Το ακόλουθο άρθρο είναι στα αγγλικά. Είναι επίσης μεγάλο σε έκταση και μπορεί κουραστικό αλλά είναι πολύ ενδιαφέρον. Για αυτό και θα παρουσιαστεί σε μέρη. Κάποια στιγμή θα μεταφρασουμε μέρη του και στα ελληνικά.
Health Care Recommendations for Lesbian Women by Susan Jo Roberts
The client-provider relationship
Early studies focused on the relationship between lesbians and health care providers, probably due to concern about problems in this area. Research found that lesbians had negative experiences in health care encounters, and that nurses and physicians held negative attitudes toward them (Mathews, Booth, Turner, & Kessler, 1986; Randall, 1989; Stevens, 1992; Stevens & Hall, 1988). Lesbians also reported fear that the quality of care would be negatively affected if they disclosed their sexuality (Buchholz, 2000; McManus, Hunter, & Renn, 2006; Stevens). Not surprisingly, researchers have found that lesbians are hesitant to disclose their sexuality to a health care provider (Cochran & Mays, 1988; Michigan Organization for Human Rights, 1991). More recent studies have found that higher rates of disclosure to providers, a change that most likely reflects increased comfort in care settings (Klitzman & Greenberg, 2002; Roberts, Patsdaughter, Grindel, & Tarmina, 2004; White & Dull, 1997).
Physical examinations and cancer screening
Not surprisingly given their anxiety about health care, several of the early surveys also found that less than 50% of lesbians had had an annual physical examination, and most sought care only when a problem arose (Bradford & Ryan, 1988; Johnson, Guenther, Laube, & Keetel, 1981; Roberts & Sorensen, 1999a; Zeidenstein, 1990). Results of a more recent survey demonstrated increased use of routine physicals (Roberts et al., 2004). Lesbians prefer a female and, if possible, lesbian providers (Johnson et al., 1981; Trippet & Bain, 1993) and frequently use "alternative" providers, such as acupunturists, massage therapists, and nonphysician health care providers (Harvey, Carr, & Bernheine, 1989; Matthews, Hughes, Osterman, & Kodl, 2005; McManus et al., 2006; Trippet & Bain; White & Dull, 1997).
Research on screening for cervical cancer in early studies also found that only about 50% had had a recent pap smear (Bradford & Ryan, 1988; Johnson, Smith, & Guenther, 1987; Johnson et al., 1981). A meta-analysis that adjusted the data from early lesbian surveys for comparison with the National Health Interview Survey found that lesbians had lower rates of pap smears than women in general (Cochran et al., 2001). More recent studies have found increased rates of pap smear screening, but they are still lower than national guidelines and heterosexual comparison groups (Diamant, Schuster, & Lever, 2000; Roberts et al., 2004; Powers, Bowen, & White, 2001; White & Dull, 1997).
This lower rate of screening was thought to be of less concern because research had suggested that the incidence of cervical dysplasia on pap smear was low, less than 3%, and was related to history of current or past male partners (Johnson et al., 1981, 1987; Roberts, Sorensen, Patsdaughter, & Grindel, 2000; Robertson & Schachter, 1981). One team of researchers found that lesbians perceive themselves to be less susceptible to cervical cancer than heterosexual or bisexual women and therefore thought they did not need routine screening (Price, Easton, Telljohann, & Wallace, 1996). Recent analyses, however, suggest that human papillomavirus (HPV) infection is found in lesbian women, and that pap smear screening guidelines should be the same as for heterosexual women (Carroll, Goldstein, Wilson, & Mayer, 1997; Cochran, Bybee, Gage, & Mays, 1996; Marrazzo, Koutsky, Kiviat, Kuypers, & Stine, 2001; Marrazzo, Stine, & Koutsky, 2000; Rankow & Tessaro, 1998a). One study found that HPV DNA was detected in 13% of the lesbians that they screened, and that HPV related lesions were found even in women who had never had sex with men (Marazzo et al., 2001).
Rates for mammography screening for lesbians are less consistent. Although some studies have found lower rates than in heterosexual women (Cochran et al., 2001; Powers et al., 2001), others have found fairly high rates of screening (Aaron et al., 2001; Burnett, Steakley, Slack, Roth, & Lerman, 1999; Diamant et al., 2000; Lauver et al., 1999; Rankow & Tessaro, 1998b; Roberts, Dibble, Scanlon, Paul, & Davids, 1998; Roberts et al., 2004; Roberts & Sorensen, 1999a; White & Dull, 1997). One study found that barriers to mammography were low perception of need and motivation, physical discomfort, and cost, but these findings are similar to that found in heterosexual women (Lauver et al.).
The lack of inclusion of sexual orientation/identity and behavior on national statistics for breast cancer makes it difficult to know the actual prevalence in lesbians. There is recent evidence of increased rates of known risk factors for breast cancer, such as increased body mass, high alcohol intake, and nulliparity in lesbians compared with heterosexual women (Case et al., 2004; Cochran et al., 2001; Diamant & Wold, 2003; Dibble, Roberts, & Nussey, 2004; Roberts, Dibble, Nussey, & Casey, 2003; Roberts et al., 1998; Yancey, Cochran, Corliss, & Mays, 2003). These findings suggest that lesbians may be at increased risk for the development of breast cancer.
It is difficult to determine the actual prevalence of breast cancer in lesbians.
Cardiovascular disease and risk factors
Research has found increased risk for cardiovascular disease in lesbians. The analysis of early lesbian health surveys found that they were significantly more likely to be obese and to smoke than women in general (Cochran et al., 2001). They also found that lesbians were less likely to consider themselves to be overweight. More recent analysis of the lesbians in studies with large samples of women also found increased cardiovascular risk and heart disease (Case et al., 2004; Diamant & Wold, 2003; Valanis et al., 2000). Risk factors included higher rates of obesity, smoking, alcohol use, and less intake of fruits and vegetables. Some studies have found that, although lesbians had the risk factors noted above, they were less likely to smoke and more likely to participate in regular exercise (Aaron et al., 2001; Roberts et al., 1998). Another study found that lesbians had a higher body mass index, waist circumference, and waist ratio than their heterosexual sisters, and were more likely to cycle their weight, all known to be risks for heart disease (Roberts et al., 2003). Lesbians were, however, equally likely to smoke cigarettes, ate less red meat, and were more likely to exercise at least weekly.
Correlates of overweight and obesity in lesbians and bisexuals have been found to be age, poorer health status, lower educational attainment, relationship cohabitation, and lower exercise frequency (Yancey et al., 2003). A common assumption has been that lesbians are more likely to be overweight or obese because they do not adhere to the societal norm that women must be thin and only have certain body types. One of the few studies on this topic found that, although heterosexual women and gay men reported lower ideal weight than lesbians or heterosexual men, lesbians and heterosexual women both reported greater concern about weight, more "body dissatisfaction," and greater frequency of dieting (Brand, Rothblum, & Solomon, 1992). Another found that lesbians had similar attitudes concerning weight, appearance and dieting, and had similar rates of bulimia as heterosexual women (Heffernan, 1996).
Smoking rates of lesbian samples have been variable in different samples, from 10% to 12% in some (Burnett et al., 1999; White & Dull, 1997) to 83% in an adolescent sample (Rosario, Hunter, & Gwadz, 1997), with most surveys reporting rates of 18% to 41% (Aaron et al., 2001; Bradford & Ryan, 1988; Roberts & Sorensen, 1999a; Roberts et al., 2004; Skinner & Otis, 1996). Some studies have found that lesbians have twice the rate of smoking of heterosexual women (Gruskin, Hart, Gordon, & Ackerson, 2001; Valanis et al., 2000). One survey of minority lesbians also found higher rates of current smoking (Mays, Yancey, Cochran, Weber, & Fielding, 2002). Reviews have concluded that smoking rates for adolescent and adult lesbians are higher than their national comparison groups, with adolescents being highest for both groups (Hughes & Jacobson, 2003; Ryan, Wortley, Easton, Pederson, & Greenwood, 2001).