title: Lesbian womens' access to healthcare, experiences with and expectations towards GPs in German primary care.
abstract: Lesbian women have higher rates of physical and psychiatric disorders associated with experiences of discrimination, homophobia and difficulties with coming out. Therefore, easy access to specialized healthcare in an open atmosphere is needed. We aimed to describe women's access to and experiences with healthcare in Germany, and to assess the responsibility of the general practitioner (GP) compared to other specialities providing primary health care.
  
  
  
  A questionnaire study was conducted via internet and paper-based sampling. Using current literature, we designed a questionnaire consisting of sociodemographic data, sexual orientation, access to care and reasons for encounter, disclosure of sexual orientation, experience with the German health system (discrimination, homophobia), and psychological burden. Depression was assessed using the depression screening from the Patient Health Questionnaire (PHQ-2).
  
  
  
  We obtained responses from 766 lesbian women. Although 89% had a primary care physician, only 40% had revealed their sexual orientation to their doctor. The main medical contacts were GPs (66%), gynaecologists (10%) or psychiatrists (6%). Twenty-three percent claimed they were unable to find a primary care physician. Another 12.4% had experienced discrimination. Younger lesbian women with higher education levels and who were less likely to be out to other physicians were more likely to disclose their sexual orientation to their primary care physician. GPs play an important role in healthcare for lesbian women, even in a non-gatekeeping healthcare system like Germany. Study participants suggested improvements regarding gender neutral language, flyers on homosexuality in waiting areas, involvement of partners, training of physicians, directories of homosexual physicians and labelling as a lesbian-friendly practice.
  
  
  
  GPs should create an open atmosphere and acquire the respective knowledge to provide adequate treatment. Caring for marginal groups should be incorporated in medical training and further education. Ideally, physicians address patients' sexual orientation pro-actively in order to address individual needs accordingly.
authors.affiliation: Department of General Practice/Family Medicine, Philipps University Marburg, Karl-von-Frisch-Str. 4, Marburg, 35043, Germany. oliver.hirsch@staff.uni-marburg.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Hirsch
authors.affiliation: Department of General Practice/Family Medicine, Philipps University Marburg, Karl-von-Frisch-Str. 4, Marburg, 35043, Germany.
authors.forename: Karina
authors.initials: K
authors.lastname: Löltgen
authors.affiliation: Department of General Practice/Family Medicine, Philipps University Marburg, Karl-von-Frisch-Str. 4, Marburg, 35043, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Becker
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003863:Depression / Q000453:epidemiology; D005260:Female; D058006:General Practice / Q000592:standards; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D018452:Homosexuality, Female / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D057240:Patient Preference / Q000706:statistics & numerical data*; D011287:Prejudice / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards; D058996:Quality Improvement; D000072339:Sexual and Gender Minorities / Q000523:psychology / Q000706:statistics & numerical data*; D014342:Truth Disclosure; D055815:Young Adult
keywords: Female homosexuality; Health surveys; Internet; Primary health care; Questionnaires