Disclosure of Sexual Orientation Among Women Who Have Sex With Women During Gynecological Care: A Qualitative Study In Brazil

Abstract

Background Evidence shows that women who have sex with women (WSW) face disparities in access to health care when compared to heterosexual women in several countries. Aim To investigate the experiences WSW have after disclosure of sexual orientation during gynecological care in Brazil. Methods We performed a qualitative study using content analysis. We recorded and transcribed interviews with 34 WSW from the 5 regions in Brazil. Data were analyzed using descriptive content analysis. Outcomes The main categories of analysis were decision-making process to disclose and attitude of gynecologists after disclosure. Results WSW disclosed their sexual orientation in an un-favorable environment. Gynecologists rarely asked about patients’ sexual orientation and used a script for hetero-normative anamnesis. The reactions of gynecologists were discriminatory, resulting in abbreviated consultations and un-comfortable gynecological exams. They missed a window of opportunity for prevention, diagnosis, and treatment of various diseases. The experiences Brazilian WSW had during gynecological care demonstrated the dominant hetero-normativity in the health care scenario. The attitudes of the gynecologists precarized the existence of WSW in health service. Clinical Implications This study suggests that gynecologists missed an opportunity to use WSW's sexual orientation disclosure to offer specific care to them. Strengths & Limitations This is the first qualitative study about WSW’s experiences during gynecological care in Brazil. Future studies should be developed from a wider sampling, especially among lower-class WSW. Conclusion The results point out the need for a change in medical training and guidelines to assist WSW in the country.

Vários tons de “não”: relatos de profissionais da Atenção Básica na assistência de lésbicas, gays, bissexuais, travestis e transexuais (LGBTT)

“…Many other studies [1][2][3] have shown that the LGBTT populations face health problems that are similar to the ones identified in the general population, but they also have demonstrated the need to identify the care specificities for each group of letters that compose the acronym L, G, B, T and T. This makes us look at vulnerabilities, risks and susceptibilities not only in the individual level, but also in the social, economic and institutional ones. The concept of equity was incorporated in the conformation of SUS precisely to tackle the inequities of each subject, of each group or of each city 7 .…”

“…To most of the LGBTT populations, health production is related to ways of experiencing their identities and to their survival and resistance strategies, which eventually materialize in corporal and sexual practices that have some relation to their degree of vulnerability in healthcare. Many lesbian women, for example, are afraid to reveal their sexual orientation during gynecological care and are not assisted in the health services 2 . When gays go to the health services and verbalize their sexual orientation, they suffer stigmas and prejudice deriving from the AIDS-homosexuality association 3 .Transvestites and transsexuals experience even greater discriminations in the access to the health services, either in the use of their social name or in the guarantee of the transsexualizing process 4 .…”

Cadê as populações LGBTT na Estratégia Saúde da Família? narrativas de profissionais de saúde em Teresina, Piauí, Brasil

“…Esse dispositivo que não permite por completo nem uma visibilização afirmativa nem uma ocultação defensiva pode ser, ainda, uma estratégia de regulação e controle social dos corpos dissidentes 18 . Muitas vezes, esses sujeitos -populações L, G e B -possivelmente tentam corresponder a padrões, a fim de que sejam melhor recebidos e atendidos nos serviços de saúde, conforme apontaram alguns estudos 3,6,19 .…”

Impactos da pandemia da Covid-19 na saúde das mulheres lésbicas

“…A invisibilidade e a violência simbólica vivenciada pelas mulheres lésbica são percebidas principalmente no atendimento ginecológico, quando estas se sentem violentadas com a realização de exames ginecológicos de forma dolorosa e inadequada ou quando a coleta de amostras citológicas para rastreamento do câncer do colo do útero não são realizadas, uma vez que se tem um imaginário comum de que essa população específica estaria menos susceptível a adquirir Infecções Sexualmente Transmissíveis (ISTs) (CABRAL et al, 2017;FERREIRA;PEDROSA;NASCIMENTO, 2018;RUFINO et al, 2018).…”