Lesbian & Bisexual women - how could your Gynaecologist improve their service?

Ok, I’m asking this for a good reason.
I’m a medical student, and eventually I’d like to work as a gynaecologist / obstetrician, so you’d actually be giving me real help with some tips to help make my language and behaviour more inclusive.

I know that the two most common questions in gynae; “Are you sexually active?” and “What type or method of contraception are you using?” aren’t exactly inclusive of non-heterosexual women, stressing as it does heterosexuality. What alternatives would you prefer?

I also realise that some women would prefer not to be out to their doctors, and find that particularly difficult when dealing with gynaecologists. Obviously, the more information your doctor has, the better care they can provide, but your privacy is paramount, so how could I adapt myself to that kind of situation?

So, in an ideal world, what could your gynae say or do to put you at ease, provide you with optimal, appropriate care and generally not piss you off?

Any help, advice or “what not to do” stories would be greatly appreciated.

Thanks ladies,
irishgirl

I’m not big on gyno visits to start with, but the one time I did go, they had me fill out a form that asked me my sexual preference (and also gave the option to not answer the question at all). I thought that was kinda cool - it suggested the doctors openly welcomed the idea that not all girls like schtupping guys.

The doc didn’t ask me whether or not I’m sexually active, she focussed more on whether my periods are regular, if there’s been any excessive bleeding etc.
Max.

I’m straight (not that there’s anything wrong with that!), but it occurs to me that “Are you sexually active?” is a good lead-in to a discussion about STDs, no matter the patient’s sexual orientation.

I think that a note on the form would be great. I think an over all discussion of not necessarily contraception but playing safe in general. Okay that sentence made no sense.

Aside from asking about my female health, I’d want my gyn able to discuss how I am over all, as well. I’d like to be comfortable with him or her discussing safe sex options, etc … I’ve never used a dental dam and have probably been extraordinarily lucky STD wise (or just choosy about partners who are also choosy).

When I was in the hospital for my c-section, I was asked several times about my relationship, if I were being abused or anything … there were notes in the bathroom and room about hotlines I could call. I think any GYN that offered that information would be useful (it should be up at Planned Parenthood, too, where a lot of young women and men go when they don’t want to talk to their parents).

I’d like a GYN to ask me about my partner(s). How they are doing, if they have any complaints … I know that its possible to pass yeastie beasties back and forth; or even encourage partners to come along, if they wish (male or female). Pair up with a male health specialist, too, maybe?

Most of my doctors, growing up, were DOs … went to school to learn how to talk to patients, as it was explained to me by the guy who delivered me and later prescribed me my first pack of birth control pills. It might be worth it to go for that. And I always felt good at Planned Parenthood … maybe you could volunteer to do a stint there and get a grasp of their ‘bedside manner’.

No Planned Parenthoods in Ireland (and FWIW I found them to be a mixed bag in America).

The Well Woman Clinic is the Irish equivalent, and they’re pretty good.

I’m reminded of a comedy routine by a gay woman whose lover was still in the closet. In the routine, she had to go to the ER for some reason.

Doctor: Is there any chance you’re pregnant?
Woman: Nope.
Doctor: Are you sexually active?
Woman: You betcha!
Doctor: How do you know you’re not pregnant?
Woman: Well, we don’t use sperm…

d’oh! I didn’t read the OPs location.

:slight_smile:

Sorry, there.

The most annoying thing about my gyno is the fact that, since I don’t see him that often, I’m having to out myself each time I go. Now, I realize he sees lots of patients, and he’s a good guy, but it would be nice if he would remember from visit to visit. I guess the thing that bothers me the most is the assumption that I’m straight and want to have kids (neither apply to me).

I work for a group of Gynos and the question is on our pt info form. It just says something like" Sexually active? __________ Sexual Preference __________ In a monogamous Relationship? ___________ Is partner male or female ________.

[QUOTE=Mynn]

yeastie beasties/

[QUOTE]

The fortunately-never-aired Sid & Marty Kroft show…

Sorry :smiley:

My gyno asks if you’re sexually active (which leads to the monogamy/safe sex discussion), and then asks if you’re using birth control. If you’re not using birth control, she’ll ask why (lesbian, trying to get pregnant, Catholic, whatever) and have a situation-appropriate discussion about whatever health-concerns are relevant. This seems like a fairly good way to do it, without making lesbians and bisexuals feel singled out, or like an afterthought.

IANALorB, but I did a stack of research on a related topic that led me to a bunch of discussions on this topic.

I’d say that just by being conscious of the fact that not all women are straight, you’re most of the way there already. Many doctors just work from the assumption that their female patients are a. straight, b. sexually active, and c. want to spawn. The patient then has to make a point of stating which of these things is not true. If you, on the other hand, approach the patient with the intrinsic understanding that she may have one of any number of sexual preferences, then you will certainly end up being at least reasonably inclusive.

An example: If a patient says she’s sexually active but not using contraceptives, most docs would probably immediately launch into a big lecture on pregnancy and STDs. What the doc should do, of course, is ask a follow-up question to determine if there’s a good reason that contraceptives are not being used. If the doctor assumes the patient is straight, then he might not ask that follow-up question, causing the patient to have to stop him and explain. Or worse, the patient might not even feel comfortable telling him that she is a lesbian, meaning that she may not get appropriate care.

Ultimately, a common complaint of all the women that I talked to was that they felt their gynecologists made assumptions about them instead of asking them for information.

p.s. I You might want to do a bit of reading on lesbian-specific health issues. Or do they cover that in med school where you are?

Thanks.
I’m not terribly surprised that the general consensus is one that it’s preferable to listen, ask polite questions and be open to all possible answers.

As so much of a person’s well-being is tied to their sexuality and gender identity, I totally understand what you’re getting at Mynn.

For example, someone might complain of a low sex drive, but actually want to talk about the problems in their relationship that is affecting their desire to sleep with their partner. If their gynaecologist hands over a prescription for a testosterone cream without asking any of the right questions, nothing useful has happened.

I’ve been on the wrong end of one of those lectures, after needing some emergency contraception, and it’s not fun. Telling him that the condom we’d used (because I’d thrown up and was playing it safe for the next 7 days, in case my pill hadn’t worked) had broken was a very satisfying moment, he at least had the grace to blush and apologise. I wouldn’t put anyone else through that experience!

What not to do: I was in the room with my girlfriend who was there for followup after having several moderately serious dysplasias treated. We were upset. I was standing behind her, holding her hand. In her chart was a power of attorney document naming me as her proxy. The (male) doctor, while digging around up there, starts talking about how uncomfortable he felt sitting next to a gay man at a wedding. :eek: I mean, how random! I felt like saying, “Um, you know we’re dykes, right?”

I think the direct approach is best: Are you having sex with anyone? Male or female or both? The worst you could do is educate someone clueless about the existence of “alternative” states of being, :wink: .

Not making assumptions - that’s a big thing.

Alright, I’m het and you asked the bi’s and lesbians, but hey, I’ve had more bad experiences at the gyno than good. Among them:

When I was in my teens a doctor more or less tried to force birth control pills on me. I didn’t want them. I said I was still virgin. His answer was “Yeah, sure - if you aren’t having sex now, you will be.” I told him I was a minor and didn’t he think we should have my parents involved in this discussion? (Yeah, as a teen I was freaked out that a doctor would go behind someone’s back and basically agree to lie to someone - jeepers! How could I trust him, then?) I tried to tell him that several women in my family had had bad, very bad reactions to the Pill and he just brushed that off. I don’t know what he was thinking, but I came away from that convinced the doctor thought I was some sort of dirty, untrustworthy slutty whore. I was pracically crying when I got back to the waiting room, which upset my parents, to whom I spilled the beans, and … let’s just say we never went back, m’okay? Alright, he wasn’t a gyno - no excuse, he handled that little visit very badly (I had gone in for a school physical, prior to going to college.)

During college years, had several doctors again try to push the Pill on me, even when I told them I was using other forms of birth control (condoms + spermicide, or sponge, or comdom + sponge), as if it were the ONLY alternative. Usually firing back with “Well, what would you do if you got pregnant?” to which my answer was always “Either have a kid or get and abortion - I’ll decide IF it ever happens” NO ONE seemed willing to listen to my concerns about the Pill, nevermind women in my family with serious, serious (as in heart-attack-in-your-30’s) heart disease and who had had blood clots while on the pill, or discuss whether I was at risk or not.

After marriage it then became the Battle of Infertility - but not what you’d expect. My husband is sterile - for the first five or six years of my marriage I would get 'Are you sure he’s not lying to you?" or “Yeah, right - lots of men SAY that.” Uh, excuse me? - this is not some one-night stand I picked up in a sleezy bar claiming lack of tadpoles, this is my husband. I’ve also had situation where we get to the Birth Control Question, I say “none”, the doc looks at how long that’s been going on, and starts getting all worked up and wanting me to undergo fertility testing and – No, goddammit! We KNOW what the problem is!

THEN, when I get that straightened out, it’s on to the discussion of fertility options – um, you know, I am a college educated woman who works for medical researchers. I am aware that there are options. The fact that we have done without them for 15 years should be a clue that maybe you should ask if we want to investigate this or not.

It was SUCH a relief to finally find a gyno who doesn’t do all that. I went in, and she asked “Birth control?” I said “none”. She said “Trying to get pregnant?” I said “No, husband sterile.” She made a note in the chart, said “Did you want kids?” I said “Not badly enough to do anything about it - we’re happy as we are.” She said “OK”. End of discussion. It was such a relief not to have to argue or explain endlessly.

I mean really - why couldn’t those other doctors have talked to ME instead of mindlessly running down their checklists of questions, not really listening? I realize I look pretty typical - that doesn’t mean I am.

Broomstick, I know your frustration. I’ve had pushy doctors, doctors who wouldn’t listen, and doctors who were just plain stubborn. (After one gyno refused to change my birth control even though it was making me violently nauseated, I felt like asking her if she was getting a commission from the pill company.)

However, doctors themselves have a lot of frustration to deal with. Women often won’t give them all of the information they need, because they’re afraid that the doctor will think badly of them, or out of just plain old embarassment. I’m sure doctors must get very tired of it

Have you read The Vagina Monologues? There’s a great rant in there about what the author wants from her gynecologist.

Another unsolicited suggestion from a hereosexual:

Don’t have every magazine in your office waiting room be baby or child themed. It sends a very clear signal that the main focus in the office is strictly on the ob part.

I’m hetero, but at one time had a lesbian gyn. She was quite “out.”
She asked the normal questions, except she didn’t specificly ask about birth control.
She asked what barrier protection I used. Then asked if I needed information on birth control.