Articles and texts on health and healthcare disparities for sexual orientation and gender minorities
Links are organized by blocks and clinical rotations.
* Created by the SOM LGBT Curriculum Team
GLOSSARY of terms
DSD: Differences of Sex Development
FtM: Female to Male
GI: Gender Identity
LGBTQI: Lesbian, Gay, Bisexual, Transgender, Queer/Questioning and Intersex
MSM: Men who have Sex with Men
MtF: Male to Female
SO: Sexual Orientation
WSW: Women who have Sex with Women
Sexual Orientation and Gender Minority Health
IN EMERGENCY MEDICINE
Multiple studies have shown that many transgender individuals avoid seeking emergency care due to the perception that their trans status would negatively affect their care. In some cases, over 50% of trans surveyed reported some type of trans-specific negative experience in an ED. Furthermore, only 33% of EM residency programs address LGBT health anywhere in their curricula.
Bauer GR, Scheim AI, Deutsch MB, Massarella C. Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey. Ann Emerg Med. American College of Emergency Physicians; 2014 Jun;63(6):713–20.e1.
Moll J, Krieger P, Moreno-Walton L, Lee B, Slaven E, James T, et al. The Prevalence of Lesbian, Gay, Bisexual, and Transgender Health Education and Training in Emergency Medicine Residency Programs: What Do We Know? Acad Emerg Med. 2014;21(5):608–11.
Factors such as higher levels of social stress, frequent patronage of bars and clubs, higher rates of alcohol and drug use, and direct targeting of LGBTI consumers by the tobacco industry may be related to higher prevalence rates of tobacco use among some LGBTI people. A growing body of evidence indicates that lesbian, gay, bisexual and transgender individuals are considerably more likely to use tobacco than the general population, with some studies estimating smoking rates as much as double the national average. Tobacco companies offer an unknown amount of financial support to LGBTI festivals, bars, media, and local organizations.
Lee J, Blosnich JR, Melvin C. Up in smoke: Vanishing evidence of tobacco disparities in the Institute of Medicine’s report on sexual and gender minority health. Am J Public Health. 2012 Nov;102(11):2041–3.
Sexual minority women and subsets of sexual minority men are at increased risk for cardiovascular disease when compared to heterosexuals. Also, stressful life events in young adulthood place LGB youth at increased risk for the development of cardiovascular disease.
Farmer GW, Bucholz KK, Flick LH, Burroughs TE, Bowen DJ. CVD Risk among Men Participating in the National Health and Nutrition Examination Survey (NHANES) from 2001–10: Differences by Sexual Minority Status. J Epidemiol Community Health 2013;67(9):10.1136.
Stressful life events, sexual orientation, and cardiometabolic risk among young adults in the United States. Hatzenbuehler, Mark L.; Slopen, Natalie; McLaughlin, Kate A. Health Psychology, Vol 33(10), Oct 2014, 1185-1194.
There are a number of different disparities in the LGBT population associated with renal physiology. These include differences in urologic health in women who has sex with women, differences in rates and causes of UTIs in gay men, and differences in the physical symptoms of surgery to treat prostate cancer as well as the fear of recurrence of the cancer in gay and bisexual men.
Sturm RM, Breyer BN, Li CS, et al. Prevalence of Overactive Bladder and Stress Urinary Incontinence in Women Who Have Sex with Women: An Internet-Based Survey. Journal of Women's Health. Nov 2014, 23(11): 935-940.
Torbit, L. A., Albiani, J. J., Crangle, C. J., Latini, D. M. and Hart, T. L. Fear of recurrence: the importance of self-efficacy and satisfaction with care in gay men with prostate cancer. Psycho-Oncology. 2014.
Kamen CS, Smith-Stoner M, Heckler CE, Flannery M, Margolies L. Social support, self-rated health, and lesbian, gay, bisexual, and transgender identity disclosure to cancer care providers. Oncol Nurs Forum 2015 Jan 1;42(1):44–51.
Méndez-Martínez R, Rivera-Martínez NE, Crabtree-Ramírez B, et al. Multiple human papillomavirus infections are highly prevalent in the anal canal of human immunodeficiency virus-positive men who have sex with men. BMC Infectious Diseases 2014;14(1):671.
Quinn, G. P., Schabath, M. B., Sanchez, J. A., Sutton, S. K. and Green, B. L., The importance of disclosure: Lesbian, gay, bisexual, transgender/transsexual, queer/questioning, and intersex individuals and the cancer continuum. Cancer. 2014.
Ong JJ, Temple-Smith M, Chen M, Walker S, Grulich A, Fairley CK. Exploring anal self-examination as a means of screening for anal cancer in HIV positive men who have sex with men: a qualitative study. BMC Public Health. 2014 Dec 11;14:1257.
Van Rijn VM, Mooij SH, Mollers M, et al. Anal, Penile, and Oral High-Risk HPV Infections and HPV Seropositivity in HIV-Positive and HIV-Negative Men Who Have Sex with Men. Zhang L, ed. PLoS ONE 2014;9(3):e92208.
Members of the LGBT community have unique concerns when considering issues involving aging and dementia. How their experiences differ from those outside of the LGBT community have often been overlooked. Members of the LGBT community with impairments in hearing or communication also face unique challenges in terms of quality of life and disclosure of their sexual orientation.
Kelly RJ, Robinson GC. Disclosure of membership in the lesbian, gay, bisexual, and transgender community by individuals with communication impairments: a preliminary web-based survey. Am J Speech Lang Pathol. 2011 May;20(2):86-94.
Studies have shown that adolescents who identify as lesbian, gay, bisexual, transgender, or questioning suffer higher rates of mental health disorders than their straight counterparts and are at higher risk for suicidality. Sexual and gender identity minority youths are also more likely to smoke, abuse prescribed and illicit drugs, and contract an STI. These health disparities are hypothesized to exist because of the difficulty of the coming-out process, the bullying and victimization that LGBT youth face at school, and general societal discrimination against sexual and gender minorities.
Poteat VP, Scheer JR, and Mereish EH. Chapter Eight: Factors Affecting Academic Achievement Among Sexual Minority and Gender-Variant Youth. Advances in child development and behavior. 2014;47: 261-300.
Kecojevic A, et al. Initiation into prescription drug misuse: Differences between lesbian, gay, bisexual, transgender (LGBT) and heterosexual high-risk young adults in Los Angeles and New York. Addictive behaviors. 2012;37.11:1289-1293.
Russell ST, Ryan C, Toomey RB, Diaz RM, and Sanchez J. Lesbian, Gay, Bisexual, and Transgender Adolescent School Victimization: Implications for Young Adult Health and Adjustment. Journal of School Health. 2011;81.5: 223-30.
LGBT individuals are at higher risk for many common psychiatric diseases, including depression and anxiety, as well as other mental health-related issues, such as substance abuse, suicidal ideation and suicide. Being LGBT itself is no longer considered a mental disorder, though controversial reorientation therapy continues despite evidence of its deleterious effects on mental health. Though LGBT youth and adults often face greater victimization and bullying, there appear to be psychologically protective effects to disclosing and seeking social support as an LGBT-identifying person.
Flentje A, Heck NC, Cochran BN. Experiences of ex-ex-gay individuals in sexual reorientation therapy: reasons for seeking treatment, perceived helpfulness and harmfulness of treatment, and post-treatment identification. Journal of Homosexuality. 2014; 61: 1242-1268.
King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, Nazareth I. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay, and bisexual people. BMC Psychiatry. 2008; 8(70)
Surgery plays an important role for many gender non-conforming patients, and there are constant innovations in gender affirming surgery. Access to surgery for these patients varies dramatically by state, insurance plan, and employer. Furthermore, within surgical training programs themselves, there is noted targeted homophobia toward LGB residents by both fellow residents and surgical attendings.
IN WOMEN's Health
Multiple studies have shown that lesbian and bisexual women are less likely to report having an annual Pap test, mammography screening, and to seek healthcare services in general. Lesbian women are also less likely to use oral contraception and much more likely to be nulliparous. Studies have demonstrated that lesbians who disclose their sexual orientation to their provider are more likely to undergo preventative screenings; fear of discrimination is a documented barrier of lesbians seeking gynecological care.
Agénor M, Krieger N, Austin SB, Haneuse S, Gottlieb BR. Sexual orientation disparities in Papanicolaou test use among US women: the role of sexual and reproductive health services. Am J Public Health. 2014;104(2):e68-e73.
General Curricula and Training on Sexual Orientation and Gender Minorities
Sequeira G, Chakraborti C, Panunti B. Integrating lesbian, gay, bisexual, and transgender (LGBT) content into undergraduate medical school curricula: a qualitative study. Ochsner J. 2012;12(4):379-382. http://www.ochsnerjournal.org/doi/abs/10.1043/1524-5012-12.4.379.