By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

My sister Ellen is getting married in two weeks, so last Sunday I threw a surprise bridal shower. We had all the traditional trappings—flowers and favors and (much to another sister’s chagrin) a shower game and prizes. The only thing not traditional: at this shower there were two brides, my sister and her fiancée, Pat.

After years of standing by invisible while sisters and brothers married, danced with their partners at each other’s weddings, celebrated births and graduations, now it’s their turn. No longer on the periphery, no longer the ‘other,’ at least for this day, these few weeks, they are finally able to celebrate their love and commitment to each other just like the rest of us.

Why am I writing about this in a nursing blog? Because this invisibility, this sidelining of lesbians like my sister and her fiancée, doesn’t only affect their family life—it extends into their health care as well. Neither Ellen nor Pat ever got routine women’s health care—no Pap smears, no clinical breast exams or mammograms, no routine assessment for osteoporosis risk. They were never hooked into the health care system by reproductive health needs, contraception, or pregnancy and childbirth, as my other sisters and I were. They didn’t have a regular gynecologist who followed them through their reproductive years and would now advise them on preventive health care as they approached menopause.

This isn’t unusual among lesbians; according to the CDC, many avoid getting routine health care. And there is evidence that lesbians may be at greater risk for some health problems. For example, it is known that pregnancy and breastfeeding are protective against certain cancers such as ovarian and breast. Many lesbians never go through pregnancy and childbirth, yet they are less likely than other women to get routine Pap tests or mammograms. And they live with the constant stress of social stigma and discrimination, risk factors for depression, anxiety, and heart disease.

There are a number of reasons why lesbians don’t get necessary health care: lack of domestic partner benefits, which prevents them from qualifying for health insurance coverage through their partner’s plan; discomfort talking with their provider about their sexuality; being misinformed about their risks; and lack of knowledge on the part of their health care providers. According to the Institute of Medicine there is an urgent need for research—we know lesbians face unique problems and risks, but we don’t have an evidence-based understanding of exactly what they are or how to address them.

As nurses we need to make sure our cultural competence extends beyond ethnicity to include factors like sexual orientation. We need to examine our own biases and honestly assess our interactions with lesbians, as well as gay, bisexual, and transgender patients, to ensure that we are accepting, caring, and knowledgeable. And we need to pay attention to their unique health needs.

Recently Ellen and Pat each experienced significant health scares. As I watched them go through repeated biopsies and distressing procedures, I realized I had failed them. I’m a nurse practitioner who practiced extensively in women’s health, but never once did I say, Hey Ellen, have you had a pap test? Hey Pat, you need to make sure you get a mammogram.

I’ve vowed to do better in the future, not just for them but for all women. It’s time for us to step up and make sure that everyone has access to the health care they need to live healthy lives. Who better to do that than nurses?

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