Chapter 10 - Gynecologic Health Care for Sexual and Gender Minorities - Module 2

Question 1

Gynecologic health…

Answer 1

Gynecologic health is experienced biologically, psychosocially, sexually, and spiritually.

Question 2

Sexual and gender minorities

Answer 2

Lesbians, bisexual women, and transgender individuals. (LBT)

Question 3

Sexual identity refers …

Answer 3

Sexual identity refers to one’s self-label as heterosexual, homosexual/lesbian, bisexual, or something else.

Question 4

Sexual behavior refers …

Answer 4

Sexual behavior refers to one’s sexual partners, as well as the sexual activities in which one engages.

Question 5

Sexual preference refers …

Answer 5

Sexual preference refers to whom one desires sexually or about whom one fantasizes, the ones to whom one is attracted or desires

Question 6

Sex

Answer 6

Sex is one’s biological characteristics - anatomical, physiological (menstrual cycle; spermatogenesis), and genetic, as a female or as a male.

Question 7

Gender

Answer 7

Gender refers to what a person, society, or legal system defines as “female” or “male.”

Gender is a construct that includes psychological, social, and cultural factors, and is typically used to describe people as male of female.

Question 8

Gender role

Answer 8

Gender role describes the set of socially or culturally defined attitudes, behaviors, expectations, and responsibilities that is considered appropriate for women (feminine) and men (masculine).

Question 9

Gender identity refers …

Answer 9

Gender identity refers to one’s self-label related to gender, regardless of biologic sex. Some choose a gender identity consistent with their biologic sex. Other choose a gender identity that is the opposite of their biologic sex. Others choose a gender identity that is independent of sex.

Question 10

Transgender

Answer 10

Transgender is a broad construct that includes a wide variety of persons who have gender identities or behaviors that are not usually associated with their natal sex.

Question 11

Homophobia

Answer 11

An individual’s irrational fear or hate of homosexual people. Also, biphobia or transphobia for irrational fear or hatred of bisexual or transgender persons.

Question 12

Heterosexism

Answer 12

Heterosexiam is the societal institutionalization of a dichotomy where one group of people - in this case, heterosexuals - are valued, and another group, in this case, SGMs - are devalued and oppressed. In other words, heterosexuality is the best sexual orientation.

Question 13

“Coming out”

Answer 13

“Coming out” is a developmental process that includes identifying and accepting oneself for who one is, and then identifying oneself as that to others. It is a never-ending process, because the decision is revisited whenever an LBT persons meets someone new.

Question 14

Disclosure of sexual orientation, methods

Answer 14

Three types of disclosure are:

• Planned - the safest, a conscious decision to inform
• Passive - clinician not specifically told, but client assumes clinician infers orientation based on appearance. LBT individual does nothing to confirm or deny.
• Unplanned - Explicit decision against disclosure but something occurs during visit that forces the disclosure.

Question 15

Barriers to to quality health care for SGMs …

Answer 15

Barriers are internal (those held by the individuals themselves) or external (those within the healthcare system and among health care clinicians).

Question 16

SGM

Answer 16

Sexual and gender minorities

Question 17

Most significant external barrier is …

Answer 17

The assumption by clinicians that all of their patients are heterosexual. In GYN offices, this perspective is made obvious when clinicians assume that all women who come to them are seeking contraception.

Question 18

BMI and sexuality

Answer 18

Current research suggests that the prevalence of eating disorders does not differ between lesbian and bisexual women and heterosexual women. However, lesbians, and in some cases bisexual women, have higher body weight and or BMI than heterosexual women.

Question 19

Most important concern WRT to sexually transmitted infections …

Answer 19

Sexual behavior is the most important concern WRT STIs. Behavior, not identity, determines risk. Sexual partners and sexual behaviors, including risky practices such as not using condoms or other barriers during sexual activity, are what determine individual’s risk for contracting and transmitting STIs.

Question 20

Bisexual women and STIs …

Answer 20

Bisexual women are at very high risk for STIs because they often have large numbers of partners and engage in risky behaviors.

Question 21

STI (sexually transmitted infections) that can be transmitted woman to woman are:

Answer 21

Confirmed:
Human papillomavirus (HPV)
Bacterial vaginosis (BV)
Herpes simplex virus (HSV) 1 and 2
Suggested by case reports:
Trichomoniasis
Syphilis

Question 22

Transgender female to male (FTM) are also called

Answer 22

Transmen or men

Question 23

Transgender male to female (MTF) are also called

Answer 23

Transwomen or women

Question 24

HIV and SGM

Answer 24

HIV transmission rates:

• Between women is rare.
• Heterosexual transmission is very likely
• Women of color most likely to be infected heterosexually
• Transgender women (MTF) have extremely high rates of HIV infection at about 28% possibly d/t the cultural norm of sex work.

Question 25

Bacterial vaginosis …

Answer 25

Bacterial vaginosis is the most common cause of vaginitis, its cause is unknown. Bacterial vaginosis (BV) is more common in lesbians and other WSW than it is in heterosexual women.

Question 26

WSW

Answer 26

Women having sex with women

Question 27

Vulvovaginal candidiasis (VVC) …

Answer 27

Vulvovaginal candidiasis (VVC) may be sexually transmissible between women.

Question 28

Risky sexual behaviors of some LBT …

Answer 28

• Unprotected oral, anal, or vaginal sex with partners, male or female, whose HIV status is unknown or positive.
• Sex during menses.
• Sharing sex toys.
• Sadomasochistic activities resulting in skin breakage.
  Among the low-income, especially women of color or those addicted to drugs:
• Sex workers for drugs or money

Question 29

Polycycstic Ovary Syndrome (PCOS), risks

Answer 29

Polycycstic ovary syndrome (PCOS) may be more common in lesbians and FTM than in other women.

PCOS is characterized by polycystic ovaries, frequent anovulation resulting in oligomenorrhea (infrequent menstruation) or amenorrhea (absent menstruation), and hyperandrogenism. Often associated with obesity.

Complications: insulin resistance, dyslipidemia, and metabolic syndrome.

Question 30

Polycycstic Ovary Syndrome (PCOS), disease

Answer 30

Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age. The name of the condition comes from the appearance of the ovaries in most, but not all, women with the disorder — enlarged and containing numerous small cysts located along the outer edge of each ovary (polycystic appearance).

Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity can all occur in women with polycystic ovary syndrome. In adolescents, infrequent or absent menstruation may signal the condition. In women past adolescence, difficulty becoming pregnant or unexplained weight gain may be the first sign.

The exact cause of polycystic ovary syndrome is unknown. Early diagnosis and treatment may reduce the risk of long-term complications, such as type 2 diabetes and heart disease.

Associated with insulin resistance

Question 31

Gynecologic Cancers and Lesbians

Answer 31

A primary health concern: breast CA #1 with cervical and ovarian CAs in top ten.

Question 32

Breast Cancer risk factors

Answer 32

Female sex, age, family history, dense breast tissue, race, increased #s of periods (early menarche, no children, late menopause), no children or delayed childbirth (1st child after 30), lack of breastfeeding, alcohol consumption, overweight or obesity, lack of physical exercise, hormone replacement therapy, recent discontinuation of birth control pills

Question 33

Breast CA and lesbians

Answer 33

Studies suggest that lesbians have an increased risk of developing breast CA. Reasons: parity, breastfeeding, BMI, and use of alcohol.

Question 34

Ovarian CA and lesbians

Answer 34

Ovarian CA risk is increased in lesbian women d/t lower parity and less use of oral contraceptives (believed to protect against ovarian cancer). Lesbians also have a higher BMI (increased CA risk) but lower smoking rates.

Question 35

Pap smears and lesbians

Answer 35

Lesbians are less likely than heterosexual women to have regular Pap tests.

Question 36

Youth and Adolescents

Answer 36

Youth and adolescents are less likely to identify themselves as lesbian or gay, regardless of their sexual behaviors. LBT youth and adolescents typically engage in high risk behaviors exposing them STIs, pregnancy, and cervical CA. LBTs have high rates of sexual abuse, homelessness, and prostitution or survival sex. Lesbian youth are likely to have body piercings or tattoos (increases risk for bacterial infections and STIs), are more likely to smoke (risk factor for cervical cancer).

Question 37

Chapter 10 is

Answer 37

complete.