For most people, going to the doctor's is a bit of a pain. Let’s face it, being prodded by a stranger and talking them through your every ailment – in gruesome detail – isn’t most people’s idea of fun.
If you’re part of the LGBTQ+ community, however, a routine appointment can quickly turn into a tangle of awkwardness. Many questions asked by healthcare professionals – from checking a patient isn’t pregnant before an X-ray or operation, to standardised questions about sexual activity and preferred contraception – are geared squarely towards straight patients. Practitioners may also make assumptions about patients' sexualities, forcing them to speak up. This effectively means they have to 'come out' at almost every appointment.
For some, that might just involve a clunky conversation and some forced laughter that they’d rather not repeat in a hurry. But for other people, disclosing their identity simply might not be a safe option, and fear of discrimination plays a major role in discouraging LGBTQ+ people from accessing care in the first place. The LGBT Foundation reports that one in five lesbian, gay and bisexual patients say that their sexual orientation is a factor in them delaying access to vital health services.
"Simply being lesbian, gay, bi or trans shouldn’t mean you should have to expect unequal treatment from healthcare services in Britain today," says Laura Russell, head of policy at Stonewall. Meanwhile, members of the LGBTQ+ community are at a heightened risk of developing health problems.
Stonewall's findings show that an alarming number of LGBTQ+ people have experienced depression, anxiety and suicidal thoughts, at a far higher rate than the general population (according to Mind, one in six people in England report experiencing a mental health problem in any given week). "Despite some outstanding progress by committed individuals and institutions, we are still seeing a bleak picture of health – both mental and physical," Russell says. "Half of LGBTQ+ people have experienced depression, while 61% reported having episodes of anxiety," she says, citing the charity’s 2018 report on the impact of discrimination in healthcare.
These statistics are even more worrying among the trans community; and a severe lack of training and awareness around transgender issues leads to a poor standard of care when assistance is sought. In Stonewall’s study, two in five trans people accessing general healthcare services in the last year said that staff lacked understanding of specific trans health needs, while many have been misgendered during appointments. The LGBT Foundation reports that three in four trans people have been called the wrong name or pronoun by a health professional.
Numerous myths and misconceptions can also prevent LGBTQ+ patients from receiving the care they need. Smear tests, for example, are sometimes denied to patients on the assumption that they are not at risk of contracting HPV (a sexually transmitted virus which can develop into cervical abnormalities, leading to cervical cancer). This is a misconception, confirms Kate Sanger of Jo’s Cervical Trust; she explains that the test is relevant to any person with a cervix who has had any sexual contact with anyone, regardless of sexuality or gender.
"We’ve had stories of gay women being told that they’re not at risk of contracting HPV because they’re not having penetrative sex with a man," she says. "Sadly, some of those women have gone on to develop cancer as a result [of abnormalities not being detected by a smear test]."
Recognising the need for inclusive language, Jo’s is also changing the way it talks about cervical screening. "Obviously if you don’t identify as a woman, and you see all the messaging is about women, you may not think it’s for you," Kate says, "or you may feel like an excluded group. We wanted to remove any barriers that were there, by talking in language that would include people."
In many cases, a lack of diversity training plays a major role in patients’ negative experiences, and initiatives like the LGBT Foundation’s Pride in Practice are working closely with the NHS to improve awareness of the unique issues that queer people face. Until doctors can create a safe environment where LGBTQ+ people feel confident and safe in accessing healthcare, mental and physical health problems in the community will continue to increase.