It can be hard to discuss the specific needs of LBT women, as comparatively little work is done to identify them.
Widespread, accurate and inclusive monitoring of sexual orientation, gender, and trans status is needed if we are going to be able to identify the areas of health and care where LBT women might have either a higher incidence of need or specific barriers to access.
Alongside this monitoring, attention, and funding, needs to be given by LGBTQ organisations to women’s health, and by women’s and health organisations to LBT women.
According to Unhealthy Attitudes, a quarter (24 per cent) of patient-facing staff have heard colleagues make negative remarks about lesbian, gay or bi people, and one in five (20 per cent) have heard similar disparaging remarks about trans people.
You’ll see below that we have even less information specific to trans women than to lesbian and bisexual women (which, as a group, it’s important to remember does include trans women). Forthcoming research from PHE on trans people’s sexual and reproductive health will provide further insight, but for now, we’ve presented data which refers to trans people of any gender. We’ve searched for better data and had no luck, so if you have research which specifically relates to trans women, please get in touch.
Read on below for some facts about LBT women’s health. Don’t forget, there’s also all the information from last year’s briefing packs.
In the 2009/2010 English GP Patient Survey, the women who self reported ‘fair’ or ‘poor’ health status could be broken down by sexual orientation as follows Lesbian- 24.9%, Bisexual- 31.6%, Heterosexual- 20.5%. They also self reported “no trust or confidence in doctor” at the following rates: Lesbian- 5.3%, Bisexual- 5.3%, Heterosexual- 3.9% (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284269/)
Sexual and Reproductive Health
The Bisexuality Report found that there was a statistically significant higher rate of pregnancy in adolescent lesbians and bisexual women. This was particularly found in bisexual adolescents where the rate was twice that found in the heterosexual adolescent cohorts (https://bisexualresearch.files.wordpress.com/2011/08/the-bisexualityreport.pdf)
Research into lesbian, bisexual and other women who have sex with women’s use of reproductive health services is limited, but multiple small scale studies in the UK highlight consistent barriers, especially around heteronormative assumptions, in access across sexual health, maternity, and infertility treatment services.
37% of LGB women questioned said they had incorrectly been told by a health professional they did not require a cervical screening test because of their sexual orientation. And a further 14% had been actively refused or discouraged from having their cervical screening taken as a direct result of their sexual orientation. (http://usir.salford.ac.uk/16596/5/LGF_Final_Report3.pdf)
Lesbian and bisexual women were up to 10 times less likely to have had a cervical screening test in the past three years than heterosexual women. (https://www.dora.dmu.ac.uk/bitstream/handle/2086/4743/Fish%20cervical%20screening.pdf?sequence=1&isAllowed=y)
Forthcoming research from PHE shows that around half of all trans people surveyed had never had an STI test.
To date there has been limited investigation of lesbian and bisexual women’s experiences of mental health services however, across the existing studies, there are consistently negative experiences and perceptions of significant barriers related to sexual orientation.
Analysis of GP use for mental health issues suggests that bisexual women, but not lesbians, are less likely than heterosexual women to have visited the GP in the last 3 months for a longstanding mental health condition. (http://bmjopen.bmj.com/content/6/5/e011633)
Exploration of attitudes of psychiatric therapists to LGB patients highlights that a significant proportion have actively treated an individual to ‘change or reduce their same sex attraction’ despite public condemnation of reparative treatment by national and international psychological and psychiatric professional bodies. (https://www.ncbi.nlm.nih.gov/pubmed/26553867)
Odds ratios of poor mental health from meta analysis of 12 UK population studies found that lesbians are 1.38 times, and bisexual women 2.23 times as likely as heterosexual women to be anxious or depressed (as measured by GHQ-12 or EQ5D). (https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0767-z)
The English GP Patient Survey also found that lesbians were twice as likely (12.3%) and bisexual women three times as likely (18.8%) as heterosexual women to report a longstanding psychological or emotional condition. (https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0767-z)
Analysis of the UK Prescription for Change survey of lesbian, bisexual and other women who have sex with women in the UK found that 19.2% of lesbian women and 30.5% of bisexual women reported an eating disorder, of which the majority was bulimia (51.1% in lesbians and 55.6% in bisexual women) followed by anorexia (34.1% and 31.3% respectively). (https://www.stonewall.org.uk/sites/default/files/Prescription_for_Change__2008_.pdf)
Nearly half of trans people under 26 surveyed by The RARE Report said they had attempted suicide, and 30% said they had done so in the past year, while 59% said they had at least considered doing so. (http://www.queerfutures.co.uk/wp-content/uploads/2015/04/RARE_Research_Report_PACE_2015.pdf)
36% of the respondents to the Trans Mental Health Study identified that they had a mental health issue. 10% of the participants had been an inpatient in a mental health unit at least once (N=607). 38% of those experienced difficulties due to being trans, with a further 16% being unsure. Less than half were able to say that their trans status or history led to no difficulties (N=56). (https://www.scottishtrans.org/wp-content/uploads/2013/03/trans_mh_study.pdf)
Cancer & Long-Term Conditions
Evidence from population-based surveys between 2011 and 2014 showed prevalence of all cancers as lesbians – 4.4%, bisexual women – 4.2% compared to heterosexual women – 3.6%. (http://ascopubs.org/doi/full/10.1200/JCO.2017.72.5465)
There is consistent evidence from three UK studies that LBWSW have lower participation in gendered cancer screening (i.e. breast or cervical cancer, screening). (https://jsna.bradford.gov.uk/documents/Health%20Needs%20Assessments/Lesbian,%20Gay%20and%20Bisexual%20Health%20Needs%20Assessment/Lesbian,%20Gay%20and%20Bisexual%20Health%20Needs%20Assessment%202010%20-%20The%20Challenge%20for%20Change.pdf, http://ripassetseu.s3.amazonaws.com/www.lgf.org.uk/_files/documents/sep_11/FENT__1316185576_north-west-lgb-women-cervical-.pdf, http://onlinelibrary.wiley.com/doi/10.1002/jpoc.21093/full)
Evidence from the English GP Patient Survey shows that self-reported prevalence of arthritis or long term join problems is highest among bisexual women at 23.6%, followed by lesbians at 21.3%, while heterosexual women have a prevalence of 19.4%. The same study showed that both lesbians (14.4%) and bisexual women (14.8%) have a higher incidence of long term back problems than heterosexual women (11.3%). There is a similar difference for asthma or long term chest problems: lesbians – 14.6%, bisexual women – 14.3%, heterosexual women- 11.4%. (http://bmjopen.bmj.com/content/6/5/e011633)
58% of respondents to the Trans Mental Health Study identified as having a disability or chronic health condition, with nearly a fifth of the sample experiencing some form of learning impairment or intellectual disability or other neuro-diversity. 8.5% were Deaf or hearing impaired, and 5% were blind or visually impaired. This finding, combined with 1% needing alternative communication strategies, and 10% having a physical disability, is clearly important in terms of ability to access support services and strategies, and to access spaces for social support. (https://www.scottishtrans.org/wp-content/uploads/2013/03/trans_mh_study.pdf)
Health Risk Behaviours
The Integrated Household Survey showed that in 2013, 30.7% of lesbians, 21.9% of bisexual women and 17.3% of heterosexual women were current smokers. (https://www.ons.gov.uk/)
UK evidence suggests that lesbian and bisexual women are more likely to have hazardous drinking patterns than heterosexual women, and this behaviour is often established in adolescence. (http://bmjopen.bmj.com/content/3/8/e002810, https://www.ncbi.nlm.nih.gov/pubmed/24612217)
Surveys of LGB people in the UK suggest that recreational drug use is higher among lesbians than in bisexual women and across the evidence base there are consistent findings that both groups use drugs more than heterosexual women. (http://www.ukdpc.org.uk/wp-content/uploads/Evidence%20review%20-%20The%20impact%20of%20drugs%20on%20different%20minority%20groups_%20LGBT%20groups.pdf)
The participants in the Trans Mental Health Study highlighted a number of situations which they would avoid due to fear of being harassed, read as trans, or being outed. 81% of the participants did avoid some situations due to fear. Over 50% avoided public toilets and gyms, suggesting that these were the most problematic areas for the participants. (https://www.scottishtrans.org/wp-content/uploads/2013/03/trans_mh_study.pdf)