LGBT issues in medicine
Encyclopedia
LGBT topics in medicine are those that relate to lesbian, gay, bisexual and transgender people's health issues and access to health services. According to the US
Gay and Lesbian Medical Association
(GLMA), besides HIV
/AIDS
, issues related to LGBT health include breast
and cervical cancer
, hepatitis
, mental health
, substance abuse
, tobacco use
, depression, access to care for transgender persons, issues surrounding marriage
and family recognition, conversion therapy, and refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."
Studies show that LGBT people experience health issues and barriers related to their sexual orientation
and/or gender identity
or expression. Many avoid or delay care or receive inappropriate or inferior care because of perceived or real homophobia or transphobia, and discrimination by health care providers and institutions., in other words reason is negative personal experience, the assumption or expectation of negative experience based on knowing of history of such experience in other LGBT people, or both.
It is often pointed that the reason of this is heterosexism
in medical care and research :
Especially with lesbian patients they may be discriminated in three ways:
Research points to issues encountered from an early age, such as LGBT people being targeted for bullying, assault, and discrimination, as contributing significantly to depression, suicide and other mental health issues in adulthood. Social research suggests that LGBT experience discriminatory practices in accessing healthcare.
/homophobia
or a lack of knowledge or experience with transgender health. Additionally, in some jurisdictions health care related to transgender issues especially sex reassignment therapy
is not covered by medical insurance. Hovever the Principle 17 of The Yogyakarta Principles affirm that "States shall (g) facilitate access by those seeking body modifications related to gender reassignment to competent, non-discriminatory treatment, care and support.
.
s to achieve feminizing or masculinizing effects. Side effects of hormone use include increased risk of blood clotting, high or low blood pressure, elevated blood sugar
, water retention, dehydration
, electrolyte disturbances, liver damage, increased risk for heart attack and stroke
.
, sometimes administered by lay persons, to achieve their desired physique. Such silicone may migrate, causing disfigurement years later. Non-medical grade silicone may contain contaminants, and may be injected using a shared needle.
is reported to occur in about 11 percent of lesbian homes. While this rate is about half the rate of 20 percent reported by heterosexual women, lesbians often have fewer resources available for shelter and counselling.
than heterosexual women.
s in gay men, and some health professionals now recommend routine screening with anal pap smear
s to detect early cancers.
According to GLMA, "the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide
because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection, and treatment of these conditions." Researchers at the University of California
at San Francisco found that major risk factors for depression in gay and bisexual men included a recent experience of anti-gay violence or threats, not identifying as gay, or feeling alienated from the gay community.
s such as bulimia or anorexia nervosa
, while obesity
affects other gay men.
are at an increased risk of sexually transmitted infection with hepatitis, and immunization for Hepatitis A
and Hepatitis B is recommended for all men who have sex with men. Safer sex is currently the only means of prevention for the Hepatitis C
.
, or GRID. This name was proposed in 1982, after public health scientists noticed clusters of Kaposi's sarcoma
and Pneumocystis pneumonia among gay males in California
and New York City
.
Men who have sex with men are more likely to acquire HIV in the modern West, Japan, India, and Taiwan, as well as other developed countries than among the general population, in the United States, 60 times more likely than the general population. An estimated 62% of adult and adolescent American males living with HIV/AIDS got it through sexual contact with other men.
The US Center for Disease Control recommends annual screening for syphilis
, gonorrhea
, HIV and chlamydia for men who have sex with men.
and marijuana; alcohol
; and tobacco
at a higher rate than the general population. Dr. David McDowell
of Columbia University
, who has studied substance abuse in gay men, wrote that club drugs are particularly popular at gay bars and circuit parties. Studies have shown that gay and bisexual men are 50% more likely to smoke than other men.
under LGBT can be controversial, with some intersex people identifying with LGBT and some not; some argue I should be included as LGBTI. Intersex people may identify as heterosexual, lesbian, gay, bisexual, trans or no such labels, and so experience some of the issues related to these groups; however, intersex people can also have a variety of health issues from birth onwards that are unique to intersex people. There are a range of ways people can be intersex, so between different types of intersex people there can be different health issues that relate to their situation. For more information, see the article on intersex.
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
Gay and Lesbian Medical Association
Gay and Lesbian Medical Association
The Gay and Lesbian Medical Association works to ensure equality in health care for lesbian, gay, bisexual and transgender individuals and health care professionals...
(GLMA), besides HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
/AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
, issues related to LGBT health include breast
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
and cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
, hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
, mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
, substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
, tobacco use
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
, depression, access to care for transgender persons, issues surrounding marriage
Same-sex marriage
Same-sex marriage is marriage between two persons of the same biological sex or social gender. Supporters of legal recognition for same-sex marriage typically refer to such recognition as marriage equality....
and family recognition, conversion therapy, and refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."
Studies show that LGBT people experience health issues and barriers related to their sexual orientation
Sexual orientation
Sexual orientation describes a pattern of emotional, romantic, or sexual attractions to the opposite sex, the same sex, both, or neither, and the genders that accompany them. By the convention of organized researchers, these attractions are subsumed under heterosexuality, homosexuality,...
and/or gender identity
Gender identity
A gender identity is the way in which an individual self-identifies with a gender category, for example, as being either a man or a woman, or in some cases being neither, which can be distinct from biological sex. Basic gender identity is usually formed by age three and is extremely difficult to...
or expression. Many avoid or delay care or receive inappropriate or inferior care because of perceived or real homophobia or transphobia, and discrimination by health care providers and institutions., in other words reason is negative personal experience, the assumption or expectation of negative experience based on knowing of history of such experience in other LGBT people, or both.
It is often pointed that the reason of this is heterosexism
Heterosexism
Heterosexism is a system of attitudes, bias, and discrimination in favor of opposite-sex sexuality and relationships. It can include the presumption that everyone is heterosexual or that opposite-sex attractions and relationships are the only norm and therefore superior...
in medical care and research :
Especially with lesbian patients they may be discriminated in three ways:
- homophobicHomophobiaHomophobia is a term used to refer to a range of negative attitudes and feelings towards lesbian, gay and in some cases bisexual, transgender people and behavior, although these are usually covered under other terms such as biphobia and transphobia. Definitions refer to irrational fear, with the...
attitudes - heterosexistHeterosexismHeterosexism is a system of attitudes, bias, and discrimination in favor of opposite-sex sexuality and relationships. It can include the presumption that everyone is heterosexual or that opposite-sex attractions and relationships are the only norm and therefore superior...
judgements and behaviour - general sexismSexismSexism, also known as gender discrimination or sex discrimination, is the application of the belief or attitude that there are characteristics implicit to one's gender that indirectly affect one's abilities in unrelated areas...
- with focusing primarily male health concerns and services; assigning subordinate to that of men health roles for women, as for service providers and service recipients
Issues affecting LGBT people generally
Research from the UK indicates that there appears to be limited evidence available from which to draw general conclusions about lesbian, gay, bisexual and transgender health because epidemiological studies have not incorporated sexuality as a factor in data collection. Review of research that has been undertaken suggests that there are no differences in terms of major health problems between LGBT people and the general population, although LGBT people generally appear to enjoy poorer health, with no information on common and major diseases, cancers or long-term health. mental health appears worse amongst LGBT people than the general population, with depression, anxiety and suicide ideation being 2-3 times higher than the general population. There appear to be higher rates of eating disorder and self harm, but similar levels of obesity and domestic violence to the general population; lack of exercise and smoking appear more significant and drug use higher, while alcohol consumption is similar to the general population. Polycystic ovaries and infertility were identified as being more common amongst lesbians than heterosexual women. The research indicates noticeable barriers between LGB patients and health professionals, and the reasons suggested are homophobia, assumptions of heterosexuality, lack of knowledge, misunderstanding and over-caution; institutional barriers were identified as well, due to assumed heterosexuality, inappropriate referrals, lack of patient confidentiality, discontinuity of care, absence of LGBT-specific healthcare, lack of relevant psycho-sexual training.Research points to issues encountered from an early age, such as LGBT people being targeted for bullying, assault, and discrimination, as contributing significantly to depression, suicide and other mental health issues in adulthood. Social research suggests that LGBT experience discriminatory practices in accessing healthcare.
Issues affecting bisexual people
Research specifically addressing the health issues of bisexual people tends to be lacking, in part because a focus on bisexuality as a separate identity-group is relatively recent and less cohesive than has been seen with lesbian, gay and transgender activisms. Bisexual health issues tend to be assumed as being covered by the health issues gay men and/or lesbians deal with, rather than as a unique set of health issues in their own right.Access to health care
Transgender individuals are often reluctant to seek medical care or are denied access by providers due to transphobiaTransphobia
Transphobia is a range of negative attitudes and feelings towards transsexualism and transsexual or transgender people, based on the expression of their internal gender...
/homophobia
Homophobia
Homophobia is a term used to refer to a range of negative attitudes and feelings towards lesbian, gay and in some cases bisexual, transgender people and behavior, although these are usually covered under other terms such as biphobia and transphobia. Definitions refer to irrational fear, with the...
or a lack of knowledge or experience with transgender health. Additionally, in some jurisdictions health care related to transgender issues especially sex reassignment therapy
Sex reassignment therapy
Sex reassignment therapy is an umbrella term for all medical procedures regarding sex reassignment of both transgender and intersexual people...
is not covered by medical insurance. Hovever the Principle 17 of The Yogyakarta Principles affirm that "States shall (g) facilitate access by those seeking body modifications related to gender reassignment to competent, non-discriminatory treatment, care and support.
Cancer
Cancers related to hormone use include breast cancer and liver cancer. In addition, transmen who have not had removal of the uterus, ovaries, or breasts remain at risk to develop cancer of these organs, while trans women remain at risk for prostate cancerProstate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
.
Depression and anxiety
According to Rebecca A. Allison, trans people are "particularly prone" to depression and anxiety: "In addition to loss of family and friends, they face job stress and the risk of unemployment. Trans people who have not transitioned and remain in their birth gender are very prone to depression and anxiety. Suicide is a risk, both prior to transition and afterward. One of the most important aspects of the transgender therapy relationship is management of depression and/or anxiety."Hormones
Transgender individuals frequently take hormoneHormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
s to achieve feminizing or masculinizing effects. Side effects of hormone use include increased risk of blood clotting, high or low blood pressure, elevated blood sugar
Blood sugar
The blood sugar concentration or blood glucose level is the amount of glucose present in the blood of a human or animal. Normally in mammals, the body maintains the blood glucose level at a reference range between about 3.6 and 5.8 mM , or 64.8 and 104.4 mg/dL...
, water retention, dehydration
Dehydration
In physiology and medicine, dehydration is defined as the excessive loss of body fluid. It is literally the removal of water from an object; however, in physiological terms, it entails a deficiency of fluid within an organism...
, electrolyte disturbances, liver damage, increased risk for heart attack and stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
.
Injectable silicone
Some trans people use injectable siliconeSilicone
Silicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....
, sometimes administered by lay persons, to achieve their desired physique. Such silicone may migrate, causing disfigurement years later. Non-medical grade silicone may contain contaminants, and may be injected using a shared needle.
Sexually transmitted infections
Trans people are frequently forced into sex work to make a living, and are subsequently at increased risk for STIs including HIV.Substance abuse
Like gay and bisexual men and women, trans people are more likely than the general population to use substances. For example, studies have shown that transmen are 50% more likely, and trans women 200% more likely to smoke cigarettes than other populations.Breast cancer
According to Katherine A. O’Hanlan, lesbians "have the richest concentration of risk factors for breast cancer [of any] subset of women in the world." Additionally, many lesbians do not get routine mammograms, do breast self-exams, or have clinical breast exams.Depression and anxiety
As with gay men, depression and anxiety are thought to affect lesbians at a higher rate than in the general population, for similar reasons.Domestic violence
Domestic violenceDomestic violence
Domestic violence, also known as domestic abuse, spousal abuse, battering, family violence, and intimate partner violence , is broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, or cohabitation...
is reported to occur in about 11 percent of lesbian homes. While this rate is about half the rate of 20 percent reported by heterosexual women, lesbians often have fewer resources available for shelter and counselling.
Physical fitness
Research shows that on average lesbians have a higher body mass indexBody mass index
The body mass index , or Quetelet index, is a heuristic proxy for human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. It was invented between 1830 and 1850 by the Belgian polymath Adolphe Quetelet during the course of developing...
than heterosexual women.
Substance abuse
As with gay men, lesbians often have high rates of substance use, including recreational drugs, alcohol and tobacco. Studies have shown that lesbian and bisexual women are 200% more likely to smoke tobacco than other women.Anal papilloma
Human papilloma virus, which causes anal and genital warts, plays a role in the increased rates of anal cancerAnal cancer
Anal cancer is a type of cancer which arises from the anus, the distal orifice of the gastrointestinal tract. It is a distinct entity from the more common colorectal cancer. The etiology, risk factors, clinical progression, staging, and treatment are all different. Anal cancer is typically a...
s in gay men, and some health professionals now recommend routine screening with anal pap smear
Pap smear
The Papanicolaou test is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal of the female reproductive system. Changes can be treated, thus preventing cervical cancer...
s to detect early cancers.
Depression and anxiety
Studies by Cochran et al. (2003) and Mills et al. (2004), among others, suggest that depression and anxiety appear to affect gay men at a higher rate than in the general population.According to GLMA, "the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection, and treatment of these conditions." Researchers at the University of California
University of California
The University of California is a public university system in the U.S. state of California. Under the California Master Plan for Higher Education, the University of California is a part of the state's three-tier public higher education system, which also includes the California State University...
at San Francisco found that major risk factors for depression in gay and bisexual men included a recent experience of anti-gay violence or threats, not identifying as gay, or feeling alienated from the gay community.
Diet and fitness
Gay men are more likely than straight men to suffer from eating disorderEating disorder
Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...
s such as bulimia or anorexia nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
, while obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
affects other gay men.
Hepatitis
Men who have sex with menMen who have sex with men
Men who have sex with men are male persons who engage in sexual activity with members of the same sex, regardless of how they identify themselves; many men choose not to accept sexual identities of homosexual or bisexual...
are at an increased risk of sexually transmitted infection with hepatitis, and immunization for Hepatitis A
Hepatitis A
Hepatitis A is an acute infectious disease of the liver caused by the hepatitis A virus , an RNA virus, usually spread the fecal-oral route; transmitted person-to-person by ingestion of contaminated food or water or through direct contact with an infectious person...
and Hepatitis B is recommended for all men who have sex with men. Safer sex is currently the only means of prevention for the Hepatitis C
Hepatitis C
Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...
.
Sexually transmitted infections
The first name proposed for what is now known as AIDS was Gay-related immune deficiencyGay-related immune deficiency
Gay-related immune deficiency was the 1982 name first proposed to describe what is now known as AIDS, after public health scientists noticed clusters of Kaposi's sarcoma and Pneumocystis pneumonia among gay males in Southern California and New York City.During the early history of AIDS, when it was...
, or GRID. This name was proposed in 1982, after public health scientists noticed clusters of Kaposi's sarcoma
Kaposi's sarcoma
Kaposi's sarcoma is a tumor caused by Human herpesvirus 8 , also known as Kaposi's sarcoma-associated herpesvirus . It was originally described by Moritz Kaposi , a Hungarian dermatologist practicing at the University of Vienna in 1872. It became more widely known as one of the AIDS defining...
and Pneumocystis pneumonia among gay males in California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
and New York City
New York City
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...
.
Men who have sex with men are more likely to acquire HIV in the modern West, Japan, India, and Taiwan, as well as other developed countries than among the general population, in the United States, 60 times more likely than the general population. An estimated 62% of adult and adolescent American males living with HIV/AIDS got it through sexual contact with other men.
The US Center for Disease Control recommends annual screening for syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, gonorrhea
Gonorrhea
Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...
, HIV and chlamydia for men who have sex with men.
Substance abuse
Studies have shown that gay men use substances, including recreational drugs such as poppersPoppers
Poppers is a slang term for various alkyl nitrites inhaled for recreational purposes, particularly isopropyl nitrite and isobutyl nitrite , and now more rarely, butyl nitrite and amyl nitrite...
and marijuana; alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
; and tobacco
Tobacco
Tobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
at a higher rate than the general population. Dr. David McDowell
David McDowell
David M. McDowell is a psychiatrist, author and creative consultant. He co-founded the Substance Treatment and Research Service at Columbia University and served as its medical director...
of Columbia University
Columbia University
Columbia University in the City of New York is a private, Ivy League university in Manhattan, New York City. Columbia is the oldest institution of higher learning in the state of New York, the fifth oldest in the United States, and one of the country's nine Colonial Colleges founded before the...
, who has studied substance abuse in gay men, wrote that club drugs are particularly popular at gay bars and circuit parties. Studies have shown that gay and bisexual men are 50% more likely to smoke than other men.
Issues affecting intersex people
Including intersexIntersex
Intersex, in humans and other animals, is the presence of intermediate or atypical combinations of physical features that usually distinguish female from male...
under LGBT can be controversial, with some intersex people identifying with LGBT and some not; some argue I should be included as LGBTI. Intersex people may identify as heterosexual, lesbian, gay, bisexual, trans or no such labels, and so experience some of the issues related to these groups; however, intersex people can also have a variety of health issues from birth onwards that are unique to intersex people. There are a range of ways people can be intersex, so between different types of intersex people there can be different health issues that relate to their situation. For more information, see the article on intersex.
See also
- Health disparitiesHealth disparitiesHealth equity refers to the study of differences in the quality of health and health care across different populations....
- Healthcare inequality
- Tamsin WiltonTamsin WiltonTamsin Elizabeth Wilton was an Cornish academic, a lesbian activist, theorist, social researcher, writer and cartoonist, and professor of Human Sexuality in the School of Social Science at the University of the West of England. Wilton was a member of the editorial board of the journal Sexualities...
- Steven Epstein (academic)Steven Epstein (academic)Steven Epstein is an American academic and the John C. Shaffer Professor in the Humanities and Professor in the Department of Sociology at Northwestern University. He spent the majority of his career as Professor of Sociology and Director of the Science Studies program at the University of...