The month of June is widely recognized as International Pride Month; Pride Month commemorates years of struggle for civil rights and the ongoing battle for equal justice under the law for the lesbian, gay, bisexual, transgender, and queer community, as well as a celebration for the accomplishments of 2SLGBTQQIA+ individuals. Despite the triumphs made through the decades, there is much we need to understand as a society as far as inclusivity and equality for the 2SLGBTQQIA+ community.
To move the needle, we need to first note the history of treatment for 2SLGBTQQIA+ members within the written laws and literature that make up our society. For example, homosexuality was listed as a disorder in the Diagnostic & Statistical Manual of Mental Disorders until 1973 (Charles C, et al) and being transgender was considered a mental illness according the the World Health Organization up until 2019 (WebMD). These occurrences highlight the fact that there are many areas in Canada where we need to increase education and promote openness, inclusion and accessibility for the members of the 2SLGBTQQIA+ community, with healthcare being one of the main areas.
So what does 2SLGBTQQIA+ mean and who does this impact? The two-spirit, lesbian, gay, bisexual, trans, queer, questioning, intersex, asexual and others are the ones who are building education and advocacy about the ways of life, quality of life, and inclusivity that is required for this society to operate justly. As Femade is inclusive in our culture towards gender and sexual orientation, providing a safe space for patients, we wanted to dive deeper into the rooted issues, homophobia and ingrained prejudice in the current healthcare system.
Fear of victimization, homophobia and a general misconception about gender identity within our healthcare system has led many 2SLGBTQQIA+ members to avoid care from physicians when they need it. Where this problem is accentuated is in circumstances that involve the patient’s reproductive or hormone decisions. Many doctors either confuse gender with sexual orientation, confuse either of these with promiscuity, and many cannot conceptualize gender nuances when talking to the patient about reproductive decisions. Two members of the 2SLGBTQQIA+ community in Ottawa spoke to us about their experiences with physicians and the healthcare system as queer individuals.
Danielle, age 24, recently underwent surgery for endometriosis. “When I had my endo surgery, they made me take a pregnancy test even though I said I was a lesbian and not even sexually active. It didn’t feel inclusive at all; like it wasn’t in their realm of possibility that a young woman could be off birth control and still have 0% of becoming pregnant”.
Danielle continued to explain that her general practitioner even suggested she become pregnant to ‘cure’ her endo and that heterosexuality and heterosexual language is always the default. This experience of Danielle’s showcases the lack of proper education surrounding not only the 2SLGBTQQIA+ community and ingrained heterosexual narrative within healthcare but also the lack of education for physicians on proper care surrounding gynecological health.
Another Ottawa resident, Kayleigh, describes her experience as more judgmental; Kayleigh has chosen to share her experience from when she asked her doctor for birth control: “Even though I explained I was in a straight relationship they just assumed I was super promiscuous because I am bisexual and they kept explaining STI prevention. That wasn’t what I was looking for, I just didn’t want to get pregnant”.
The unfortunate truth is that these incidents aren’t isolated. Medical schools in Canada require little to no training about 2SLGBTQQIA+ individuals and the language is based on the majority. 2SLGBTQQIA+ individuals find themselves educating and explaining to their physician which in turn leaves them feeling exhausted and avoiding seeking a healthcare professional altogether (Lee R., 2000). Josi, a transgender woman explains her first experience discussing her gender identity with her general practitioner: “She wasn’t comfortable prescribing hormones and told me I would need a psych evaluation first. It’s not like I’m an uncertain 13 year old asking for hormones, I was 21 and had been hoping to wake up a girl my whole life”. At this point, this kind of treatment and lack of education for medical practitioners shouldn’t come as much of a surprise. A 2016 Canadian study found that 95% of medical students agreed that while the specific health care needs of transgender patients is important, less than 10% feel like they would be able to accurately provide it (Chan B, et al., 2016). Many physicians, like in Josi’s case, do lean on other healthcare professionals to guide them in these medical decisions but the narrative they use needs to be more understanding and encouraging.
So what can we do? It’s obvious that Canada’s medical education and healthcare system needs to vastly increase their education, both in preclinical and clinical training. We need to continue advocating for more representation and to decrease the stigma and discrimination around the 2SLGBTQQIA+ community. An increase in exposure in the curriculum will lead to better 2SLGBTQQIA+ healthcare, reduced stigma and increased willingness to treat. We need to be more inclusive of the minorities regardless of what effort that might take, and take the time to work with the patient in better understanding their life goals.
Here at Femade, we are attempting to shift the ingrained heterosexual cis-gender narrative and amplify the voices and stories of those experiencing injustice. We strive to create an inclusive space where those assigned female at birth can receive proper pain management and gynecological care without fear of judgment, victimization and homophobia. We seek to create a work environment where individuals from all backgrounds can feel their knowledge is valued. We hope in the future to participate in more initiatives to aid the 2SLGBTQQIA+ community by making strides for equality within healthcare.
Everyone deserves to walk into a space where their life and health is valued.
Resources
“Being Transgender Not a Mental Disorder, WHO Says.” WebMD, https://www.webmd.com/sex/news/20190529/being-transgender-not-a-mental-disorder-who-says. Accessed 14 June 2022.
Chan B, Skocylas R, Safer JD. Gaps in transgender medicine content identified among Canadian medical school curricula. Transgend Health 2016;1:142–50
Charles, Christopher, et al. “Improving Healthcare for LGBTQ Populations.” CFMS FEMC, p. 9.
Curmi C, Peters K, Salamonson Y. Lesbians’ attitudes and practices of cervical cancer screening: a qualitative study. BMC Womens Health 2014;14:153.
Lee R. Health care problems of lesbian, gay, bisexual, and transgender patients. West J Med 2000;172:403–8