We Need to Talk About Gender and Sexuality in the Doctor’s Office

Last night, I had the privilege of attending “Gender and Sexuality in the Doctor’s Office: LGBTQ Experiences of Healthcare Across Contexts,” a visiting scholar lecture at CLAGS by Emily Allen Paine, a doctoral candidate in the Department of Sociology at The University of Texas at Austin. Many of us are aware that health disparities exist in the LGBTQ+ community. But what causes these health disparities?

In short, Paine attributes these disparities mainly to stigma. Structural stigma includes elements like the absence of policies protecting LGBTQ+ people, a heightened prevalence of hate crimes, and negative general attitudes toward LGBTQ+ people. Studies have shown that sexual minorities who live in areas of higher structural stigma have shorter lifespans and worse mental health outcomes than those who live in more affirming areas. Folks who are visibly stigmatized are more likely to be exposed to this discrimination.

Sexual and gender minorities face unique stressors related to their stigmatized identities, including fear of bias-based violence, discrimination and prejudice, hypervigilance, internalized homophobia and transphobia, and identification concealment.

When sexual and gender minorities make it to the doctor’s office, the stigmatization is oftentimes reinforced. Approximately 70% of medical school deans rate LGBTQ+ curriculum as fair, poor, or very poor. Many doctors are uncomfortable talking about queer sexuality and there is even less understanding surrounding trans issues.

Paine surveyed 25 LGBQ cis women (nine had gender nonconforming expressions) and 25 transmasculine folks from 2014-2017. They were all between the ages of 21 and 45 and over half were nonwhite. Paine also interviewed 25 staff members of LGBTQ+ health organizations.

Medicine is a key site where social categories of sex, gender, and sexuality are produced. When patients were misrecognized by providers who either assumed the patient to embody a binary identity or could not recognize how to categories the patient, their emotional responses were marked by confusion, panic, and fear.

Provider responses to these interactions varied. Some disengaged, refusing to look at or speak to the patient directly. Others denied care to the patient or devalued and stigmatized the patient. Finally, other providers tried to “sort out” the patient, employing medical power to categorize them. According to Paine, binary medical constructs of sex and gender are regulated and reproduced through these interactions, indicating the need for organizational shifts. As part of these shifts, the medical establishments must demedicalize LGBTQ+ identities in order to provide better care.

Trans folks and LGBQ cis women are less likely to seek healthcare than cis GBQ men and heterosexuals. Paine said that one of the most common barriers to receiving and continuing care that these communities face is perceived fatphobia in medical interactions. Citing “fat broken arm syndrome,” Paine explained how medical professionals quickly attribute a patient’s poor health or complaints of pain to their body size. Furthermore, the public health discourse surrounding lesbian obesity is, in itself, an additional stigma these populations face.

Some of those Paine surveyed reported that clinics reflected some cultures and identities more than others, causing them to feel like they were less deserving of care or that they were using precious resources meant for other populations. LGBTQ+ health centers that want to serve the whole community need to better reflect the whole community, including LGBQ cis women.

Also, when discussing interventions, we must consider how the target community understands their bodies, health needs, and power – otherwise, the intervention just becomes another barrier.

Here’s how you can challenge homophobia, transphobia, and stigmatization:

• Check out these tips for ways to be a better ally to LGBTQ+ people in eating disorder recovery,

• LGBTQ+ positive therapists are out there – here’s how to find one.

• Here are four ways that you, as a provider, can create a safe space for patients.

Diana Denza is NEDA’s senior communications associate. She graduated from Fordham University in 2011 with a degree in communications. Diana is a fan of good writing, wildly-colored hair, and cute desk toys.