Healthcare professionals need explicit and consistent sensitivity and anti-discrimination training to improve health outcomes of women who self-identify as a sexual minority, according to study results from the International Journal of Environmental Research and Public Health.

Sexual minority women (SMW) are female patients who define themselves by sexual identity (lesbians, bisexual women), behavior (women who have sex with women, women who have sex with men and women), or relationship status (women who are married to or cohabitate with other women).

 “Although there is [a] limited evidence-base, in general, SMW experience worse mental health, physical health, and higher risk factors for physical ill-health than their heterosexual counterparts,” wrote Catherine Meads, of the Anglia Ruskin University in Cambridge, United Kingdom, and the study lead investigator.

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To further study the effects of sexual orientation on healthcare experience and outcomes, the researchers conducted a systematic review of studies published from 2010 to 2018 on SMW health experiences in the United Kingdom. Search terms included text words for sexual minority identity, behavior, and relationship status, as well as lesbian, gay, bisexual, and transgender health.

A total of 23,102 citations were identified; after exclusion criteria, 26 studies were included, described in 29 papers, 22 of which provided qualitative results and 9 qualitative results. Study cohorts were from the general community and ranged in age from teenagers to >50 years.

The analysis of the studies found a consistent trend experienced by SMW: the presumption of heteronormativity, which was experienced in the images and language used in the waiting areas, leaflets, forms, and vocabulary used by staff. Other barriers experienced by SMW included experiences of negative responses to coming out, ignorance and prejudice from healthcare professionals, and barriers to raising concerns or complaints.

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The negative effect of these barriers “was that [SMW] either delayed or did not access health care,” reported the investigators.  “Years of experience of prejudice means that women need positive signs/images that a [practice] will be [LGBTQ] friendly.” To counter this, healthcare practitioners need to be aware that “treating people equally and respectfully does not mean treating them the same, but making adjustments appropriate to their life situations. The assumed heterosexuality that SMW may encounter influences every aspect of their journey through [the healthcare system],” they added.

“There is a strong need to enhance healthcare professionals’ understanding of how to provide culturally competent care for LGBTQ people and to understand this group’s health needs,” the investigators concluded.


Meads C, Hunt R, Martin A, Varney J. A systematic review of sexual minority women’s experiences of health care in the U.K. Int J Environ Res Public Health. 2019;16(17):3032.