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Feature Article

Lesbian, bisexual and queer women’s health: a guide for GPs

RUTH MCNAIR
OPEN ACCESS

Parenting issues can also arise related to preventing social stigma and encouraging resilience in the children. However, parents can be reassured that the social, physical and mental health outcomes for children of same-sex parented families are the same as for children in any family.7

Resources for LBQ women on reproduction and families are provided in Table 1.

Socially determined health issues 

Identity formation and coming out

Social attitudes regarding minority sexual orientation have a huge role to play in the health and wellbeing of LBQ women. This starts during sexual identity formation (usually around puberty) and can progress through the life stages. Although attitudes have dramatically improved over the past few years, there are still regions and cultural subgroups in which homophobia, biphobia and transphobia are prevalent. 

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For LBQ young people, the role of families of origin is critical to their mental health and resilience during the period of identity formation. For example, in a recent US study of 843 LBQ women between 18 and 25 years of age, up to 41% had experienced rejection from their families after coming out, and for many this had affected their self-esteem and community connection.8 Analysis of the US National Longitudinal Study of Adolescent Health showed that lesbian and bisexual young women reported lower levels of parental support than heterosexual women, and that this correlated with higher levels of depression and suicidality.9 

LBQ young people from socially conservative communities can internalise the negative messaging and regard themselves as abnormal or morally corrupt. Conversely, family support builds resilience, self-esteem and wellbeing for LBQ young people.10 

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Affirmation of emerging minority sexual identities by a health professional can be important during the coming out period. This can include assisting the young person to find like-minded peers and supportive adults through either school or community networks.

Resources on family and multicultural support and LBQ young people are listed in Table 1.

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Mental health

LBQ women are at least twice as likely as heterosexual women of any age to experience depression, anxiety and suicidal ideation. This has been related to ‘minority stress’, which is the day-to-day reality or potential of experiencing negative attitudes and threats.11 It can also involve a greater likelihood of abuse and violence from strangers and within families and intimate relationships, again at least twice as high as heterosexual women.12 Intimate partner violence (IPV) is at least as likely among female couples as heterosexual couples, and may even be higher. In the US National Violence Against Women Survey, all types of IPV were twice as likely among the lesbian and bisexual women as among the heterosexual women.13 Issues associated with IPV for same-sex couples include a family history of violence, past IPV, fusion (where the couple have few social outlets as individuals) and alcohol intake.14 Unfortunately IPV services tend to be gendered so it can be difficult for female perpetrators to seek help, and fear of discrimination in services can be a barrier to help-seeking for victims.15

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Dr McNair is Honorary Associate Professor in the Department of General Practice at The University of Melbourne, Melbourne; and Director at Northside Clinic, Melbourne, Vic.