily basis. However, receiving them in such a vulnerable context as a gynecological consultation has extensive consequences on their sexual and general health, both in the short and long term.
information orphans
“I have never had information on prevention in risk practices and other care practices. I think the only thing they suggest is planning, even when I have explicitly said that I do not need it or that I have no chance of getting pregnant.” These are the words of María, a pansexual woman who from Bogotá, the Colombian capital, says that “the gynecological space” has become for her something “stressful, impersonal and absolutely violating many levels of health.”
There is very little health data focused particularly on lesbian women, and even less on sexual health. Nevertheless, a Human Rights Watch report states that the barriers to access to health care are higher in the LGBT+ population. 8% of gay and bisexual people had received discriminatory comments from professionals in the US, and the same number had encountered doctors who had refused to treat them. The percentage increased to 21% in the case of trans people.
In the absence of figures, in France 24 we collected more testimonies that show how history repeats itself. Vanessa, a young lesbian woman, recounts a situation that resonates with Maria’s words. “I had to listen to a very uncomfortable conversation between a gynecologist and her assistant. She asked me if I used prevention methods against sexually transmitted diseases (STDs) and she didn’t allow me to answer anything before saying on air: ‘no, you don’t use that. ‘ Then she told her assistant, ‘That’s why they get more STDs.’ I obviously felt very judged.”
In addition to the trial to which she was subjected, Vanessa left the consultation without information: “She told me to get tested for STDs regularly, but she also did not tell me how these diseases were avoided in lesbian sexual relations.”
The perception that sex between women does not involve risky practices is one of the most widespread ‘myths’. “Any sexual relationship, whatever the couple, that has fluid-to-fluid contact, is already at risk of STDs, whether from chlamydia, herpes, HIV, or human papillomavirus (HPV),” says María Alejandra Cifuentes, a gynecologist. and endocrinologist specializing in childhood and youth.
However, many health professionals continue to make lesbian sexual practices invisible (as happened to Laura). In the case of Júlia, a young Catalan woman, this perception made her gynecologist not consider it necessary to do a cytology, an examination of the cells of the cervix that serves, among other things, to detect HPV.
“In one of my first gynecological examinations that I had, after the general questions, the consultation quickly ended and I asked her if it was not indicated to have a cytology as a screening method for HPV. Her response, even having had the opportunity to inquire more in the type of relationships that I had, it was not because there was no active penetration, understanding that as the presence of a penis, penetration according to the common ideology, and that there was no risk of transmission,” he says.
Medical desertion: fear of discrimination
The accumulation of discriminatory situations around sexual health ends up leading many lesbian, bisexual, pansexual women and women with dissenting sexual orientations to move away from the medical environment. “There is a lot of desertion on this type of visit, causing these women to miss a medical consultation for many years for fear of being discriminated against and judged,” says the gynecologist Cifuentes.
For both María and Vanessa, this translates into greater “laziness” in attending this type of appointment. “Laziness above all to try to make myself understood, in a dialogue that is known that many times she is not going to go well,” says María. Vanessa acknowledges that she always ends up going, but that she must overcome the “laziness” of having to put up with “value judgments”.
Not going to the recommended medical check-ups can cause women to refuse to seek care despite needing it and that a health condition worsens or, in the same way, that a disease develops without knowing, as is the case of HPV.
The Human Rights Watch (HRW) report collects studies that show how lesbian and bisexual women undergo fewer screenings for colon, breast and cervical cancer, although they do not specify in figures how much less than heterosexual women.
Being lesbian, bisexual or pansexual and having safe practices: how to do it?
In the basic medical knowledge to be able to decide autonomously what sexual practices to have, the main thing is to remember that the vast majority of STDs can be transmitted from mucosa to mucosa, secretions found in the vagina, in the anus and in the mouth. Semen is also a vector for some STDs like HIV and HPV.
To avoid direct contact between mucous membranes or body fluids, there are several options in addition to the condom normally used for penises, which are also useful for penetrative sex toys. The female condom is a barrier that is inserted into the vagina; there are the so-called ‘finger condoms’, which act as a kind of gloves; the latex squares are used for various practices, such as oral sex.
To solve the information gaps, Laura talks about the importance of networks of friends: “What we do is give us data from gynecologists who we consider treat you better, who don’t attack you, who don’t make you invisible.” She also says that “when someone travels to another country” she brings “latex barriers” and other protection methods that are difficult to find in Colombia, in her case, and in many other countries and regions of Latin America.
In the same way that social media is important, so are LGBT+ activism networks. Many of them have information on ways to obtain these protection methods and on allied professionals.
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