Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People
The health of LBGTQ people is an area of study that emerged at the start of my own career, beginning with a focus on lesbians and bisexual women. Before the 1980s there was almost no research-based information on this topic. In 1981, my colleagues and I published the results of a survey of ~100 lesbians in the American Journal of Obstetrics and Gynecology.1 As I look back on that very modest effort, I see how little we understood then about what have turned out to be important issues, and, the danger of generalizing from small convenience samples. Our focus in that first survey was almost exclusively on traditional gynecologic problems and we did not inquire about general health issues such as chronic disease risk factors. We collected information on STI history, but because of our tiny sample size, wrongly concluded that these groups were at low risk. We probably suspected, but did not questions related to possible health care disparities, in particular the reluctance of lesbian and bisexual women to seek health care because of their fear of the reception they would receive in the practitioner’s office. The health of transgender men and women was nowhere on our horizon.
Fast forwarding to the present, I can confidently say “how things have changed!” Research with regard to lesbian and bisexual health is a mature field of inquiry, having progressed from case reports and surveys to analysis of population-based data.2 Recommendations for these women can now be made based on a solid evidence base. Although transgender health research is still in its infancy, numerous expert opinions are available to help us take care of the increasing number of transgender and gender nonconforming people seeking care.
Recommendations for LGBTQ health care are available from several authoritative sources. Among these are the Institute of Medicine,3 the Centers for Disease Control,4 the Joint Commission,5 and Healthy People 2020.6 The American College of Obstetricians and Gynecologists offers Committee Opinions on caring for lesbians and bisexual women7–9 and transgender people,9,10 including adolescents.11
I am pleased to present this monograph addressing the health care needs of lesbian, bisexual women, and transgender men and women. I am especially excited that the authors, from 2 major academic health centers, are personally involved in the care of these groups. This is not an ivory tower symposium.
Drs Nicole Nisly and Katherine Imborek, and their team at the University of Iowa Carver College of Medicine, in collaboration with the University of Iowa Hospitals and Clinics, spearheaded the development of one of the first dedicated primary care clinics for the LGBTQ population at an academic health center. They and their colleagues provide a description of that process, including lessons learned. You can use their experience in your own practice setting to improve the care you provide for these groups. In separate chapters, these authors share how they manage primary care for transgender and nonbinary people (Dr Nisly and colleagues), and the primary care of lesbians and bisexual women (Drs McCune and Imborek).
Drs John Randolph, Molly Moravek, and Holly Crissman from the University of Michigan Medical School, provide advice based on their experience in Michigan Medicine’s Comprehensive Gender Services unit. They provide detailed information on managing the hormone transition for trans women (Dr Randolph) and trans men (Dr Moravek), and a description of the role of gynecologists in surgical procedures for transgender people (Drs Crissman and Randolph).
One theme permeates the entire symposium: LBGTQ people deserve knowledgeable and welcoming health care. They do not always get it, as demonstrated in the considerable information we now have about health care disparities for these groups.3 This symposium provides a solid knowledge base. It is up to each of us to provide the welcome.
1. Johnson SR, Guenther SM, Laube DW, et al. Factors influencing lesbian gynecologic care: a preliminary study. Am J Obstet Gynecol. 1981;140:20–28.
2. Ward BW, Dahlhamer JM, Galinsky AM, et al. Sexual Orientation and Health Among US Adults: National Health Interview Survey, 2013. Hyattsville (MD): National Center for Health Statistics; 2014.
3. IOM (Institute of Medicine). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press; 2011.
5. The Joint Commission Advancing effective communication, cultural competence, and patient- and family centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: a field guide. Oak Brook, IL, October 2011. Available at: LGBTFieldGuide.pdf.
7. American College of Obstetricians and Gynecologists. Legal status: health impact for lesbian couples. Committee Opinion No. 428. Obstet Gynecol. 2009;113(pt 1):469–472.
8. American College of Obstetricians and Gynecologists. Health care for lesbians and bisexual women. Committee Opinion No. 525. Obstet Gynecol. 2012;119:1077–1080.
9. American College of Obstetricians and Gynecologists. Marriage and family building equality for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Gender Nonconforming Individuals. Committee Opinion No. 749. Obstet Gynecol. 2018;132:e82–e86.
10. American College of Obstetricians and Gynecologists. Health care for transgender individuals. Committee Opinion No. 512. Obstet Gynecol. 2011;118:1454–1458.
11. American College of Obstetricians and Gynecologists. Care for transgender adolescents. Committee Opinion No. 685. Obstet Gynecol. 2017;129:e11–e16.