Access to health services for lesbian women: a literature review

Silva, Adriane das Neves; Gomes, Romeu

doi:10.1590/1413-812320212611.3.34542019

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FREE THEMES • Ciênc. saúde coletiva 26 (suppl 3) • 2021 • https://doi.org/10.1590/1413-812320212611.3.34542019 copy

Access to health services for lesbian women: a literature review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study explores access to health services for lesbians in the light of current literature. A literature search was conducted using various databases and an interpretive synthesis of the findings of the selected articles was produced anchored in the concepts of habitus and symbolic violence developed by Pierre Bourdieu. Two main themes and their respective units of meaning were identified: (a) barriers and difficulties experienced by lesbians in accessing healthcare (issues related to coming out as a lesbian and difficulties experienced by health services and professionals in dealing with lesbian women); and (b) lesbian women’s experiences in health services (unequal care, invisibility, and feeling uncomfortable). We conclude that, despite advances in policy and care protocols, sexual and gender diversity needs to be widely discussed in social, educational, and health settings.

Key words:
Female homosexuality; Lesbians; Healthcare access

Author	Year	Country	Method	Central focus
Kerker et al¹⁷17 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):970-979.	2006	US	Comparative study	Sexual behavior and access to health
Araújo et al¹⁸18 Araújo MAL, Galvão MTG, Saraiva MMM, Albuquerque AD. Relação usuária-profissional de saúde: experiência de uma mulher homossexual em uma unidade de saúde de referência de Fortaleza. Esc Anna Nery 2006; 10(2):323-327.	2006	Brazil	Case study	Experiences of lesbians with healthcare
Heck et al¹⁹19 Heck JE, Sell RL, Gorin SS. Health care access among individuals involved in same-sex relationships. Am J Public Health 2006; 96(6):1111-1118.	2006	US	Comparative study	Health care for lesbians and heterosexual women
Mravcak²⁰20 Mravcak SA. Primary care for lesbians and bisexual women. Am Fam Physician 2006; 74(2):279-286.	2006	US	Document analysis	Access to health among lesbians and bisexual women
Tjepkema²¹21 Tjepkema M. Health care use among gay, lesbian and bisexual Canadians. Health Rep 2008; 19(1):53-64.	2008	Canada	Comparative study	Healthcare for gays, lesbians, and bisexuals
Barbosa and Facchini²²22 Barbosa RM, Facchini R. Acesso a cuidados relativos à saúde sexual entre mulheres que fazem sexo com mulheres em São Paulo, Brasil. Cad Saude Publica 2009; 25(Supl. 2):s291-s300.	2009	Brazil	Ethnographic study	Healthcare for lesbians
Matebeni et al²³23 Matebeni Z, Camargo TMCR, Camargo Júnior KR, Dias LF. All sexed up: a resposta de mulheres lésbicas negras jovens ao sexo (mais) seguro em Johannesburg, África do Sul. Physis 2009; 19(2):333-348.	2009	Africa	Exploratory study	Experiences of lesbians with HIV/AIDS
Bjorkman and Malterud²⁴24 Bjorkman M, Malterud K. Lesbian women's experiences with health care: a qualitative study. Scand J Prim Health Care 2009; 27(4):238-243.	2009	Norway	Exploratory study	Sexual orientation and access to health services
Dilley et al²⁵25 Dilley JA, Simmons KW, Boysun MJ, Pizacani BA, Stark MJ. Demonstrating the importance and feasibility of including sexual orientation in public health surveys: health disparities in the Pacific Northwest. Am J Public Health 2010; 100(3):460-467.	2010	US	Comparative study	Access to health among gays, lesbians, and bisexuals
Fish and Bewleys²⁶26 Fish J, Bewley S. Using human rights-based approaches to conceptualise lesbian and bisexual women's health inequalities. Health Soc Care Community 2010; 18(4):355-362.	2010	UK	Qualitative exploratory descriptive study	Human rights and lesbian and bisexual women's health
Austin and Irwin²⁷27 Austin EL, Irwin JA. Health behaviors and health care utilization of southern lesbians. Womens Health Issues 2010; 20(3):178-184.	2010	US	Comparative study	Healthcare utilization among lesbians and women from the general population
Formby²⁸28 Formby E. Lesbian and bisexual women's human rights, sexual rights and sexual citizenship: negotiating sexual health in England. Cult Health Sex 2011; 13(10):1165-1179.	2011	UK	Qualitative exploratory descriptive study	Lesbian and bisexual women’s sexual health
Charlton et al²⁹29 Charlton BM, Corliss HL, Missmer SA, Frazier AL, Rosario M, Kahn JA, Austin SB. Reproductive Health Screening Disparities and Sexual Orientation in a Cohort Study of U.S. Adolescent and Young Adult Females. J Adolesc Health 2011; 49(5):505-510.	2011	US	Comparative study	Sexual orientation and reproductive health.
Marques et al³⁰30 Marques AM, Oliveira JM, Nogueira C. A população lésbica em estudos da saúde: contributos para uma reflexão crítica. Cien Saude Colet 2013; 18(7):2037-2047.	2012	Brazil	Reflexive study	Lesbians and health services
Corbett et al³¹31 Corbett SL, Frecker HM, Shapiro HM, Yudin MH. Access to fertility services for lesbian women in Canada. Fertil Steril 2013; 100(4):1077-1080.	2013	Canada	Qualitative exploratory descriptive study	Lesbians and fertility services
Carvalho et al³²32 Carvalho CS, Calderaro F, Souza SJ. O dispositivo "saúde de mulheres lésbicas": (in)visibilidade e direitos. Rev Psicol Polit 2013; 13(26):111-127.	2013	Brazil	Document analysis	Health policies for lesbians
Carvalho et al³³33 Nóbrega BSM, Oliveira JL, Almeida RO, Abdalla FTM, Nichiata LYI, Carvalho PMG. Prevention of sexually transmitted diseases by homosexual and bisexual women: a descriptive study. Online Braz J Nurs 2013; 12(4):931-941.	2013	Brazil	Qualitative exploratory descriptive study	Lesbian women’s experiences in health services
Mosack et al³⁴34 Mosack KE, Brouwer AM, Petroll AE. Sexual identity, identity disclosure, and health care experiences: is there evidence for differential homophobia in primary care practice? Womens Health Issues 2013; 23(6):e341-e346.	2013	US	Comparative study	Healthcare for lesbians and heterosexual women
Araújo and Penna³⁵35 Araújo LM, Penna LHG. A relação entre sexo, identidades sexual e de gênero no campo da saúde da mulher. Rev Enferm UERJ 2014; 22(1):134-138.	2014	Brazil	Reflexive study	Sexual and gender identity in health services
Brown et al³⁶36 Brown JL, Pecheny M, Tamburrino MC, Conde LL, Perrotta GV, Capriati A, Andia AM, Mario S, Ibarlucia I. Atención ginecológica de lesbianas y bisexuales: notas sobre el estado de situación en Argentina. Atención ginecológica de lesbianas y bisexuales: notas sobre el estado de situación en Argentina. Interface (Botucatu) 2014; 18(1):673-684.	2014	Argentina	Qualitative exploratory descriptive study	Healthcare experiences of lesbians and health services
Marques et al³⁷37 Marques AM, Nogueira C, Oliveira JM. Lesbians on medical encounters: tales of heteronormativity, deception, and expectations. Health Care Women Int 2015; 36(9):988-1006.	2014	Portugal	Exploratory study	Experiences of lesbians with medical consultations.
Poteat et al³⁸38 Poteat TC, Logie CH, Adams D, Mothopeng T, Lebona J, Letsie P, Baral S. Stigma, sexual health, and human rights among women who have sex with women in Lesotho. Reprod Health Matters 2015; 23(46):107-116.	2015	Africa	Cross-sectional study	Health service experiences of lesbians, bisexual women, and heterosexuals
Rubin³⁹39 Rubin R. Minimizing Health Disparities Among LGBT Patients. JAMA 2015; 313(1):15-17.	2015	US	Exploratory study	Health inequalities between gay, lesbian, and bisexual patients
Hirsch et al⁴⁰40 Hirsch O, Löltgen K, Becker A. Lesbian womens' access to healthcare, experiences with and expectations towards GPs in German primary care. BMC Fam Pract 2016; 17(1):162.	2016	Germany	Quantitative exploratory descriptive study	Lesbian women’s health and primary care
Videla and Munoz⁴¹41 Videla CF, Muñoz AV. Experiences of lesbian users about the process of perinatal care in the metropolitan region of Chile in 2016. Interface (Botucatu) 2018; 22(66):777-778.	2016	Chile	Cross-sectional exploratory study	Experiences of lesbians with perinatal care
Daly et al⁴²42 Daly F, Neil S, Samantha W. Sexual rights but not the right to health? Lesbian and bisexual women in South Africa's National Strategic Plans on HIV and STIs. Reprod Health Matters 2016; 24(47):185-194.	2016	Africa	Document analysis	Sexual violence, lesbians and bisexuals, and the right to health
Munson and Cook⁴³43 Munson S, Cook C. Lesbian and bisexual women's sexual healthcare experiences. J Clin Nurs 2016; 25(23-24):3497-3510.	2016	New Zealand	Descriptive study	Access to health among lesbians and bisexuals
Silberman et al⁴⁴44 Silberman P, Buedo PE, Burgos LM. Barreras en la atención de la salud sexual en Argentina: percepción de las mujeres que tienen sexo con mujeres. Rev Salud Publica 2016; 18(1):1-12.	2016	Argentina	Cross-sectional descriptive study	Difficulties in access to sexual health care among lesbians
Bränström et al⁴⁵45 Bränström R, Hatzenbuehler ML, Pachankis JE. Sexual orientation disparities in physical health age and gender effects in a population-based study. Soc Psychiatry Psychiatr Epidemiol 2016; 51(2):289-301.	2016	US	Comparative study	Health inequalities between gays, lesbians, and bisexuals
Vitiritti et al⁴⁶46 Vitiritti B, Andrade SMO, Peres JEC. Diversidade sexual e relações profissionais: concepções de médicos e enfermeiros. Temas Psicol 2016; 24(4):1389-1405.	2016	Brazil	Qualitative exploratory descriptive study	Discourse of health professionals on sexual diversity
Moscheta et al⁴⁷47 Moscheta MS, Febole DS, Anzolin B. Visibilidade seletiva: a influência da heterossexualidade compulsória nos cuidados em saúde de homens gays e mulheres lésbicas e bissexuais. Saude Transf 2016; 7(3):71-83.	2016	Brazil	Qualitative exploratory descriptive study	Relationship between health professionals and gays/lesbians/bisexuals
Alpert et al⁴⁸48 Alpert AB, CichoskiKelly EE, Fox AD. What lesbian, gay, bisexual, transgender, queer, and intersex patients say doctors should know and do: a qualitative study. J Homosex 2017; 64(3):1368-1389.	2017	US	Exploratory study	GLBT and access to health
Müller⁴⁹49 Müller A. Scrambling for access: availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa. BMC Int Health Hum Rights 2017; 17(1):16.	2017	Africa	Qualitative exploratory descriptive study	Healthcare for gays, lesbians, bisexuals, and transsexuals
Müller⁵⁰50 Müller A. Health for all? sexual orientation, gender identity, and the implementation of the right to access to health care in south Africa. Health Hum Rights 2016; 18(2):195-208.	2017	Africa	Qualitative exploratory descriptive study	GLBT and access to health services
Ruﬁno et al⁵¹51 Rufino AC, Madeiro A, Trinidad AS, Rodrigues dos Santos R, Freitas I. Disclosure of sexual orientation among women who have sex with women during gynecological care: a qualitative study in Brazil. J Sex Med 2018; 15(7):966-973.	2018	Brazil	Qualitative exploratory descriptive study	Experiences of lesbians with gynecological care
Ruﬁno et al⁵²52 A C, Madeiro A, Trinidad A, Santos R, Freitas I. Práticas sexuais e cuidados em saúde de mulheres que fazem sexo com mulheres: 2013-2014. Epidemiol Serv Saude 2018; 27(4):e2017499	2018	Brazil	Cross-sectional study	Sexual practices and healthcare for lesbians

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[1] Collaborations

AN Silva worked on the conception, research, methodology, and final draft. R Gomes, the doctoral student’s advisor, participated in all stages of the article.