Unique Considerations for LGBT Patients with Endometriosis

Endometriosis can be an extremely painful condition.

Often, patients will complain of experiencing debilitating pain during and between periods, pain with urination and bowel movements, migraines, bloating, pain while having sex, and infertility issues.  It used to be a common myth that endometriosis was a disease that just affected women who were of childbearing age. It’s now known that the disease doesn’t discriminate based on race, religion, sexual orientation or socioeconomic status. It should be noted, though, that these things might impact a patient’s experience of the disease.

It is frequently assumed that patients with endometriosis are heterosexual, both in clinical and non-clinical settings. The questions health care providers usually ask are hetero-normative and non-inclusive of all patients. It’s imperative to consider our society’s assumptions regarding LGBT couples, their sexuality, family planning, and reproductive/sexual health, and how our assumptions impact conversations in healthcare settings. It’s important to ask whether LGBT patients with endometriosis are cared for and understood so that their needs can be met.

Unique Considerations for LGBT Patients with Endometriosis

It’s often very uncomfortable for an LGBT patient to disclose their sexuality, etc. They fear judgment and might be fearful based on past experiences. A relationship status is usually inquired about in order for the provider to begin an evaluation of sexual activity and other medical aspects, which could include sexually transmitted diseases, contraception and even a history of abuse. While some may answer honestly about their relationship status, and might answer truthfully with an answer of “No”, without elaboration to a question such as, “Do you have a boyfriend right now?”, this won’t provide the clinician with the information they’re seeking. A patient might even ignore the topic completely in an effort to avoid judgment. This could hinder care, rendering the provider unable to completely evaluate the patient. It’s also important not to use hetero-normative speech and say “partner” or “spouse” rather than assigning a gender. This shows the LGBT patient that the provider is potentially more sensitive.

An area of research that needs attention is that of transgender patients with endometriosis. Often, the needs of transgender patients are neglected in academic research because they’re frequently misunderstood and ignored by scholars. This is considering, due to the article referenced, those with female reproductive organs who self-identify as men. Even though they might appear to be one gender, their gynecologic health needs to be considered regarding endometriosis. It is crucial that providers ask in-depth medical history questions, even if the transgender person appears to be a man, outwardly. Some transgender patients have the diagnosis and still need gynecologic care. Certain barriers cause a fear of negative provider response when it comes to talking about sexual identity.

Those who suffer from endometriosis are a diverse group.  Healthcare providers should be setting aside personal prejudices and assumptions. It’s important that a patient knows their provider is inclusive and competent.

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