Knight Daniel A, Jarrett Diane
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Am Fam Physician. 2017 Mar 1;95(5):314-321.
Despite recent shifts in societal attitudes toward same-sex relationships, women who have sex with women face a variety of barriers to optimal health, including a history of negatively perceived interactions in clinical settings that lead them to delay or avoid health care. Women who have sex with women may be at disproportionate risk of obesity, tobacco use, substance use, mental health issues, intimate partner violence, sexually transmitted infections, and some cancers. Disparities can exist throughout the lifetime. Lesbian and bisexual adolescents are vulnerable to bullying, family rejection, and risky sexual behavior that may lead to sexually transmitted infections or unintended pregnancy. Sexual minority stress, which is a response to stigmatization, prejudice, and internalized homophobia, contributes to many of these conditions. Family physicians should foster trust and communication to provide a nonjudgmental, welcoming environment supportive of culturally competent health care and optimal outcomes. When indicated, clinicians should refer women who have sex with women to culturally sensitive community resources and legal advisors for assistance with medical decision making, hospital visitation, conception, and legal recognition of nonbiologic parents.
尽管最近社会对同性关系的态度有所转变，但与女性发生性行为的女性在获得最佳健康方面面临各种障碍，包括在临床环境中曾有过被负面看待的互动经历，这导致她们推迟或避免寻求医疗保健。与女性发生性行为的女性可能在肥胖、吸烟、药物使用、心理健康问题、亲密伴侣暴力、性传播感染以及某些癌症方面面临更高的风险。这种差异可能贯穿一生。女同性恋和双性恋青少年容易受到欺凌、家庭排斥以及可能导致性传播感染或意外怀孕的危险性行为的影响。性少数群体压力，即对污名化、偏见和内化的恐同心理的一种反应，是导致这些情况的诸多因素之一。家庭医生应建立信任并促进沟通，以提供一个无偏见、友好的环境，支持具备文化能力的医疗保健并实现最佳治疗效果。如有需要，临床医生应将与女性发生性行为的女性转介至具有文化敏感性的社区资源和法律顾问处，以协助她们进行医疗决策、医院探视、受孕以及非生物学父母的法律认可等事宜。
