Maggie McKay (Host): Welcome to Wellness Waves, a podcast from Bergen New Bridge Medical Center. I'm your host, Maggie McKay. Joining us today is Dr. Samantha Cohen, a family medicine physician at the LGBTQ+ Health and Wellness Center to discuss the top five health issues for LGBTQ women. Thank you so much for being here today, Dr. Cohen.

Samantha Cohen, DO: Hi. Thank you for having me.

Host: Let's start with: What are the most common health issues faced by LGBTQ women and how do these differ from the general population?

Samantha Cohen, DO: For the context of this conversation, I'll generally be talking about like cisgender women who identify as lesbian, bisexual, queer. This population often gets left out of the conversation, and I could do a whole 'nother podcast on transwomen's healthcare. But for now, we'll stick with this area. But LGBTQ women deal with a lot of the same issues, as anyone else. But there are a couple extra barriers, things like stigma, bias, lack of provider training can make patients uncomfortable or questions feel clunky or invasive. And over time, patients might just delay their visits, skip their visits altogether.

So, some of the main health issues, I would say, are missed screenings, so like breast cancer screening, cervical cancer screening, whether it's just from avoiding going to the doctor or misinformation about their cancer risks. Another would probably be higher rates of mental health issues, anxiety, depression, substance use, eating disorders, things like that, which are often tied to minority stress.

And then, a lot of times, queer women get inadequate or inappropriate sexual or reproductive healthcare. They might get birth control counseling when they don't need it. They might not get it when they do need it. So, it's not that queer women have, you know, different health needs, it's just that they face different barriers to getting that care.

Host: You mentioned stigma. How do factors like discrimination and stigma impact the mental and physical health of LGBTQ women?

Samantha Cohen, DO: So, mental and physical health are so tightly intertwined, as I'm sure most people know. But queer women face some level of discrimination or stigma, whether it's overt or not. Sometimes it's external. It's how others see you, treat you based on their perceived beliefs.

Other times the discrimination or the stigma can be internal. So, not every lesbian is out and proud and marching at Pride Parades. And this is something that I dealt with that was particularly stressful for me when I was coming out. So for some women, it's safer to hide their identity at work or at home, or they might not have support from family or friends. And all this being said, when someone faces ongoing stress, it shows up in the body. This can look like high blood pressure, inflammation, substance use to cope with tough situations. So therefore, someone's mental health and physical health have to be considered in the same context.

Host: So with that, understood. What are some specific screening or preventive care recommendations for LGBTQ women to manage health risks effectively?

Samantha Cohen, DO: So, one recommendation would be for patients to be aware that preventative care should always be tailored to their age, their anatomy, their risk factors, regardless of their social identity. So for example, if someone has a cervix and they are 21 or older, they are going to get cervical cancer screening regardless of their gender identity or their partner history in the same way that anyone with a colon should get colon cancer at age 45.

So, the basics of preventative, primary care still matter. So getting those Pap smears, those mammograms, colonoscopies, vaccines, basically social identity should never obscure basic healthcare needs in human bodies. So, no assumptions should be made.

Host: And what are the top misconceptions about LGBTQ women's health? How can education help address these myths?

Samantha Cohen, DO: I would say one misconception is that it's kind of non-existent. Some might argue we have the field of OB-GYN dedicated to women's health, but a lot of this is based on cisgendered heterosexual models. Think about walking into an OB-GYNs office. Everything is pink. There are like art with pregnancies around and the nurses might ask, "Oh, do you have a boyfriend?" when you're talking about birth control and things like that. So, there's a lot of little things that might not seem very affirming to a queer woman.

I'd say another misconception is that there are less risks for queer women. I think there's a lot of stigma that only gay men can get STIs or can be on prep for HIV prevention when really that's not the case. Everybody, you know, is at risk at some level. So, it's important to talk to the doctors about what your risk might be, but it's important to know that there are risks when engaging in certain behaviors.

Host: Dr. Cohen, how does the risk of certain cancers like breast or cervical cancer differ among LGBTQ women compared to cisgender heterosexual?

Samantha Cohen, DO: I would say, overall large scale population data is kind of lacking in this. But based on what we know, there are a couple of interesting factors that actually do increase queer women's risks for certain types of breast cancer and cervical cancer. So in terms of breast cancer, underscreening is a big one. Cancers are often not caught early enough. If a woman is avoiding going to the doctor or doesn't feel comfortable getting a mammogram, this leads to later diagnoses that could have been caught earlier on.

There's also an increased risk for breast cancer, because queer women have a higher prevalence of nulliparity, which basically means not having children. So, that means over time they experience more menstrual cycles, a longer cumulative exposure to estrogen and progesterone when these hormones would be reduced temporarily during pregnancy. So, I think that's an interesting risk factor.

And then, in terms of cervical cancer, same thing applies with underscreening, not wanting to get a pap smear and then getting diagnosed later in life. There's also a misconception that lesbian or bisexual woman can't get HPV, which is what causes cervical cancer, because it can only be spread to women who have sex with men. But it's important for me to emphasize that HPV transmission can occur between women for sure. It can be passed via skin to skin, genital contact, toys, et cetera. And this patient population is also less likely to get the HPV vaccine series. So for all those reasons, cervical cancer is definitely at a higher risk.

Host: Wow. That's a lot to consider and really good to know. I mean, I'm sure a lot of people didn't know that. How can health policies be improved to address disparities in healthcare access and treatment for LGBTQ women?

Samantha Cohen, DO: I think it can start at an office level the most easily. This looks like having inclusive intake forms, asking for preferred name pronouns, training all the staff so that every interaction from the front desk, to the nurses, to the providers, feels extra affirming. And just making this mandatory for staff and generally being aware of different implicit biases and just making everything feel more inclusive.

And especially at our Bergen New Bridge LGBT Health and Wellness Center, we're very, very sensitive to the patient safety and respect. So for us, it's not just being affirming. It's the baseline expectation for human decency and care. And then, honestly, even little things like pride flags, inclusive signages, stickers, asking gender-neutral questions. So, "Tell me about your partner" instead of "Tell me about your boyfriend-girlfriend." All of that can make a very big difference in a women's health space. And they tell patients, you are safe here. And when patients feel safe, they'll open up and that's when good care happens.

Host: That's great. Yeah. You said earlier in the beginning that a lot of women may avoid coming to get screenings and take care of their health, because they feel comfortable. So, thank goodness you guys are making it comfortable. In closing, is there anything else you'd like to add that you'd like women to know?

Samantha Cohen, DO: I think women should just know it's important to advocate for themselves. Health is important, so even if something might seem like it might not matter, or it's just a little screening, it can be life-saving. So, taking the time to either research providers, do your homework, and being able to know what kind of care you need for your specific body is really important and that there are people out there who will make you feel affirmed. We'll be inclusive. We'll allow you to open up and be your full self.

Host: That's great. Thank you so much for sharing your expertise. This has been very informative.

Samantha Cohen, DO: Oh, of course. My pleasure.

Host: Again, that's Dr. Samantha Cohen. To find out more, please visit newbridgehealth.org/health-services/lgbtq-health. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening to Wellness Waves, a podcast from Bergen New Bridge Medical Center.