Health care providers are an important source of sexually transmitted infection (STI) prevention information for young adult sexual minority women (SMW). However, very few studies have described patient–provider STI communication in this understudied and underserved population. We explore sexual minority women's experiences communicating with health care providers about sexual health, with particular attention to STI prevention, to inform programs and practices that address their unique needs and concerns.
We conducted 29 in-depth interviews with sexual minority cisgender women and nonbinary assigned female at birth (AFAB) individuals aged 18–36 years. The sample included White (55%), Asian (31%), Black (17.2%), and Latina (3.4%) participants. We used thematic analysis with deductive and inductive coding to identify themes related to patient–provider STI prevention communication.
Heteronormative health care provider assumptions inhibited participants' willingness to disclose their sexual orientation and discuss sexual health issues with providers. Most sexual health conversations focused on pregnancy and contraception, which many felt was irrelevant to them, and limited STI prevention recommendations to condom use. Participants reported that some providers lacked medical knowledge on AFAB-to-AFAB STI transmission and were not able to provide relevant STI prevention information. Providers' bias related to gender identity and race/ethnicity furthered some participants' mistrust generated from providers’ heteronormative assumptions.
Our study describes several barriers that AFAB sexual minorities felt inhibited their patient–provider sexual health communication. Interventions are needed to improve patient–provider STI prevention conversations with AFAB sexual minorities so they can access the sexual health information they need to effectively protect themselves from STIs.
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- Exploring the cervical cancer screening experiences of Black lesbian, bisexual, and queer women: The role of patient-provider communication.Women & Health. 2015; 55: 717-736
- Sexuality talk during adolescent health maintenance visits.JAMA Pediatrics. 2014; 168: 163
- ACOG committee opinion: Health care for lesbians and bisexual women.American College of Obstetricians and Gynecologists, Washington D.C.2012 (Available:)www.acog.orgDate accessed: August 9, 2018
- Bisexual invisibility and the sexual health needs of adolescent girls.LGBT Health. 2016; 3: 342-349
- Participant recruitment for qualitative research: A site-based approach to community research in complex societies.Human Organization. 1999; 58: 128-133
- The place of inter-rater reliability in qualitative research: An empirical study.Sociology. 1997; 31: 597-606
- Within-case and across-case approaches to qualitative data analysis.Qualitative Health Research. 2003; 13: 871-883
- Sexual behaviour of lesbians and bisexual women.Sexually Transmitted Infections. 2003; 79: 147-150
- Health and identity-related interactions between lesbian, bisexual, queer and pansexual women and their healthcare providers.Culture, Health & Sexuality. 2017; 19: 1181-1196
- Checklists for improving rigour in qualitative research: A case of the tail wagging the dog?.BMJ (Clinical Research Edition). 2001; 322: 1115-1117
- Sexual health, risk behaviors, and substance use in heterosexual-identified women with female sex partners: 2002 US National Survey of Family Growth.Sexually Transmitted Diseases. 2010; 37: 531-537
- Analyzing qualitative data: Systematic approaches.2nd ed. Sage, Thousand Oak, CA2017
- Gender outlaw: On men, women, and the rest of us.Vintage, New York1994
- When Black + lesbian + woman ≠ Black lesbian woman: The methodological challenges of qualitative and quantitative intersectionality research.Sex Roles. 2008; 59: 312-325
- The problem with the phrase women and minorities: Intersectionality-an important theoretical framework for public health.American Journal of Public Health. 2012; 102: 1267-1273
- Using thematic analysis in psychology.Qualitative Research in Psychology. 2006; 3: 77-101
- Sexual orientation disclosure in health care: A systematic review.British Journal of General Practice. 2018; 68: e187-e196
- Bodies that matter: On the discursive limits of sex.Routledge, London2011
- NCHHSTP AtlasPlus.(Available:)www.cdc.gov/nchhstp/atlas/Date: 2017Date accessed: October 21, 2018
- Intersectionality and in-depth interviews: Methodological strategies for analyzing race, class, and gender.Race, Gender & Class. 1999; 6: 156-181
- Intersectionality and the LGBT Cancer Patient.Seminars in Oncology Nursing. 2018; 34: 30-36
- Developing and using a codebook for the analysis of interview data: An example from a professional development research project.Field Methods. 2011; 23: 136-155
- Los Angeles, CA: SocioCultural Research Consultants.(Available:)www.dedoose.comDate: 2016Date accessed: November 26, 2018
- Meta-analysis of single-session behavioral interventions to prevent sexually transmitted infections: Implications for bundling prevention packages.American Journal of Public Health. 2012; 102: e34-e44
- Healthcare experiences of a Black lesbian in the United States.Journal of Health Psychology. 2017; 24 (135910531769003): 52-64
- Sexual orientation disparities in sexually transmitted infections: Examining the intersection between sexual identity and sexual behavior.Archives of Sexual Behavior. 2013; 42: 225-236
- Do sexual minorities receive appropriate sexual and reproductive health care and counseling?.Journal of Women’s Health. 2018; 28: 53-62
- Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development.International Journal of Qualitative Methods. 2006; 5: 80-92
- Sexually transmitted infections and risk behaviours in women who have sex with women.Sexually Transmitted Infections. 2000; 76: 345-349
- “I just think that doctors need to ask more questions”: Sexual minority and majority adolescents’ experiences talking about sexuality with healthcare providers.Patient Education and Counseling. 2016; 99: 1467-1472
- Young women who have sex with women: Falling through cracks for sexual health care.(Available:)www.advocatesforyouth.org/publications/552?task=viewDate: 2001Date accessed: May 25, 2018
- Discomfort, Judgment, And Health Care For Queers.Journal of Bioethical Inquiry. 2012; 9: 149-160
- Implementing curricular and institutional climate changes to improve health care for individuals who are LGBT, gender nonconforming, or born with DSD: A resource for medical educators.(Available:)www.aamc.org/publicationsDate: 2014Date accessed: November 26, 2018
- Health needs of women who have sex with women.BMJ. 2003; 327: 939-940
- Finding the perfect doctor: Identifying lesbian, gay, bisexual, and transgender-competent physicians.American Journal of Public Health. 2015; 105: 1114-1119
- Interviews in qualitative research.Sage, Thousand Oaks, CA2010
- Healthcare experiences of underrepresented lesbian and bisexual women: A focus group qualitative study.Health Equity. 2018; 2: 131-138
- Pediatric residents’ knowledge, perceptions, and attitudes towards homosexually oriented youth.Annals (Royal College of Physicians and Surgeons of Canada). 2002; 35: 401-405
- Predictors and consequences of negative patient-provider interactions among a sample of African American sexual minority women.LGBT Health. 2015; 2: 140-146
- Culturally competent sexual healthcare as a prerequisite for obtaining preexposure prophylaxis: Findings from a qualitative study.LGBT Health. 2017; 4: 310-314
- Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women.Perspectives on Sexual and Reproductive Health. 2005; 37: 6-12
- Emerging sexual health issues among women who have sex with women.Current Infectious Disease Reports. 2012; 14: 204-211
- Prevalence and risk factors for infection with herpes simplex virus type-1 and -2 among lesbians.Sexually Transmitted Diseases. 2003; 30: 890-895
- Sampling for qualitative research.Family Practice. 1996; 13
- Beyond the qualitative interview: Data preparation and transcription.Field Methods. 2003; 15: 63-84
- Risks and prevention of sexually transmissible infections among women who have sex with women.Sexual Health. 2005; 2: 209
- From silence to sensitivity: A new identity disclosure model to facilitate disclosure for same-sex attracted women in general practice consultations.Social Science and Medicine. 2012; 75: 208-216
- Disclosure for same-sex attracted women enhancing the quality of the patient-doctor relationship in general practice.Australian Family Physician. 2015; 44: 573-578
- Lesbian health inequalities: A cultural minority issue for health professionals.Medical Journal of Australia. 2003; 178: 643-645
- Qualitative data analysis: A methods sourcebook.Routledge, London2014
- Development of a conceptual framework for understanding shared decision making among African-American LGBT patients and their clinicians.Journal of General Internal Medicine. 2016; 31: 677-687
- Interviewing adolescents about sexual matters.Pediatric Clinics of North America. 2017; 64: 291-304
- Absent sexual scripts: Lesbian and bisexual women’s knowledge, attitudes and action regarding safer sex and sexual health information.Culture, Health & Sexuality. 2009; 11: 67-81
- Sexually transmitted disease (STD) diagnoses and mental health disparities among women who have sex with women screened at an urban community health center, Boston, MA, 2007.Sexually Transmitted Diseases. 2010; 37: 5-12
- Reproductive health care priorities and barriers to effective care for LGBTQ people assigned female at birth: A qualitative study.Women’s Health Issues. 2018; 28: 350-357
- Brief sexuality-related communication: Recommendations for a public health approach. 2. 2015 (Geneva. Available:)www.who.int/about/licensing/Date accessed: November 26, 2018
Jaquelyn L. Jahn, MPH, is a doctoral candidate at the Harvard T.H. Chan School of Public Health in the Department of Social and Behavioral Sciences. Her social epidemiologic research focuses on health inequities across gender, sexual orientation, and race/ethnicity.
Rachel A. Bishop, MPH, works to address systemic health inequities as Manager of External Affairs at MassHealth in the Office of Medicaid for the Commonwealth of Massachusetts.
Andy S.L. Tan, PhD, MPH, MBA, is Assistant Professor, Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health. His research is aimed at understanding health communication processes that contribute the burden of cancer and disparities across the cancer control continuum.
Madina Agénor, ScD, MPH, is Gerald R. Gill Assistant Professor of Race, Culture, and Society, Tufts University. She investigates health/health care inequities in relations to various dimensions of social inequality, especially sexual orientation, gender identity, and race/ethnicity, using an intersectional lens.
Published online: February 25, 2019
Accepted: January 10, 2019
Received in revised form: January 8, 2019
Received: September 6, 2018
Supported by American Cancer Society Postdoctoral Fellowship 128863-PF-15-149-01-CPHPS, project title: Sexual orientation and human papillomavirus vaccination among young women.
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.