Sexual Orientation and Sexual Health Care Needs: A Comparison of Women Beneficiaries in Outpatient Military Health Care Settings

ABSTRACT

The objectives of this study are to compare the sexual concerns, interest and experiences in discussing these concerns with their doctor for women of “Only Men” and “Some to Only Women” sexual orientation. A survey was mailed to women patients from two military outpatient settings, with 1,196 women responding. Of eligible respondents (N = 1,170), 90% reported “Only Men” and 10% reported “Some to Only Women” sexual orientation. Sexual concerns varied by sexual orientation, while interest and experience in discussing sexual concerns and desire for physicians to initiate the topic differed minimally. Women with “Some to Only Women” sexual orientation have both similar and differing sexual concerns compared to “male-only” oriented women. Larger primary care patient-based studies of sexual health care needs of sexual minorities are needed.     

Mental health issues: a comparison of lesbian, bisexual and heterosexual women

This study examines mental health issues among women of different sexual orientations. An anonymous survey was administered at 33 health care sites across the United States; the sample (N = 1304) included lesbians (n = 524), bisexual (n = 143) and heterosexual women (n = 637). Not only did sexual orientation influence the probability of experiencing emotional stress, but also whether a bisexual woman or lesbian had disclosed her sexual orientation (was "out") impacted the likelihood of having or having had mental health problems. Bisexual women and lesbians experienced more emotional stress as teenagers than did heterosexual women. Bisexual women were more than twice as likely to have had an eating disorder compared to lesbians. If a bisexual woman reported being out she was twice as likely to have had an eating disorder compared to a heterosexual woman. Lesbians who were not out and bisexual women who were out were 2-2.5 times more likely to experience suicidal ideation in the past 12 months. Lesbians and bisexual women who were not out were more likely to have had a suicide attempt compared to heterosexual women. Lesbians used psychotherapy for depression more commonly than did heterosexual or bisexual women. This is one of the few studies that compares lesbians, bisexual and heterosexual women. The implications of these findings are discussed.     

Understanding and reducing stress and psychological distress in older women with heart disease

Stress and psychological distress were assessed in 457 older women who were subsequently randomized to a six-week heart disease management program ("Women take PRIDE") or to a "usual care" control group. Baseline distress was significantly associated with age, symptoms, physical functioning, social support, optimism, and self-esteem (p < .05). Only 20% of women reported their physician had recommended reducing stress. At four months follow-up, intervention women compared to controls were significantly more likely to report reductions in stress levels (p = 0.02) and also showed improvement in emotional behavior (p = 0.09).     

The potential impact of discrimination fears of older gays, lesbians, bisexuals and transgender individuals living in small- to moderate-sized cities on long-term health care

As an exploration of the potential impact of fears of discrimination against GLBTs in long-term health care settings, this study compared perceptions of GLBT persons and heterosexuals. A total of 132 GLBT persons and 187 heterosexuals living in Eastern Washington completed a survey that contained demographic questions and perceptions of discrimination in long-term care settings. Most respondents suspected that staff and residents of care facilities discriminate against GLBTs. GLBT respondents who believed that residents of care facilities are victims of discrimination were more likely to believe that they would have to hide their sexual orientation if admitted to a care facility. GLBT respondents were more likely than heterosexual respondents to believe that GLBTs do not have equal access to health care and social services, that GLBTs residents of care facilities are victims of discrimination, that GLBT sensitivity training programs would benefit staff and residents of care facilities, and that GLBT retirement facilities would be a positive development for older GLBTs. This study is offered as a preliminary investigation of concerns about GLBT discrimination in health care settings, how concerns are expressed, and the implications of those concerns for health care needs.     

Unwanted pregnancies and preventive health care use in Thailand

Research on the consequences of unwanted pregnancies can offer useful perspectives on the need to improve and expand the range of family planning options available to women in developing countries. This paper investigates the use of maternal and child health services by women who have unwanted or mistimed pregnancies. The results of our analysis indicate that wantedness of births exerts a significant influence on health care use in Thailand, after controlling for other determinants of utilization. Women with unwanted pregnancies are less likely to seek prenatal care or receive tetanus toxide inoculations. Further, women from disadvantaged socioeconomic groups, women with high parity and those with lower educational levels have the highest proportion of unintended pregnancies. The study concludes by making suitable policy recommendations.     

Mental health concerns of gay and bisexual men seeking mental health services

Little data exist about the mental health needs of gay and bisexual men. This is due to limitations of existing studies such as small and nonrepresentative samples, failure to assess sexual orientation, and concerns about stigmatization, possibly causing sexual minority individuals to be reluctant to disclose their sexual orientation to researchers. Fenway Community Health is a large urban health center that serves the LGBT community. The large number of gay and bisexual men who present for mental health treatment allows for a unique opportunity to gain insight into mental health, prevention, and intervention needs for this group. The current study is a review of the mental health information from all of the gay and bisexual men who reported that they were HIV-negative during their mental health intake over a six-month period at Fenway Community Health (January to June 2000; N = 92). The most frequent presenting problems were depression, anxiety, and relationship issues. Additionally, presenting problems included current or past abuse, substance abuse, finance and employment, recent loss, and family issues. The most frequent diagnoses were depression, anxiety disorders, and adjustment disorders. These findings support the notion that presenting problems and mental health concerns among gay and bisexual men are similar to those frequently reported by individuals in other mental health facilities, however, specific psychosocial stressors are unique to this population.     

A feminist model of family care: practice and policy directions

Using a feminist perspective, this article examines women's experiences in caring for older family members with chronic illnesses or disabilities. Central to this analysis are the concepts of the social construction of gender-based inequities in caring, the interconnections between generations of women as givers and receivers of care, and variations in family care by gender, race, ethnicity, social class and sexual orientation. The authors critique current practice interventions and policies and purpose models for the elimination of gender-based inequities in caregiving and the provision of caregiver choice and empowerment for women and men, including feminist models of practice with women caregivers and economic and long-term care supports.     

Quantifying Sexual Orientation Among Homeless and Unstably Housed Women in a Longitudinal Study: Identity,Behavior, and Fluctuations Over a Three-Year Period

ABSTRACT

Sexual orientation has been linked to certain health conditions, and yet quantifying sexual orientation in longitudinal studies is challenging. This study examined different methods of accounting for sexual orientation in a cohort study of 300 homeless and unstably housed women followed every 6 months over 3 years. Altogether, 39.7% (n = 119) could be considered sexual minority at one or more time points based on identity and/or behavior; 16.3% (n = 49) reported shifts in sexual identity. Only 24.0% (n = 72) were identified as sexual minority through a single measure of sexual identity, 27.0% (n = 81) were identified with a single measure of identity and behavior, 33.0% (n = 99) were identified through annual measures of identity and behavior, and 22.0%–22.3% (n = 66–67) were identified through latent class analysis including all identity/behavior measures. This study found that sexual fluidity is common in unstably housed women, and many sexual minority women would be missed in longitudinal studies with different methods of accounting for sexual orientation.     

Mental health differences between men and women caregivers,BRFSS 2009

This study uses data from the 2009 Behavioral Risk Factors Surveillance System (BRFSS) to examine differences between male and female caregivers by demographics, health-related quality of life (HRQOL), and the effect of social support on HRQOL. Roughly two-thirds of caregivers were women, and demographic characteristics differed among men and women caregivers. Women caregivers reported significantly more mentally and physically unhealthy days than men, but there were no differences between men and women in general health or life satisfaction. Men were significantly more likely to report that they rarely or never received social support. Despite this, the effect of social support on HRQOL was stronger in men than in women. Implications of these findings for caregiver support programs are discussed.     

Bisexual women in marriages

A clinical sample of women who were currently or previously married were surveyed regarding demographics, homosexual experiences before marriage, problems in marriage, and sexual orientation. The average age of the 45 participants was 35.9. Before marriage, 21 (47%) were somewhat aware of their homosexual feelings but were much less likely to have thought of or identified themselves as homosexuals. Sexual difficulties were very common in these marriages (89%), the most cited sexual difficulty being a lack of sexual desire for their spouse (62%). Based upon Kinsey-type ratings, the sample could be described as almost exclusively heterosexual in behavior and fantasies before marriage. Some changes could be seen during marriage toward more of a homosexual orientation. The dramatic change, however, occurred following marriage, when the women reported even more of a homosexual orientation, tending toward the homosexual end of the Kinsey continuum. At the time of the study, a majority of the sample was, in fact, relating almost exclusively to other women. This study found that, compared to homosexual men who have been married, these women are more likely to marry at an earlier age, unlikely to be aware of their homosexual feelings prior to marriage, and more likely to terminate their marriage earlier because of conflicts arising as a result of their bisexual orientation and sexual dissatisfaction.     

Barriers to Optimal Care between Physicians and Lesbian,Gay, Bisexual,Transgender, and Questioning Adolescent Patients

The objective of this article was to identify barriers to optimal care between physicians and LGBTQ (lesbian, gay, bisexual, transgender, and questioning) adolescents. To this end, 464 anonymous, self-administered surveys were distributed in 2003 to residents and attending physicians in pediatrics, internal medicine, obstetrics-gynecology, psychiatry, emergency medicine, and family practice at Upstate Medical University. The survey included questions pertaining to practice, knowledge, and attitude pertaining to lesbian, gay, transgender, or questioning (LGBTQ) adolescents. One hundred eight four surveys were returned. The majority of physicians would not regularly discuss sexual orientation, sexual attraction, or gender identity while taking a sexual history from a sexually active adolescent. As well, the majority of physicians would not ask patients about sexual orientation if an adolescent presented with depression, suicidal thoughts, or had attempted suicide. If an adolescent stated that he or she was not sexually active, 41% of physicians reported that they would not ask additional sexual health-related questions. Only 57% agreed to an association between being a LGBTQ adolescent and suicide. The majority of physicians did not believe that they had all the skills they needed to address issues of sexual orientation with adolescents, and that sexual orientation should be addressed more often with these patients and in the course of training. This study concludes that barriers in providing optimal care for LGBTQ adolescents can be found with regard to practice, knowledge, and attitude regardless of medical field and other demographics collected. Opportunities exist to enhance care for LGBTQ adolescents.     

Active duty military personnel presenting for care at a Gay Men's Health Clinic

Under the "Don't Ask, Don't Tell, Don't Pursue, Don't Harass" Department of Defense policy, gay men and women are allowed to serve in the military, but they are not allowed to disclose their sexual orientation. This study was performed to determine the incidence of active duty military personnel seeking care at a Gay Men's Health Clinic. Nine percent of the clients, who had served between June and August 2002, were active duty U.S. Navy sailors. They all expressed fears of being discharged from the military when asked why they did not access military healthcare. The "DADTDPDH" policy breeds distrust between men who have sex with men (MSM) service-members and their healthcare provider and this ensures inadequate healthcare.     

Educational Attainment by Life Course Sexual Attraction: Prevalence and Correlates in a Nationally Representative Sample of Young Adults

Researchers know relatively little about the educational attainment of sexual minorities, despite the fact that educational attainment is consistently associated with a range of social, economic, and health outcomes. We examined whether sexual attraction in adolescence and early adulthood was associated with educational attainment in early adulthood among a nationally representative sample of US young adults. We analyzed waves I and IV restricted data from the National Longitudinal Study of Adolescent Health (n = 14,111). Sexual orientation was assessed using self-reports of romantic attraction in waves I (adolescence) and IV (adulthood). Multinomial regression models were estimated and all analyses were stratified by gender. Women attracted to the same-sex in adulthood only had lower educational attainment compared to women attracted only to the opposite-sex in adolescence and adulthood. Men attracted to the same-sex in adolescence only had lower educational attainment compared to men attracted only to the opposite-sex in adolescence and adulthood. Adolescent experiences and academic performance attenuated educational disparities among men and women. Adjustment for adolescent experiences also revealed a suppression effect; women attracted to the same-sex in adolescence and adulthood had lower predicted probabilities of having a high school diploma or less compared to women attracted only to the opposite-sex in adolescence and adulthood. Our findings challenge previous research documenting higher educational attainment among sexual minorities in the US. Additional population-based studies documenting the educational attainment of sexual-minority adults are needed.     

Women's Sexual Identity Patterns: Differences Among Lesbians,Bisexuals, and Unlabeled Women

To better understand women with same-sex attractions who do not identify as lesbian or bisexual (i.e., unlabeled women), we examined differences and similarities among self-designated lesbian, bisexual, and unlabeled women. Two hundred eight non-heterosexual women ranging in age from 18 to 69 years (85% identified as White) completed an online survey examining indicators of sexual orientation and beliefs and self-perceptions associated with sexual identity. Compared to lesbians, unlabeled women reported the weakest collective sexual identities and, along with bisexuals, they were less likely to view sexual orientation as fixed, being more focused on the “person, not the gender.” Unlabeled women reported the greatest likelihood that their sexual identity would change in the future. These findings highlight the complexity of women's sexual identities and question the adequacy of categorical approaches.     

Same-Sex Sexuality and Educational Attainment: The Pathway to College

Research finds lower levels of academic performance among sexual minority high school students, but some studies suggest sexual minorities have higher levels of educational attainment in adulthood. To further our understanding of how and why sexual orientation is associated with educational success, this study turns attention to the pathways to college completion, examining points along educational trajectories in which sexual minorities fall behind or surpass their heterosexual peers. Using data from the National Longitudinal Study of Adolescent to Adult Health, we find that sexual minority women are less likely than women with no same-sex sexuality to complete college, in part due to their high school performance and transition into college. Men who experience same-sex sexuality only in adolescence struggle in high school, but men who experience same-sex sexuality for the first time in adulthood are more likely to earn a college degree than men who do not experience same-sex sexuality.     

Sexual minorities and selection of a primary care physician in a midwestern U.S. city

How and why sexual minorities select a primary care physician is critical to the development of methods for attracting these clients to a physician's practice. Data obtained from a sample of sexual minorities in a mid-size city in our nation's heartland would indicate that these patients are loyal when the primary care physician has a positive attitude toward their sexual orientation. The data also confirms that most sexual minorities select same sex physicians but not necessarily same sexual orientation physicians because of lack of knowledge of physicians' sexual orientation. Family practice physicians and other primary care physicians can reach out to this population by encouraging word of mouth advertising and by displaying literature on health issues for all sexual orientations in their offices.     

Seeking control in the midst of uncertainty: Women’s experiences of choosing mode of birth after caesarean

Problem

Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. To support informed choices for birth after caesarean, it is necessary to understand the factors that influence women’s decision-making.

Women’s experiences of intrapartum care and recovery in relation to planned caesarean sections: An interview study

Problem and backgroundApproximately one third of women in high-income countries give birth by caesarean section (CS). Better understanding of women’s CS experiences is vital in identifying opportunities to improve women’s experience of care.AimTo identify opportunities for service improvement by investigating Australian women’s experiences of care and recovery when undergoing a planned CS.MethodsQualitative telephone interview study with 33 women who had a planned CS at one of eight Australian hospitals. Semi-structured interviews were conducted to elicit women’s perspectives, experiences and beliefs surrounding their planned CS. Interviews were transcribed verbatim and analysed inductively using NVivo-12.ResultsWomen’s experiences of CS care were mixed. Regarding intrapartum care, many women stated their planned CS was a positive experience compared to a previous emergency CS, but was scarier and more medicalised compared to vaginal birth. CS recovery was viewed more negatively, with women feeling unprepared. They reported disliking how CS recovery restricted their role as a mother, wanting more time in hospital, and greater support and continuity of care.DiscussionWomen reported largely positive intrapartum experiences of planned CS but relatively negative experiences of CS recovery. They wished for time in hospital and support from staff during recovery, and continuity of care.ConclusionBy incorporating shared decision-making antenatally, clinicians can discuss women’s birth expectations with them and better prepare them for their planned CS and recovery.     

Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study,from Australia

BackgroundPerinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions.AimTo compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth.MethodsA retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 – 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care.ResultsThe cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24–0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93–3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10–4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57–1.09).ConclusionsThis evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.     

Examining Sexual Orientation Disparities in Unmet Medical Needs Among Men and Women

Using the National Longitudinal Study of Adolescent Health (N = 13,810), this study examines disparities in unmet medical needs by sexual orientation identity during young adulthood. We use binary logistic regression and expand Andersen’s health care utilization framework to identify factors that shape disparities in unmet medical needs by sexual orientation. We also investigate whether the well-established gender disparity in health-seeking behaviors among heterosexual persons holds for sexual minorities. The results show that sexual minority women are more likely to report unmet medical needs than heterosexual women, but no differences are found between sexual minority and heterosexual men. Moreover, we find a reversal in the gender disparity between heterosexual and sexual minority populations: heterosexual women are less likely to report unmet medical needs than heterosexual men, whereas sexual minority women are more likely to report unmet medical needs compared to sexual minority men. Finally, this work advances Andersen’s model by articulating the importance of including social psychological factors for reducing disparities in unmet medical needs by sexual orientation for women.