The Journal of the Arkansas Medical Society Issue 9 Vol 114 | Page 15

able at all , thus misinforming health testing and recommendation protocol . One in five WSW has been told that she didn ’ t need a Pap test ; of those who requested one , one in 50 were refused . 5 If extrapolated to the estimated population of WSW , that would mean that about 37,000 women took steps to obtain a potentially beneficial Pap test but were denied that service by their providers based on their sexual identity .
College-Aged Women as a Model Population
College-aged women are an important demographic for a needs assessment regarding women ’ s health for several reasons : high levels of sexual activity , high risk for contraction of sexually transmitted infection ( STIs ), high numbers of abortions , 3 and high usage of oral contraceptives . College-aged women are also at increased risk for contracting human papilloma virus ( HPV ). 6
In addition to risk factors for college-aged women , several disparities in women ’ s health care have been established in previous literature . Non-heterosexual-identifying women face barriers to health care access , with lesbian women being much less likely to have had a gynecological examination in the past year than women of other sexual identities . 7 There has been little to no research done linking women ’ s health disparities with medical history , especially when considering a focus on college-aged women .
METHODS
In the preliminary phase of research , we sought to assess women ’ s health access among college students . A campus-wide survey was conducted at a small , private college in the mid- South . Students were contacted via email with a link to a self-administered survey created using SurveyMonkey . Questions in the survey focused on gender , sexual identity , sexual history , medical history , and perceived risk for women ’ s health issues such as pregnancy , STIs , or cancer . The survey was created to take no more than 30 minutes of the respondents ’ time . A consent page prefaced the series of questions ; respondents were required to agree to the information about confidentiality and the nature of the research to progress to the survey questions . Names and other identifiers of survey respondents were kept confidential by nature of the online software .
Electronic results from SurveyMonkey were processed using IBM SPSS 21 to obtain Pearson correlation coefficients . Each of the independent variables – gender , sexual identity , age , insurance status , and receipt of gynecological exam – were cross-tabulated with the dependent variables – utilization of health services , insurance status , referral follow-up , sexual relations , receipt of gynecological exam , pregnancy , female-specific cancers , and STI / HIV testing .
We also analyzed existing data sets from the following sources : peer-reviewed books and journal articles related to female same-sex behavior and / or health outcomes of that behavior ; and published reports by HHS , the CDC , the Census Bureau , the Pew Research Center , and ACOG . State reports on lesbian and bisexual health were also used as primary data sources .
The above-mentioned data sets were qualitatively coded , and any references to rates of health-related conditions , tests , or statuses were compiled by sexual identity . These included diseases , tests and screenings , insurance status , and establishment with a primary care physician . For each of these references , a standard deviation for the rates was calculated using Microsoft © Excel ® 2007 spreadsheet software to test each set of rates against the three main hypotheses , as described below .
RESULTS
One of the most significant results from the campus-wide survey was that bisexual-identifying women were 34.6 % more likely to have had sexual relations with a man in the past six months than with a woman .
The prevalence of certain health characteristics in shown by the percentage rate of each characteristic among each of the sexual identities . The hypotheses of this project were assessed as follows .
Hypothesis 1 : Bisexuality is a distinct sexual identity from lesbianism ; therefore , bisexual women will show significantly different rates of health-related characteristics than lesbians .
( 1 )
Hypothesis 2 : Bisexual women ’ s sexual and medical histories more closely approximate those of heterosexual women than those of lesbians .
( 2 )
Hypothesis 3 : Bisexual women ’ s sexual and medical histories more closely approximate those of heterosexual women than those of lesbians , creating an ordered “ health care hierarchy .”
( 3 )
or ( 4 )
DISCUSSION
The finding that bisexual women were more likely to have sexual relations with men is significant in relation to other data showing that those who strictly engaged in female-female relations have a very low rate of STIs . 3 This finding suggests that because lesbian women tend to have sexual relations exclusively with women , they would be at lower medical risk than heterosexual women , at least with regards to STIs and HPV . The findings also support the idea of a “ health care hierarchy ” in which heterosexual women have the highest level of health care utilization , while lesbians have the lowest level , with bisexual women in between but closer to heterosexual women .
Quantitative analysis revealed specific information by considering data that separated lesbians from bisexual women . Bisexual women are less likely to have a PCP and to have had a mammogram in their lifetime . They also have a higher rate of abnormal Pap test results , are more likely to have asthma , and are much more likely to have been raped than lesbians or heterosexual women . Lesbians , on the other hand , were twice as likely as their bisexual and heterosexual counterparts to have type-2 diabetes .
• Hypothesis 1 was supported by 90 % of the health characteristics in the data set ( see Table 1 ); SD = 0.32 .
• Hypothesis 2 was supported by 70 % of health characteristics considered ; SD = 0.48 .
• Hypothesis 3 was only supported by 20 % of the health characteristics ; SD = 0.42 .
In other words , the first two hypotheses are supported by a majority of the data while the third hypothesis is not well supported . Therefore , the results of this project support the idea that bisexuality is a distinct sexual identity with unique health implications , and that bisexual women ’ s medical and sexual histories more closely approximate those of heterosexual women than those of lesbians . This approximation has not been established in previous literature , and future research using larger data sets and more detailed sexual and medical information could verify this relationship and provide more detailed information .
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