– There is a firmly established stereotype that lesbians do not have frequent and intense sex, so there are relatively few publications on their sexual health – explains Ane Piżl, who combines work in emergency medical services with equality education. Polish offices, and above all Polish doctors, are not prepared for patients other than heterosexuals. Data is missing, knowledge and familiarity are lacking.
- There are studies that show that gays have a higher risk of rectal and prostate cancer. They are also more likely to develop testicular cancer, which may be due to the fact that social campaigns, leaflets and messages encouraging preventive examinations are not addressed directly to them – explains Ane Piżl
- There are more such examples. Healthcare representatives usually address recommendations to heterosexual people, they think very stereotypically
- Where should the change begin? Ane Piżl points out that the first thing worth taking care of is the language we use in the office
- During admission to the gynecological ward, a woman very often has to choose between “unmarried woman, divorced woman, widow” in a survey. A lesbian or bisexual woman who married overseas does not have any truthful field on this form
- More information can be found on the Onet homepage
Karolina Świdrak, MedTvoiLokony: Do Polish health care workers – doctors, clinic and hospital workers, paramedics, therapists – perceive LGBT + people?
Ane Piżl: Unfortunately, as a rule not at all. We live in the world of the so-called “heteronorm”, i.e. the common assumption that every person who does not differ significantly from the norm is, by implication, heterosexual and cisgender – that is, that his gender identity is consistent with the birth certificate, the one given at birth. The same assumption also applies to health protection, with regard to patients and patients. Someone may ask what importance psychosexual orientation and gender identity have for the treatment process. In an ideal world it might not have, but in the world we live in, it unfortunately does. There are at least two things behind the worse health of LGBT + people – one is the experience of homophobia, biphobia and transphobia, and the other is ignoring LGBT + people when designing preventive and health promotion campaigns.
equality educator, graduate of the Medical University of Warsaw and Gender Studies at the Polish Academy of Sciences. Member of the Anti-Discrimination Education Society and Amnesty International’s network of educators. Co-author of “TRANSformacja” – a guide on creating a trans-inclusive workplace. Trains in the field of tolerance and the language of equality. She runs an educational profile on Instagram: @ane_ratownica
Statistics show, for example, that the percentage of polycystic ovaries in lesbians is more than twice as high as in heterosexual women. Bisexual women and lesbians are also twice as likely to be at risk of suicide, three times more likely to develop alcohol and drug addiction, and have a higher risk of social isolation than women in general. There are studies that show that gays have a higher risk of rectal and prostate cancer. They are also more likely to develop testicular cancer, which may be due to the fact that public campaigns, leaflets and messages encouraging preventive examinations are not addressed directly to them. Similarly, there is an established stereotype that lesbians do not have frequent and intense sex, so there are relatively few publications on their sexual health. There is a lack of information addressed to this group of patients regarding sexually transmitted diseases and options for protection against them. Even the majority of gynecologists and gynecologists do not share this knowledge with patients. I am a lesbian myself, and in over 20 years of regular visits to gynecologists, no one has ever brought up this topic with me.
On the other hand, from the position of a patient, I experienced many situations that revealed the ignorance of the staff – at one of the gynecological wards in Warsaw, during the rounds, on the day of my surgery, the professor asked me to leave the room, “because only women are to be left.” In another hospital, a nurse used deadname for me – that is, my old name, which as part of the transition as a non-binary person, I had formally changed many years back.
The effect of silence on the topic of lesbian sexuality, the ubiquitous heteronorm, with which we started our conversation today.
We should also not forget that in the acronym LGBT +, apart from lesbians, gays, transgender and bisexual people, there are also intersex people, i.e. those whose bodies have different sexual characteristics that cannot be clearly classified as male or female. Their needs are also an important and broad topic when we talk about the health of LGBT + people. Even if most intersex people are heteronormative.
What usually goes wrong when a non-heterosexual person goes to a doctor or therapist? What – in your opinion – are the most important lessons to be learned in Poland in this area?
I am convinced that everything starts with language. And this is already at the stage of registration or filling in the application form. If for a moment you put yourself in the place of someone who, when seeking medical help, fears that they will be mistreated because of their gender identity or psychosexual orientation, it is easy to understand how important it is to send a signal of acceptance and respect at this stage. If someone, during the first meeting – with a paramedic, with a registrar, with a doctor or even with the form on the website, he sees respect for diversity, it will directly translate into his trust in the facility and staff, and this in turn has an impact on the treatment process.
In inclusive thinking and speaking, it would be best not to make assumptions. Above all, do not fall into the trap that all patients are cisgender and heterosexual. Therefore, in the doctor’s office, instead of asking “do you have a permanent sexual partner”, it is better to ask “whether you have a partner or a partner”. In this way, we not only make it easier for a non-heteronormative person to respond directly, but we also generally express our respect for diversity. If a heterosexual man would be indignant at such a question, it is only evidence of his homophobia.
It is also worth examining the forms and surveys critically. During admission to the gynecological ward, a woman very often has to choose between “unmarried woman, divorced woman, widow” in a survey. A lesbian or bisexual woman who is married abroad does not have any truthful field on this form. And it is not about an individual situation in which they do not know what to choose, but another example of omission that LGBT + people experience in public space every day.
A big and quick change for the better would also be the introduction of a question about pronouns that a given person uses in the registration forms. The lack of this item in the survey can be a source of confusion and misgender, which is usually very uncomfortable for everyone.
Including inclusive entries in the forms is a clear signal of respect for diversity, thanks to which even people who are not directly affected by this particular provision, but experience minority stress for a different reason, may appreciate this awareness and feel safe in a given facility. This can have a real impact on their openness, readiness to ask for help more often, carry out preventive examinations, so it will ultimately affect health.
Of course, there will also be people who will not know how to answer the pronoun question because they have never encountered such a question. Perhaps they know nothing about transgender and non-binary people and have never been in inclusive language training. True inclusiveness also implies being mindful of their needs and patience to explain or describe areas in the questionnaires that may be incomprehensible. Inclusive language is not meant to embarrass anyone who is not “up to date”, but to connect and notice everyone.
Is there an inclusive language in Polish health care? Do we know it, can we use it properly? Some time ago my editorial friend interviewed a female surgeon. I remember how many emotions the word «surgeon» evoked
Yes, it’s also interesting for me that feminatives still arouse so many emotions. But I am sure that the dust will settle and over time everyone will get used to the surgeon and the ward, just as nobody has a problem with the registrar, nurse and the hospital ward today. Here, of course, we touch on the problem of gender inequality – the fact that so-called “inferior status” professions sound completely ordinary in feminative forms, but those socially associated with “prestige” are accepted by many people only in male forms. Fortunately, the world is changing and there is less and less room for sexism in it. So I think the surgeon will stay in the language permanently. Just like presidents, presidents, guests and professors.
But inclusive language is not only about feminatives. These are everyday language choices when we talk about people from different disadvantaged groups. And in medicine, we talk about them all the time. About the elderly, about people with disabilities, about those with experience of alcoholism, about people in a crisis of homelessness. Language expresses our respect or our lack of it. And, unfortunately, in health care, this is often the lack.
How should you talk to patients and patients from minority groups? This is one of the areas you discuss during your training sessions. What are the most important rules?
The key is not to stereotype people on the basis of one trait – age, gender, appearance, origin, thickness, language, level of education, neuro-type, addiction. Our brain likes to take shortcuts, but it’s good to disturb it. In an inclusive language, we want to speak to everyone with respect. When talking to an elderly person, avoid infantilization – referring to a patient as “grandma” is simply inelegant. Also, the lack of patience with the elderly and their needs is something to be aware of and try to work on. We’ll all be old one day (if we live to be). Let us treat others as we ourselves would like to be treated in our old age.
When talking to LGBT + people, it is worth replacing “homosexuality” and “transsexualism” with the words “homosexuality” and “transgenderism”. Instead of “sex change”, talk about transitions, gender-affirming treatments and correction. Non-binary people should not be excluded from the umbrella of transgenderism.
When talking to a family who has experienced the suicide of a loved one, instead of talking about “committing” suicide (you commit a crime), it is better to say that someone took his own life. Similarly, instead of an “ineffective and successful suicide attempt,” it is better to write and talk about a non-lethal or fatal attempt.
“Wheelchair” is also not the best word, because “disabled” comes from the Latin “invalid”, “irrelevant”. It is also unacceptable to use contemptuous expressions regarding skin color or mental health. In medicine, by definition, there should be no place for contempt – no matter what language who speaks, where he comes from and what psychosexual orientation he or she has.
During the inclusive language trainings I conduct for medical staff, we also talk about the language to use in the team so that all people feel comfortable in the workplace. To eliminate gender inequality – both in language and in relationships. Just to get away from the feudal hierarchy that is still present in Polish hospitals. To pay attention to the fact that in the process of treating and caring for a patient, doctors will not be able to cope on their own. They need close cooperation with nurses, rescuers, orderlies, physiotherapists and laboratory workers. That the hands of students in clinical hospitals are also helpful, and that patience for them has broad benefits for the future. That it is worth showing equal respect to all people – regardless of their position.
Many people finally get angry that these linguistic considerations are artificial, unnecessary and that it is difficult to suddenly reform the entire language we speak in medicine. But it is natural that over the years we change the terms with which we describe reality. Rather, no physician or physician, referring to the topic of tuberculosis, will talk about “galloping consumption” today, nor will he talk about “apoplexy” when we talk about a stroke. The language changes, it’s natural. It is worth taking it at face value that we have an influence on where this change goes. The more that these are not individual ideas of equality activists and educators. You can read about the recommendation to use an inclusive language in the publications of the Polish Psychiatric Association and the Polish Language Council. It is a matter of knowledge and culture.
Which of the social groups in Poland is most affected by exclusion in contact with health care?
This is a difficult question, all the more so as the key concept in discrimination is intersectionality, that is, noticing the fact that it is people who are the most difficult, not from one particular group, but those who experience overlapping oppression. For example, it is not easy to be a lesbian in Poland. But it is certainly easier for a person like me – educated, white, able-bodied, in a big city (even if I experience systemic discrimination because of my transgender and homosexuality), than for a black woman in the suburbs or a low-income person who is raising a child with a disability . So I work to notice every form of exclusion and all oppressed people. But I definitely want to emphasize the situation of the elderly, the more so as Eurostat data show that Poland is a terrible country to grow old in. Especially in the context of health. And here we come back to intersectionality, because although it is not talked about loudly, there are also, for example, lesbians among older people – who experience isolation and exclusion from these two overlapping contexts – age and orientation. And among the elderly there are also people with disabilities, and neuro-typical and transgender people of various origins. Sensitivity to their situation, mindfulness and kindness in contact with them is the first step to change for the better.