Addressing LGBTQ+ Issues in Obstetric and Gynecological Care

Hard-won gains by more than a generation of activists paved the way for a more equitable social and political climate, but members of LGBTQ+ communities still face challenges in many domains of daily life, including healthcare access and experience within the healthcare system.

LGBTQ+ patients may experience these disparities acutely while seeking care concerning sensitive sexual and reproductive issues. A 2018 study in which LGBTQ+ people assigned female at birth were interviewed about their experiences with Ob-Gyn care revealed that some individuals experienced discrimination from healthcare providers while others felt that clinicians were merely unequipped to address their unique needs.

“You don’t really want to see the doctor if you’ve been discriminated against in the healthcare setting,” says obstetrician-gynecologist Justine Reilly, MD, who serves at Women’s Health, a clinical partnership between Ascension Seton and UT Health Austin. “Medical training involves a lot of pattern recognition. Unfortunately, that often teaches us the practice of putting people into boxes.”

Care informed by personal experience

Dr. Reilly recalls her first experiences as a lesbian seeking gynecological care as an example of the challenges some patients may face in the Ob-Gyn setting. “The doctor certainly was not as informed about my sexual health as well as I might have expected. The only question I was asked regarding my sexual history was whether I used condoms.”

According to Dr. Reilly, gaps in specialized understanding among health care providers can lead to negative sexual health outcomes for patients. She cites a recent study that found that many physicians were unaware that HPV (human papillomavirus, a common virus that can cause a variety of symptoms, and has been linked to cancers later in life) can be transmitted between female partners, leading to cervical cancer to go undetected among women who have sex with women.

In her own practice, Dr. Reilly aims to address these biases head-on. “It starts with patient-centered care. When it comes to sexual and reproductive healthcare, taking an inclusive sexual history is a critical first step.”

This approach involves awareness of the unique needs of transgender and gender-nonconforming Ob-Gyn patients. “A person is certainly more than the sum of their anatomic parts, but their anatomy does dictate what screening they need. We can always figure out how to get that done while minimizing dysphoria (discomfort or unease).” At the same time, Dr. Reilly warns against making assumptions about the appropriate care for non-cisgender patients. “Not all gender-nonconforming patients want to take hormones; not all trans people want gender-affirming surgery, some do. People can get pregnant even while they’re on testosterone.”

Leading with respect

Dr. Reilly is optimistic that the field of Ob-Gyn medicine is headed in this more inclusive direction. “Our professional society, American College of Obstetricians and Gynecologists have several publications called committee opinions that would warm the heart of any person who’s LGBTQ or an ally,” she says. “I think our professional society is excellent at trying to move us forward into what the future of Ob-Gyn should look like.”

While she points to the Association of American Medical Colleges’ 2014 publication of LGBTQ-informed medical curriculum as a sign of positive change in the broader healthcare community, Dr. Reilly believes that practitioners have a lot to learn from patients themselves.

“Language is important, objectivity is important, but also acceptance is important. Patients can tell that you want to learn and know about their experience, that you’re coming from a place of non-judgment.”

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