Abstract
Dear Editor,
Thanks for the excellent article on equality in health care for lesbian, gay, bisexual and trans (LGBT) patients by Julie Fish in the June 2010 issue of InnovAiT.
However, I feel there was an important omission on the subject of cervical screening for women who have sex with women. Quite rightly, it is pointed out that these women should be encouraged to attend cervical screening. Although Dr Fish makes the point that 19% of women who have never had heterosexual intercourse have human papilloma virus infection, it is more important to note that the vast majority of women who identify as lesbian have also previously had heterosexual sex. We should therefore be impressing upon the vast majority of female patients, the importance of cervical screening rather than making any (likely incorrect) assumptions. In my experience, the belief that women who identify as ‘lesbian’ do not need to have cervical screening is worryingly pervasive among GPs and doctors in general. A large survey carried out in Great Britain reported that, of women who reported sex with women in the last 5 years, 85% also reported a male partner(s) during that time (Mercer et al., 2007). Moreover, compared with women who reported sex exclusively with men, women having sex with women and men were found to have significantly greater numbers of male partners and were more likely to be having unsafe sex. A survey of women attending sexual health clinics in Seattle also reported similar results (Marrazzo et al., 2001). Additionally, a greater proportion of women who reported same-sex genital contact had had heterosexual intercourse prior to age 16, compared to those women who had never reported having same-sex genital contact (43 and 21%, respectively) (Mercer et al., 2007).
Secondly, it is important to be aware that sexual orientation does not necessarily predict sexual behaviour. Many people who identify as gay may nevertheless be engaging in heterosexual sex. Conversely, those who identify as straight may well be engaging in sexual behaviour with members of their own sex, hence the use value in sexual health of the descriptor ‘men who have sex with men’ (MSM), which describes behaviour, rather than ‘gay men’, which describes self-identified orientation. Although patients should be given the opportunity to tell health care providers their sexual orientation, in terms of taking a purely sexual history, it is important to find out what patients are doing and with whom rather than solely how they identify.