Seventeen percent of DIVA readers have experienced homophobia when receiving treatment from their GP or hospital. That’s the finding of an online poll carried out throughout April of this year. These disturbing results reveal that British lesbian tax-payers aren’t always receiving equal treatment in publicly funded health service provision – and this is a fact borne out by recent research conducted by campaigning organisation Stonewall.

Alan Wardle, Stonewall’s director of parliamentary and public affairs, explained: ‘People think of discriminatory practices in the provision of goods and services as being refused service at hotels and B&Bs, and so on. But we did some research and found that discrimination also extended into publicly funded services, like healthcare.’

The homophobia uncovered in the research took many forms. One of the more extreme incidents happened to Sarah, who attended an appointment at a minor hand surgery unit to have nerves reattached on her left hand. The head surgeon and an assistant were in theatre treating her, when a report came on the radio about the Civil Partnership of Elton John. The assistant wondered aloud who would be wearing the frock. The two practitioners then conducted a ten-minute conversation in which they mocked gay marriage, suggesting it was disgusting that gay people could now adopt children. Understandably, Sarah felt unable to object to the views expressed, as she was in the middle of having her hand stitched up.

This incident represents the extreme end of inadequate health practice, but there’s a rather more common example, and it’s one that carries potentially serious consequences.

The Department of Health (DH) recommends that women between the ages of 20 and 64 have routine cervical smears every three to five years as part of the NHS Screening Programme, yet some lesbians in the Stonewall and DIVA surveys reported they were questioned by their health provider about their need for a smear, actively discouraged from having one, or refused one.

Mary moved to a new area and registered with her local GP. She was asked if she was having regular sex, and when she said yes, she was asked whether she’d like to take the pill as a form of contraception. But when Mary explained that she was a lesbian and didn’t need the pill, the GP said that there was no need for her to have a cervical smear test. It had been over three years since Mary’s last smear, and she was keen to have one done, especially as she was a smoker. Her GP insisted that it wasn’t necessary and didn’t book her an appointment.

Annabelle had a similar experience when she presented for her smear test. ‘I’d just signed up with a new doctor in Manchester. I’d never had a smear test – I was 27 – but asked if I could have one. The doctor went through all the usual questions about birth control, assuming I was heterosexual. When I came out to her, she wouldn’t give me a smear test. She argued with me for ages, but eventually, because I stood my ground, she gave me one. She never asked me if I’d ever slept with men before. She presumed that I’d always been a dyke, and that I therefore wouldn’t be at risk from cervical abnormalities.’



Statistics show that a woman’s risk of cervical cancer is cut by 84% if she has a smear test every five years, and 91% if she has a smear every three years. It’s estimated that NHS cervical screening saves more than 1000 lives each year. Why aren’t lesbians being treated equally in this area of health provision?

The notion that it isn’t necessary for lesbians to undergo cervical screening comes from two misconceptions: that women who identify as lesbians have never had sex with a man, and that women who’ve never had penetrative sex with a man aren’t at risk of cervical cancer.

And yet data collected from the Audre Lorde and Bernhard sexual health clinics for lesbians show that 10% of lesbians had smear abnormalities; 81% of lesbians had had penetrative sex with a man, and 10.9% of this group had smear abnormalities; and 5% of the lesbians who had never had penetrative straight sex had cervical abnormality.

A British Medical Journal editorial published in 2003 had this to say: ‘An unfortunate perception exists among healthcare providers and women who have sex with women that they don’t need regular cervical smears… sexual intercourse with men is a powerful risk factor for cervical cancer. However, it’s important to counter the erroneous assumption that women who have sex with women aren’t at risk of catching human papillomavirus. Around one in five women who’ve never had heterosexual intercourse have human papillomavirus which is associated with developing high-grade cervical intraepithelial neoplasia’ – in other words abnormal cervical tissue development.

But this isn’t just a problem confined to public healthcare provision. Following a series of uncomfortable experiences of coming out to various GPs, Sally, 48, decided to go to a BUPA clinic for a general health check, part of which included a smear test. ‘My partner did the same, chose a male doctor, and was very happy with the treatment she received. But I chose a female doctor, and she questioned my need for a smear test, despite the fact that I’d paid for it, and that I’d had pre-cancerous test results in my 20s. I tried to unpack what that meant, wondering if I was just wasting her time, wondering if she just didn’t want to do the smear on me because she felt uncomfortable with my sexuality. I didn’t want to complain – I was worried about that going down on my medical records, and it compromising any future treatment I might receive.’

DIVA asked BUPA whether it operated a policy on offering smear tests to lesbians that differs from the treatment procedure for heterosexual women in their clinics. A spokesman replied, ‘BUPA treats lesbian women exactly the same as heterosexual women. It’s required that staff ensure everyone having a smear test is aware of the reason for the test, the benefits of the test, and what the test might mean to them.’ He assured DIVA that ‘diversity training is compulsory for all employed staff, and available for all self-employed staff. It’s also included in the employment contract they hold with BUPA.’

When he was asked about Sally’s case, he replied: ‘Without the name of the doctor in this case study, it’s unfortunately not possible to comment on what she experienced.’

DIVA contacted the Royal College of General Practitioners and the Royal College of Physicians to find out exactly what’s currently in the curriculum to educate prospective health practitioners about the specific needs of lesbians. However, nobody from either organisation was available for comment at the time of going to press.

Alan Wardle said: ‘In the health service, not enough training is given around diversity issues. Sensitivity to the gender of the patient’s partner is only one aspect. There needs to be recognition of the specific health needs of our communities, because at the moment there seems to be a very limited understanding.’

But change is afoot. Stonewall has recently campaigned successfully to amend the Equality Bill so that lesbian and gay people will have protection in the provision of goods and services – including healthcare services. The new regulations are due to come into force in October this year.

The Department of Health (DH) is currently preparing for the changes. A spokesperson said that some of the recent measures taken included alerting ‘all NHS and Council chief executives and directors of social services that the Department of Trade and Industry has published a consultation paper called Getting Equal: Proposals to Outlaw Sexual Orientation Discrimination in the Provision of Good and Services, and that this will have implications for the provision of health services. We are also consulting across DH policy teams on the implications.’

Additionally, the DH is looking at how LGB patients are monitored, how homophobia is reported, and its reviewing literature on UK health inequalities. The DH spokesperson added: ‘Evidence clearly points to sexual orientation and gender identity being significant factors contributing to health inequalities and poor experience of health services. All health services need to take concerted action to address these issues on all fronts.’

Stonewall will keep a close watch on how well the new laws will work. Alan Wardle assured DIVA; ‘In October, the legislative imperative will enforce behavioural change. We’ll be keeping an eye on how the legislation operates in practice, and we’ll be prepared to bring test cases to ensure that the law is enforced.’

Some names have been changed to preserve confidentiality. For more information, visit www.stonewall.org.uk