My case study covers a 32-year-old female TJ, being seen for an annual physical exam. She is currently pregnant without complications from receiving sperm at a local sperm bank. She has a family history of diabetes and is presently experiencing vaginal discharge. She has been currently being seen by an obstetrician for prenatal care. Current medications include prenatal vitamins and occasional Tylenol for pain. Her sexual orientation is lesbian, and her pregnancy history is Gravida1; Para 0; Abortions 0.
Patients that identify as lesbian or bisexual tend to participate in more risky behaviors such as smoking or occasional alcohol use compared to heterosexual women (Gonzales, G., Quinones, N., & Attanasio, L., 2019). Lesbian and bisexual individuals experience discrimination and stigma and may delay care related to fear (Fagan, M. P., & Ireland, C. L., 2020). Mental health factors are a concern related to depression, suicide ideation, and self-harm (Fagan, M. P., & Ireland, C. L., 2020). Sexual orientation may place the patient at a higher risk for sexually transmitted diseases and HIV, but testing should only be based on the level of risk, not orientation (Fagan, M. P., & Ireland, C. L., 2020). Patients within the LBGT community have increased health disparities due to the lack of insurance and physician care due to fear of bias and discrimination (Anticuar, S., 2021). Should a patient come out to disclose sexual orientation, it should be acknowledged, but sexual behavior should not be assumed (Fagan, M. P., & Ireland, C. L., 2020).
The following questions may be asked to develop a health history assessment without regard to sexual orientation.
“Currently, how many weeks pregnant are you? Or How many weeks along are you?”
“Current due date?” “When was your last Obstetrician appointment?”
“Is there a significant other involved with the pregnancy?”
“Can you tell me how long you have had vaginal discharge? Color? Consistency? Any Odor?”
“Have you had any other symptoms?” Burning with Urination? Vaginal pain or itching?”
“Do you smoke or drink?”
Anticuar, S. (2021). Examining Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Adults in Davidson County, Tennessee.
Fagan, M. P., & Ireland, C. L. (2020). Guide for Providing Care for Lesbian, Gay and Bisexual Patients in Primary Care Quick Reference Guide.
Gonzales, G., Quinones, N., & Attanasio, L. (2019). Health and access to care among reproductive-age women by sexual orientation and pregnancy status. Women’s Health Issues, 29(1), 8-16.
Your post regarding the potential nuances of caring for LGBTQ females was informative. I also felt that your line of questioning was a good start to get some basic, helpful information related to her health and well-being. While there is a large quantity of evidence-based research and data surrounding heterosexual pregnant females and their care, the same is not so for LGBTQ patients; although, the information is on the rise given the changes to our culture. However, it will still be many years before a robust database will be available. As noted by Malmquist et al. (2019), healthcare providers often still address LGBTQ patients with a heteronormative undertone, that is mother/father directed, especially with forms and pre-printed material. As a heterosexual female, this is something that could easily be overlooked as offensive because we aren’t looking at patient information from the same lens. According to Malmquist et al. (2019), as well as others I have read specifically for this discussion post, the experiences in healthcare for LGBTQ patients have been a mix of positive and negative.
Another line of questioning to consider would be her thoughts on the sperm donor profile. Since the women are permitted to visualize the physical and other attributes of the donor, we can initiate conversation to the thought process behind the chosen donor. In the future, the child may want to know more about the other, biological side of their genetics. More recently, some information has become available to donor recipients that includes a donor profile including hobbies, education, and character traits, physical description, and even some inclusion of staff perceptions of the donor, a practice that originated in sperm banks that initially served only lesbian couples (Scheib & McCormick, 2016). Utilizing a sperm bank donor requires that the sperm be frozen which decreases the chances of conception (Scheib & McCormick, 2016). This may or may not have been her first round of insemination. This can become a profound source of financial and emotion stress if it’s taken multiple rounds to produce a pregnancy. There are several more layers to this patient’s pregnancy than surface value that need to be investigated and discussed in order to provide inclusive, well-rounded care.
References:
Malmquist, A., Jonsson, L., Wikstrom, J., & Nieminen, K. (2019). Minority stress adds
Additional layer to fear of childbirth in lesbian and bisexual women, and transgender
People. Midwifery, 79, 1-7.
Scheib, J. & McCormick, E. (2016). Sperm donor, choosing a. In Goldberg, A. (Ed.),
The SAGE Encyclopedia of LGBTQ Studies (pp. 1109-1113). SAGE Publications.
DOI: http://dx.doi.org/10.4135/9781483371283.n390
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