a provider's handbook on culturally competent care - Massachusetts ...

designed to specifically meet the needs of both abused and abusive lesbian women. Providers need to beknowledgeable about local community resources and the services available. (See the Intimate Partner Violencechapter for more information about assessing for intimate partner violence).Mental Health Disorders: Studies have shown that gay and lesbian youth have more risk factors for suicide,including feelings of hopelessness and increased rates of alcohol and substance abuse. Adolescents withsame-sex orientation are twice as likely to attempt suicide as their heterosexual peers. 24FAMILY PLANNINGThere are many lesbian couples who may desire to start their family together. Along with adoption,reproductive options including intrauterine inseminations and in vitro fertilization have expanded. Thefirst decision a lesbian couple generally makes is who the birth mother will be. If both women want tobear children, it is helpful to discuss which woman may be a preferable first choice, looking at risk factorsincluding age and medical problems. Preconception counseling is important. The next step is for the coupleto decide on a sperm donor. Some lesbian couples may choose to use a known donor and have a familywith involvement of the biological father, while other couples may prefer to use an unknown donor whowould not be involved in the parenting of the child. Prospective mothers should seek legal counsel sincestate laws for same-sex adoptions vary.The birth mother will be exposed to the bodily fluids of the sperm donor, and as such, he needs to betested for STDs including HIV, hepatitis, gonorrhea, chlamydia, and syphilis. Ideally, sperm is collectedand frozen for later use, and the donor is tested at baseline and in three months. However, if the couple isusing fresh sperm, then it is important that the donor is practicing safer sex and that he is tested at baselineand then again at three months when he donates the specimen. There are many reputable sperm banksthroughout the nation that can provide tested specimens. When using a sperm bank, the donor has theoption of having his name released to the child when the child reaches age 18. This can be a very difficultdecision for women to make, and it is important to discuss whether or not they will want the offspring toknow the name of the donor in the future. Sperm banks often will only release the sperm to a physician’soffice for insemination. The success of insemination using frozen sperm is markedly increased if coupledwith intrauterine insemination by a skilled provider.Some lesbian couples must also confront issues of infertility; however, the evaluation of fertility is too largeand variable to be covered in this chapter. Fertility specialists can provide services that range from bloodtests, surgical procedures, inseminations, medications for ovulation, and in vitro fertilization using the eggsof either woman or donor eggs.Lesbian couples have many options to proceed with a safe and healthy pregnancy. It is important forproviders to offer a supportive environment to encourage women to discuss these issues and obtaininformation.CONCLUSIONIn summary, providers need to provide a safe environment in which all women feel supported and freeto discuss issues impacting their health care needs, including sexual orientation. Lesbians need the samepreventative health screening, STD checks, and safer sex discussions as heterosexual women. In addition,they need to be assessed for smoking and alcohol use as these risk factors are increased in the lesbiancommunity. It is also important for providers to ascertain if their lesbian patients are living in a safeenvironment and have a supportive network of friends and/or family. In a greater context, more researchand population statistics are needed. Not until we have data that clearly outlines the health disparitiesfaced by lesbians and a society that unreservedly supports the lesbian, gay, bisexual, and transgendercommunities and their needs, including health care benefits for domestic partners and laws that preventdiscrimination based on sexual orientation, will providers have all the information and tools they need toprovide the best care possible to the lesbian community.43