1998: Lesbische vrouwen
Lesbische vrouwen en gezondheidszorg in nederland
1998 in Women Wise, Canada
‘Mijn gynaecoloog vond het heel normaal dat mijn vriendin erbij was’
Doctors, nurses and teachers in Great Britain often display a variety of attitudes that show they either disapprove of or misunderstand their lesbian patients. The British scientist Dr. Hazel Platzer stated this during her lecture given at the international Conference, ‘Teaching to Promote Women’s Health’, held in Toronto, June 1996.
Her stories about the way lesbian women are often treated by healthcare workers in Great Britain, raises curiosity about the situations in other countries, like the Netherlands, known for a liberal approach towards homosexuality, or the United States, where homophobia is still going strong.
Are physicians aware of the sexual preferences of their clients? How do they become informed? Are they prejudiced about lesbian women participants of health Care services in general, and in the gynecological fields in particular?
In the Netherlands I interviewed some lesbian doctors, who know the medical world from the inside, a (lesbian) nurse, and several lesbian women who visit their doctors on a regular base.
My General Practitioner claims she only has one lesbian patient: I think it is highly impossible that this is really true. Why doesn’t she know?
One of the reasons might be the fact that the medical schools do not pay much attention to training physicians-to-be in asking the right questions. There is no way for most of them to know how to ask ‘open questions’, which enable patients to answer freely. In the medical schools there is a large gap in the information about homosexuality, so if patients don’t really tell their doctors for some specific reason they are gay, all doctors assume their patients are heterosexual.
In the Netherlands the government created a Women’s Health Care Center in Utrecht, where a team of women, specialized in different fields, provide health care especially for women. Rikste Hinloopen is the main physician there, and being a lesbian herself, she attracts many lesbian patients to the center. ‘During my medical training it was really hard to come out being gay’, she says. ‘The whole setting was macho, focused on male students. I had hardly any chance to talk about the fact that I wasn’t attracted to my male colleagues, so they joked about me a lot. Those doctors have lesbian patients to attend to right now!’
Leoniek van der Schoor is a gynecologist in a hospital in the eastern part of the Netherlands. She gave birth to two children, during the time she worked there, and lives with her female partner in a small village nearby.
‘When I started to be an assistant, nobody paid any attention to sexual matters. That is changing now, thank God. But most doctors still handle issues like homosexuality like it belongs to a different planet. In their daily routine they give it no thought that some people might have different sexual preferences from their own. I remember young colleagues giggling amongst themselves about the fact a patient had told one of them she couldn’t possibly have herpes, because she had a female partner. They were snickering about how women can transfer STD’s (sexual transmitted diseases) by way of oro-genital contact.’
As far as Leoniek van der Schoor is concerned, it is impossible to create standards for doctors about their approach to homosexual man and lesbian women. There are as many varieties of sexuality as there are people. She thinks it will be far better to train physicians in communication techniques. Doctors should learn to question their own values about different lifestyles. Only then can they handle their prejudices and know how to deal with them. Dealing with different lifestyles has everything to do with your own way of thinking. Leoniek: ‘I can see this happening with my own patients. I know of some of them that they live together with women, but not of all of them. Sometimes that is not really necessary at all for a gynecologist. I think a general practitioner should know however, because a GP takes a key position in the health care system.’
One of the most important conclusions drawn by Hazel Platzer is, that clearly some doctors in Great Britain show sheer hostility when partners of the same sex request information in a crisis-situation or hospitalization. In the Netherlands this is very seldom the case if doctors know who the actual partner is. Most physicians assume women are heterosexual, but when they are told this is not the case, they treat partners with respect. Rikste Hinloopen: ‘In my practice I don’t see lesbian women being treated as heterosexuals any more, but that is because these women choose very carefully to whom they want to go. In Utrecht (in the center of Holland) lesbian women have their own network. They inform each other about doctors and other issues that are important to know. So, when it is clear to a physician the partner is female, they are treated with due respect.’
Marjo van Loosdregt is a social worker for a provincial research and advice-center in the South of the Netherlands. She is convinced that within the network of lesbian women throughout the country a lot of information is exchanged. ‘I belong to the group of emancipated lesbians, who marched for our rights in the seventies. I am fortunate to belong to a relatively small group of women with a network of their own. But for women who are struggling with their coming out it is different. They are having a difficult time once they are confronted with the health care system. They don’t show up with their female partners.’
Whenever lesbian women meet prejudice, it is mostly from people who are ill-informed. It is hardly ever because of hostility. Rikste Hinloopen has a child, together with her partner. Her partner gave birth to the baby under auspicious circumstances. ‘Because’, Rikste says, ‘in the hospital where our baby was born, they have lesbian couples all the time. They don’t do anything else but help couples with insemination. In our experience, it was actually the nurse, who really frowned when I appeared to be the other parent.’
Riet Jansen has been a nurse all her life. She lived in Canada and the United States for a while with her American partner. Her memories of that time are not positive at all. First of all her girlfriend always acted like they were ‘only’ roommates, even within her own circle of close friends. So it was unspeakable to think they would go to a doctor together. After a couple of years they split up and Riet came back to the Netherlands, where she now lives with her new partner. Riet: ‘I was always used to going to see a doctor by myself. That is what I did when the doctor took a biopsy out of my breast, although that was a really scary experience. That would be completely different now. Now I would go and see a physician with my partner if anything serious were the matter.’
However, in general, in the Netherlands lesbian women advise other lesbians to tell their doctors on the first visit that they are gay. The more naturally they talk about it themselves, the less prejudice they meet. Leoniek van der Schoor: ‘I want to know whether the woman present is just ‘a’ friend or ‘the’ girlfriend of my patient. You talk differently when you know the partner is there with her. I can see it works the same way for my colleagues. Most of the time doctors respond in a positive way. One woman says: ‘My gynecologist found it quite normal my girlfriend came along.’
What experiences do lesbian women themselves have with their doctors? One woman told me: “One time my pap smear wasn’t okay. My GP, a woman, asked me whether it bothered me while having intercourse. She had forgotten I lived with a woman. When I told her that, she apologized for not remembering it. So, sometimes these remarks are easily made and they are not really thoughtful.”
Something similar happened to another woman: “I went to see my GP because of a vaginal irritation and asked her whether the infection was contagious between two women. Because of this remark she took it for granted that I didn’t have any kids, because she said: ‘Okay, because you haven’t been pregnant I will use the virgin speculum.’ But I do have two grown up children!”
But not all women come across responses like this. One woman for example reports: “At the age of 29 I wanted my tubes to be tied. That was an unusual request at that young age, without having a family. The gynecologist had a standard questionnaire in front of him and he asked me: ‘Do you have a boyfriend?’ I answered, ‘No, I have a girlfriend.’ At the end of the session, he said he really appreciated my being so open about my relationship. He confessed that he found it quite difficult to handle issues like this in a conversation with a patient. He understood that I did not want to have children at any time and that I wanted to make sure it would never happen. It didn’t make any difference for me whether I would have had a male or a female partner. That doctor appealed to my knowledge. He asked: ‘How can I handle this in a better way with patients in the future?’ ”
Young and older women
Ingrid Verbeek is a lesbian therapist in Groningen. She says: ‘One of the reasons I call myself a lesbian therapist is that I want women to know where to find me when their being gay is an issue in their therapy: she knows beforehand that I will be able to recognize a part of her identity. I don’t work with heterosexual values, which many gay women encounter in the healthcare system. During the first meeting I tell a client that I am a lesbian and I ask what her sexual preference is. That does not mean the sexual preference is the main issue in the therapy, but I like things to be clear. I connect the problems women can have due to their being lesbian and look at the social implications that might have. Each therapist should be aware of the fact that there are people out there in the society who react in negative ways to gay people. Those reactions may have a greater impact on women than you would think.’
Leoniek van der Schoor notices in her gynecological practice that lesbian women don’t really like vaginal exams. Hetero-women are not specifically fond of it either. This is especially true for women who haven’t had vaginal contact for a long time, like those who are very young or older women who are not longer sexually active. It is not directly connected to being a lesbian.
Ingrid Verbeek too has the experience that lesbian women don’t like to be examined vaginally, especially when women have never had any kind of intercourse. Sometimes however, women during a vaginal exam are confronted with painful memories of being together with a man. Marjo van Loosdregt: “I don’t believe in the presumption that lesbian women hate vaginal exams more than heterosexual women. That would mean lesbians never do anything vaginal and nothing is less true. There are just as many varieties to think of when women make love. Such a presumption swaps one stereotype for another. I believe this is only true for women with sexual abuse experiences, and, in those cases, it is quite a normal reaction to hate a vaginal exam.”
Lesbian women can be one step ahead of their doctors if they tell them directly about their preferences. That is the conclusion from the answers given to me by the women I interviewed. The doctors amongst them realize that the lesbian patients they have in their practices are mostly outspoken. They worry though about the reactions from their other female patients, if they know their doctor is a lesbian. Especially in smaller towns, where communities are more ‘uptight’ than in a big city. Although women should have a choice to ask for a lesbian therapist or doctor, it surely would not be very sane to have lesbian women go around in their own circle only. It would mean it would never be necessary for physicians to learn about different lifestyles. Even in a progressive country like the Netherlands this would put lesbian women on an isolated spot within the Health Care System.
Women, who have come out are probably not the ones who suffer from their doctor’s attitude towards them. Their opinion is not representative for the average lesbian woman in the Netherlands. I think I may say that the situation in my country is not similar to the one in Great Britain. Nevertheless it seems to be too early to be ecstatic about the so-called Dutch tolerance in the general Health Care system. It would be great if a scientific survey could show how the situation here really differs from the countries surrounding us.