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I guess everyone has familiar thoughts which come to mind when one is en route to a cervical screening appointment.
I bet they range from the mundane – “will the room be cold?” - To – “it’s fantastic the NHS offers the chance to have cervical screening free of charge”.
I imagine that a small, but significant group of women will walk through the door as I often did thinking – what am I doing to say when they ask that question.
The question is “Are you using contraception?” It is a perfectly reasonable question for a nurse or doctor to ask, and it is not difficult to answer.
I used to answer truthfully, and when I said no the next question would be why? I developed a stock answer “I don’t need it”. Over the years that prompted many more questions “Are you no longer sexually active? “Have you discussed this with your partner? Does he agree?” “Are you sure, because at your age you could still become pregnant”. All asked by diligent professionals trying to provide good care.
So why did my heart sink? Well, the questions are completely inappropriate because I am a lesbian, and at that moment I would have to do the calculation – Do I need come out? Is it safe? How will the nurse or doctor react? Will there be negative consequences?
I have not yet come out during a screening appointment but, these days I have the confidence, I will in future. I will do so in the knowledge that other lesbian or bi women have experienced discrimination as documented by the National LGBT Partnership and the LGBT Foundation.
Evidence from multiple studies show that healthcare settings are often not LGBT-friendly, which has the effect of discouraging LGBT people from seeking help and accessing basic services.
"I felt that I wasn’t normal because all of the wording and assumptions were made that I would be having sex with men. In this ignorance and assumption of heteronormativity, I felt many of my needs were missed.” I know of women who know the danger of missing screening appointments, but having been subject to criticism or inappropriate curiosity refuse to attend.
Others are jeopardised by ignorance or mistaken assumptions by ill-informed professionals. “Nurse and doctor have always said I don’t need one - lesbians cannot get cervical cancer, so of course, I won’t go through an embarrassing procedure I don’t need!” Wrong, wrong, wrong. HPV doesn’t discriminate between genders or sexual orientation so if you’ve ever had any form of sexual contact, whether that’s touching, sharing sex toys or penetrative sex, then you might have come into contact with it.
Some lesbian and bi women have really good experience of the NHS. Connie (35), a bisexual women living in London, described a positive experience when she had sought medical advice after contracting a sexually transmitted infection from a same-sex sexual encounter. “The doctor who saw me was great; non-judgmental, reassuring and able to prescribe me medication straight away. She asked me questions, listened to me and I felt really comfortable. It made me feel like healthcare has moved on a lot in this country because I remember as a young woman always being asked how many partners I’d had and feeling really ashamed and judged. And doctors would always assume I am straight! These days you are asked whether you have had female partners, it’s better.”
@RainbowNHSBadge is a new initiative being rolled out by NHS staff to give a visible cue that patients can safely come out. I welcome this and I thank the staff who came up with the idea, but when the NHS Long Term plan was published the words Lesbian, Gay and Bisexual only made it as far as the glossary. Finding a member of staff whom one can trust is still a matter of chance.
There needs to be recognition by the leadership of the NHS, and professional bodies such as the Royal Colleges and the GMC, that the needs of LGBT citizens. As a consequence we have poorer health outcomes and that is unacceptable. With the appointment of the new LGBT advisory group we should see progress made and patient groups can help to accelerate progress by ensuring that lesbians and bi women cease to be invisible, and trans women receive timely, appropriate care.
All we want is to be treated with the same respect and dignity as anybody else. Surely that is not too much to ask.
Baroness Barker is a Liberal Democrat Lords Spokesperson for the Voluntary Sector.