Every October, the nation’s attention turns to issues of women’s health. As Breast Cancer Awareness Month, October serves as an opportune time for women’s health groups, medical institutions and others to raise awareness of a disease that has touched many women. Yet, other health risks particular to women and especially to lesbians are also of importance.
Jan Warren-Findlow, an associate professor of public health sciences at the University of North Carolina-Charlotte, says attention to these other important health factors can sometimes be lost. Her research primarily involves cardiovascular disease, which remains the number one killer of women.
“There’s a part of me that says maybe we put too much emphasis on breast cancer and not nearly enough on heart disease,” she says.
Risks for heart disease in women are numerous, Warren-Findlow explains. As with other minorities, whose smoking rates tend to trend higher, tobacco use can increase lesbian women’s risks for heart disease and heart attacks just as it does for lung and other cancers.
Generally, a male-dominated medical culture also plays a role in the ways women’s cardiovascular disease goes unnoticed.
“We’ve now discerned that women typically have different kinds of heart disease than do men,” she says. “That classic image of a guy clutching his arm or chest isn’t how heart disease or a heart attack manifests in women.”
She says women often present disease in the microvascular heart veins. Tools, screenings and instruments used to measure heart disease often don’t examine these smaller veins; many of these tools and the research behind them have been tailored toward men.
“When a woman complains of chest pain, they use the standard screenings on her and they don’t see anything in the big arteries and they don’t necessarily have good screening tools to look at the tiny parts of the heart,” the professor explains. “So, she continues to have unexplained chest pain and they don’t really see that she’s having heart disease and she ends up having a heart attack.”
The types of doctors women choose to see can also have an impact on health risk. Heterosexual or bisexual women who are sexually active with men might choose to see obstetricians and gynecologists.
“At a certain point life,” Warren-Findlow warns,” she really needs to start transitioning to a primary care doctor because the risk profile shifts from being less reproductive-oriented to more cardiovascularly-oriented. You need someone who is really monitoring your blood pressure, your cholesterol level, your weight and your physical activity.”
Lesbian women who are not sexually active with men face their own set of unique health risk factors. Many are circumstantial, Warren-Findlow says.
“Many lesbians don’t necessarily see a physician as often as they maybe should,” she says.
Young women, she explains, often accustom themselves to at least yearly check-ups if they are prescribed contraceptives.
“The protocol is that you must come in yearly for a pelvic and cervical cancer screening,” she says. “If you’re not taking contraceptives you don’t necessarily get into that routine.”
Better communication between providers and patients can increase positive health outcomes. Many times, both patient and physician are uncomfortable talking about sexual health issues. Such discomfort can intensify if a patient is not out.
“It is important when talking about groups of people who might be marginalized in society to talk about whether people are out and in what venues they may be out because that can have an affect on health, physically, emotionally and mentally,” Warren-Findlow says. “If you’re only out with your partner and you are not able to be out with family or at work that can set up conflicts with mental health; you’re not able to be authentically who are are.”
Such concerns carry over into the doctor’s exam room.
“If they don’t feel like they can be honest [with their physician] that can influence their health risks,” she says.
Ultimately, Warren-Findlow believes more open and honest communication needs to occur between providers and patients.
“I would really like us to get to a place where providers had more time to really pay attention to people’s medical history,” she says. “The medical history should include whether you are sexually active and if you are willing to disclose your sexual orientation. That might have some really important information that a provider will need to know. Most people don’t even get asked and providers just assume.”
She adds, “I try to teach my students that when we talk about sexual orientation, we’re not just talking about gays and lesbians. Heterosexuality is a sexual orientation, too, that has its own health risks. Different groups have different risks.”