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Prescription for Change Lesbian and bisexual women's health check 2008 for ChangeLesbian and bisexual women's health check 2008by Ruth Hunt and Dr Julie FishSurvey results analysed by Sigma Research Smoking, alcohol and drugs Cervical screening Domestic violence General fitness and exercise The impact of discrimination Lesbian and gay taxpayers fund 60,000 posts within the NHS. Yet with the
marked exception of gay men's sexual health, their specific health needs are
almost invisible. Stonewall's engagement with tens of thousands of lesbian
and bisexual women across Britain in recent years suggests that their healthcare
is particularly neglected. That's why we commissioned this groundbreaking
national survey.

We've been overwhelmed by the response. Over six thousand women have
told us about their health needs and experiences, making this the biggest survey
of lesbian health ever conducted outside the US. The picture they paint should
disturb any healthcare practitioner.

Lesbians are more likely to have smoked and to drink heavily than women
in general. At various ages they are less likely to have had a smear test and more
likely to have had breast cancer. Levels of self harm and suicide are significantly
higher than in the wider population. Half have had negative experience of
healthcare within the last year alone and a similar number feel unable to be
open about their sexual orientation to their GP.

Many healthcare providers have taken marked steps forward as good employers
since employment protections for lesbian and gay people were first introduced
in 2003. But this major survey suggests that this progress has not fed into the
services they provide.

This study is timely. In April 2007, it became unlawful to discriminate against
lesbian and bisexual women in the delivery of public services. It's clear that the
NHS now needs to take some very significant steps forward to meet its new
statutory obligations.

Ben Summerskill, Chief Executive
Smoking, alcohol and drugs:
Two thirds of lesbian and bisexual women have smoked compared to half of women in general.
Just over a quarter currently smoke.
Nine in ten lesbian and bisexual women drink and 40 per cent drink three times a week compared to a quarter of women in general.
Lesbian and bisexual women are five times more likely to have taken drugs. Over one in ten have taken cocaine, compared to three per cent of women in general.
Less than half of lesbian and bisexual women have ever been screened for sexually transmitted infections.
Half of those who have been screened had an STI and a quarter of those with STIs have only had sex with women in the last five years.
Fifteen per cent of lesbian and bisexual women over the age of 25 have never had a cervical smear test, compared to seven per cent of women in general. One in five who have not had a test have been told they are not at risk. One in fifty have been refused a test. One in twelve lesbian and bisexual women aged between 50 and 79 have been diagnosed with breast cancer, compared to one in twenty women in general. One in five lesbian and bisexual women have deliberately harmed themselves in the last year, compared to 0.4 per cent of the general population. Half of women under the age of 20 have self-harmed compared to one in fifteen of teenagers generally.
Five per cent have attempted to take their life in the last year and sixteen per centof women under the age of 20 have attempted to take their life. ChildLine estimate that 0.12 per cent of people under 18 have attempted suicide. One in five say they have an eating disorder, compared to one in 20 of the general population.
One in four lesbian and bisexual women have experienced domestic violence, the same as women in general. In two thirds of cases, the perpetrator was another woman.
Four in five have not reported incidents of domestic violence to the police and of those that did, only half were happy with their response.
General fitness and exercise:
Four in five lesbian and bisexual women say that they think they are in good health. The BMI for lesbian and bisexual women is the same as women in general.
Half exercise three times a week. Discrimination in healthcare:
Half have had negative experiences in the health sector in the last year, despite the fact that it is now unlawful to discriminate against lesbian and bisexual women.
Half of lesbian and bisexual women are not out to their GP.
One in ten say that a healthcare worker ignored them when they did come out.
Just three in ten lesbian and bisexual women say that healthcare workers did not make inappropriate comments when they came out.
Just one in ten felt that their partner was welcome during a consultation.
Nine in ten lesbian and bisexual women drink Half have had negative experiences in the health sector in the last year One in five lesbian and bisexual women have deliberately Five per cent have attempted to take harmed themselves in the last year their life in the last year One in four lesbian and bisexual women Fifteen per cent of lesbian and bisexual women over have experienced domestic violence the age of 25 have never had a cervical smear test 1 Smoking, alcohol and drugs "I believe many lesbians (the ones who pub and club) are at higher risk of
life-style illness than straight women, smoking, drinking etc because there are
fewer alternatives outside these sort of environments where lesbians can be
together (other than once you are established in a social network) yet there
is no targeted health promotion that features lesbians."

Victoria, 55, West Midlands Only a third of lesbian and bisexual women have never smoked cigarettes, compared toover half of women in general who have never smoked. Two thirds have smoked at sometime in their life. More than a quarter of lesbian and bisexual women currently smoke. "Get community groups involved with Quit-Smoking initiatives and have
lesbian/bisexual only support groups. I think this is the single biggest threat to
gay women's health."

Sarah, 31, London Twenty one per cent of lesbian and bisexual women who smoke smoke more than 20 cigarettes a day, compared to 28 per cent of women in general who smoke. Seventy nine per cent of respondents say they smoke fewer than 20 cigarettes a day.
Lesbians are therefore more likely to have ever smoked than women in general, but no more likely to smoke now, and among those that do smoke a smaller proportionsmoke 20 or more cigarettes per day. "I think that most lesbians drink more than heterosexual women as there is so
much more emphasis on drinking in most lesbian oriented places."
Michelle, 31, London Nearly four in five lesbian and bisexual women drink alcohol, and a quarter of respondents think lesbian and bisexual women drink more than heterosexual women.
Only one in five respondents had not had a drink in the last week, compared to two infive women in general. Two in five respondents had drunk on three or more days in aweek, compared to a quarter of women in general. On how many days out of the last seven did you have
an alcoholic drink?
Lesbian & bisexual women "I have been sober and in recovery for the past 11 years. I attend Alcoholics
Anonymous meetings and in particular found the Gay Alcoholics Anonymous
meetings my salvation."

Yasmin, 45, East of England "I don't think there are sufficient spaces for lesbians and bisexual women.
Most of the scene is oriented towards men. Also, I'm kind of sick of the emphasis
on bars and pubs. Something different would be nice. I'm not much of a clubber
and would much prefer a new way of meeting other women. I work with lesbian,
gay, bisexual and trans young people as a youth worker and find that many young
lesbians feel they have to go out and get hammered every weekend."

Helen, 27, Scotland Lesbian and bisexual women are five times more likely to have taken drugs compared to women in general. Three in ten have smoked marijuana in the last year,fifty per cent more than women in general. Over one in ten lesbian and bisexual women have taken cocaine compared to three per cent of women in general and thesame number have taken ecstasy. One in eight have taken amyl nitrate (poppers), a drug which is traditionally associated with gay men. Respondents to the survey also indicated that they had taken speed, crystal meth, Ketamine, heroin, and Viagra as well as magic mushrooms and nitrous oxide. "I think substance misuse (drink and drugs) is more noticeable among lesbians
because we're a smaller group (compared with heterosexual women)."
Nicola, 46, London More than a quarter of lesbian and bisexualwomen currently smoke Two in five respondents had drunk on three or more days in a week, compared to a quarter of women in general "Lesbians, as sexually active/proactive people, are invisible. Awareness needs to
be raised to let the mainstream public services know that gay women don't just sit
in bed stroking kittens and drinking camomile tea."

Zoe, 40, North East "I am appalled at how little sexual healthcare advice and support there is for
lesbians. I recently had a check and had no idea I could contract so many STDs
through lesbian sex. There is little education and support for lesbians."

Saheema, 31, London Less than half of lesbian and bisexual women have ever been tested for sexually transmitted infections. Over half of lesbian and bisexual women who have been testedfor sexually transmitted infections have had an infection (a quarter of all respondents). Over half of lesbian and bisexual women have never been for a sexual health check up.
Three quarters of those who have not been tested "don't think I'm at risk". One in tenhave not been tested because they are "too scared" to get tested. Others reported thatas they had no symptoms, they assumed they were fine. Four per cent have been toldby healthcare workers that they do not need a test. "After coming out to a nurse at a GP practice (when I went for a smear), she didn't
know whether to test me for Chlamydia, and suggested that I see next time if I'm
‘still.' – presumably she meant still lesbian! I haven't been back to the GP since."

Isabella, 31, Scotland A fifth of the entire sample (77 per cent of those who have been tested) had ever had thrush which, in common with other sexually transmitted infections, can be passedon to a partner through oral and penetrative sex. Five per cent (a fifth of those whohave been diagnosed with an STI) have Bacterial Vaginosis, and lesbian and bisexualwomen also have been diagnosed with genital warts, Chlamydia, genital herpes, pelvicinflammatory disease and Hepatitis B and C. Lesbians and bisexual women have bothoral and penetrative sex and can share fluids through hands, mouth and sex toys.
"My GP took no account of the fact that I could pass Bacterial Vaginosis to my
partner and did not prescribe the appropriate medication for my partner, as a result
we passed it back and forth for some time before attending a walk in centre
because we didn't want to go back to the GP."

A quarter of those who have been diagnosed with a sexually transmitted infection have only had sex with women in the last five years. "Doctor did not know how I had got genital herpes as there was ‘no penis involved'."
Tracey, 26, London "Is there such thing as safe sex for lesbians? I do not know about this and neither
do my lesbian friends."
Catherine, 26, North West Of those who have not been tested, two in five have had sex with men in the last five years. Three in five of those who have slept with men in the last five years have not attended screening because they do not think they are at risk. Others were refusedscreening by healthcare workers.
"I made my ex-girlfriend get tested for STDs at the beginning of our relationship
because she'd had a varied and not-so-safe sexual history with other men and
women before we got together. They told me she didn't need a HIV test because
she hadn't slept with a man in a year. I'm sorry, what? Here's me thinking that
medical science knows HIV can incubate asymptomatically for ten or more years.
But apparently not. Not sleeping with a man for a year is the magical cure no
one's telling us about. So that's all right then. She was too embarrassed to go
back, and I wouldn't sleep with her until I knew she was clean."

Toni, 22, Scotland 3 Cervical screening "I had cervical cancer, surgery and radiotherapy. It was detected at a routine
smear test and was already advanced. A lot of lesbians think they don't need
a smear test because they're gay."

Louise, 56, South East "I was treated for cervical cancer after receiving a positive smear. I was originally
told that I didn't need a smear as I had never had sex with a man."
Francesca, 45, West Midlands Fifteen per cent of lesbian and bisexual women over the age of 25 have never had a cervical smear test compared to seven per cent of women in general. Seventy per cent have had a smear test in the last three years, which is comparable with national data. Of those who have never been tested, one in five have been told by a health worker that they are not at risk. Nearly half are "scared to have a test". One in fifty lesbian and bisexual women have been refused a test, even though theyhave requested one. Women who are diagnosed with cervical cancer are not monitored by the NHS on the grounds of sexual orientation therefore it is impossible to conclude that lesbians are not at risk.
"I was taken off the list for regular cervical smear tests when I came out to
a Practice Nurse. It took me 10 years to do something about it, but I have been for
a test in the last year – my first one. The Practice Nurse initially asked me if I'd ever
had sex with a man when I explained why I hadn't had a test before. When I said no,
she said, ‘Do you know what the test is for?' as if it only had relevance for women
who are sexually active with men. Her attitude changed immediately, and she
became quite supportive once I told her research showed there were other causes
of cervical cancer and all women should be tested. It did feel like I was
educating her, though. I sometimes get tired of being a learning experience."

Phoebe, 38, East Midlands One in five lesbian and bisexual women who have not attended a smear test do not think they are at risk of cervical cancer. Even some of those who have had sex with men inthe last five years do not think they need a test: one in ten lesbian and bisexual womenwho have had sex with men in the last five years have not attended a cervical smear test.
"I've not had a smear test because I'm not out to my GP and only had sex with
a guy once."
Emma, 29, South West Lesbian and bisexual women say healthcare practitioners often ask inappropriate questions: "I think nurses should be encouraged to ask more inclusive questions when giving
smears. I find it amusing when nurses ask ‘Do you have sex?' followed by ‘Do you
use contraception' and ‘Are you pregnant or seeking to become pregnant?'"

Abigail, 36, London During cervical screening, lesbian and bisexual women sometimes find that they have tomake a decision about whether or not to come out, sometimes in the middle of an examination. Abigail went on to say: "Once a nurse asked me these questions in the middle of performing the smear –
it wasn't the MOST comfortable moment at which to declare ‘I'm a lesbian' but
I did it anyway. She went very quiet indeed."

Abigail, 36, London Practitioners are also unable to provide relevant health information: "More seriously, afterwards, I asked her whether penetrative sex with toys was
risky in respective of cervical cancer or whether the risk factor only related to
penetration by a penis. She had no idea. That's not really good enough."

Abigail, 36, London Furthermore, some lesbian and bisexual women report that smear tests are uncomfortable but being open with a health practitioner can help with the procedure: "Having had to come out to the nurse doing the smear test because of the
discomfort when they used the speculum she then advised me to always ask
for the small size as despite being sexually active this wasn't as a heterosexual
person and the medium speculum was too large."

Lauren, 39, East Midlands "My partner had breast cancer and although the care she received generally
was good, our relationship was never acknowledged and at best I was treated as
her ‘friend' which at times we found difficult and stressful. We didn't like to say
anything critical to staff about this because the important thing was that they
behaved well to my partner and her care was good."

Olivia, 49, London Over one in twelve lesbian and bisexual women aged between 50 and 79 have beendiagnosed with breast cancer, compared to one in twenty of women in general. Three in ten lesbian and bisexual women check their breasts for lumps or changesevery month and half every few months. Four in five lesbians over the age of 50 havehad a breast screening test, which is similar to women in general. "Mastectomy support groups inevitably get around to discussing intimacy with
partners – I have no idea how women with female partners cope with such groups.
During that period, that concerned my body so intimately, I would have liked to
have had the chance to attend a gay-friendly women's group."

Chloe, 55, South West "Once I was sent to a NHS counsellor who suggested that my depression was
because ‘my girlfriend didn't let me be the man'. I didn't have a girlfriend
at the time."

In the last year, five per cent of lesbian and bisexual women say they have attempted to take their life and sixteen per cent of women under the age of 20 have attempted totake their life. ChildLine estimate that 0.12 per cent of people under the age of 18 haveattempted suicide. It is impossible to know how many lesbian and bisexual women havetaken their life in the last year because medical notes do not record sexual orientation;however, Mind, the mental health charity, suggests that one in every 100 people who arehospitalised after a suicide attempt will successfully take their life in the next year.
"I've seen two different therapists this year and neither of them raised my
sexuality as something that might have an impact on my mental health. I felt as
if they might not even know how to raise it because they were heterosexual, and
didn't understand what might and might not arise as issues or problems."

Keira, 23, East of England In the last year, one in five lesbian and bisexual women say they have deliberately harmed themselves in some way compared to 0.4 per cent of the general population. Half of lesbian and bisexual women under the age of 20have self harmed, compared to one in fifteen of teenagers generally.
Three quarters of those who have self-harmed in the last year have cut themselves, and one in five have swallowed pills bisexual women who have self-harmed in the or objects. Respondents also say that they have "scratched last year have swallowed themselves" or "punched walls" or "broke bones".
Mind estimate that one in 20 of the general population haveeating disorders. One in five lesbian and bisexual womenalso say that they have had, or have been told that they have had, eating problems. One in ten lesbian and bisexualwomen say they have or have had bulimia (or compulsive eating), and seven per cent say they have had anorexia now or in the past. Two per cent of the general population has been diagnosedwith bulimia, and one per cent has been diagnosed with anorexia. "Avoided or ignored so that my identity seems invisible. Mental health care
professionals have been unable to talk about it or my partner despite at times
that being partly why I was there."
Nadia, 40, West Midlands Respondents felt that mental health services failed to recognise their needs, and failed to provide inclusive services. "I am a black lesbian mother and I suffer from clinical depression. I am isolated
because of the different levels of discrimination due to my race, sexuality, mental
health problems and single mother status. Health workers tend to take the
culturally sensitive approach and will expect me to fit in the black community
who are often homophobic as most family help is centred around religious
organisations. If they know my sexuality they may feel LGBT organisations are
appropriate but none deal with the combination of mental health, families and race.
My own family believe homosexuality is a result of mental illness."

Anne-Marie, 32, London 6 Domestic violence "There is very little information regarding domestic abuse within a lesbian
relationship; everything seemed tailored to the heterosexual relationship, and
I had to specifically look for information regarding my circumstances."

Sophie, 19, North East One in four of all lesbian and bisexual women have experienced domestic violence in a relationship. Two thirds of those say the perpetrator was a woman, a third a man.
One in four of the general population of women has experienced domestic violence. Lesbian and bisexual women had experienced domestic abuse from another woman said that the abuse was emotional and physical. One in five of all lesbian and bisexualwomen said that they had been repeatedly belittled and "made to feel worthless", andthe same number said that they had been stopped from seeing friends and relatives.
One in five have also been pushed or slapped by another woman and kicked and bitten. Over half of those who have experienced domestic abuse from a female partnerhad experienced some form of physical violence. One in fourteen say they had beenforced to have unwanted sex.
"I think same-sex rape between women needs a lot more attention – as a survivor
of a woman-on-woman rape, I was terribly let down by both the lack of services
and awareness and had to cope largely on my own."

Charlie, 31, South East Thirteen per cent of lesbian and bisexual women also say that they have been frightened that they will be hurt, or someone close to them will be hurt. One in 25 saythey have experienced death threats and one in eleven say they have experienced on-going abuse after separation. "A former female partner stalked me for half a year after the end of our
relationship. She was not violent but psychologically intimidating (knowingly
paying me unwanted attention, coming uninvited to my work, waiting in my flat
lobby, sending me gifts, harassing me in the street)."

Tilly, 31, Scotland Lesbian and bisexual women also report that they have experienced domestic violencefrom men when in a relationship with them, again including physical and emotionalabuse. Three in twenty say that a male partner once forced them to have unwantedsex, and nine per cent say that their sexuality was used against them. Eight in ten lesbian and bisexual women who have experienced domestic violence have never reported incidents to the police. Of those that did report, only half werehappy with how the police had dealt with the situation. Eight in ten lesbian and bisexual women who have experienced domestic violence have never reported incidents to the police Half of lesbian and bisexual women say they exercise at Half of respondents have least three times a week 7 General fitness and exercise Lesbian and bisexual women are slightly more likely than women in general to think their health is good or very good. Eight in ten lesbians think that their health is good orexcellent and only two per cent think their health is poor. Lesbian and bisexual women are no more likely to be overweight or obese than womenin general. Half of respondents have a normal BMI, a quarter are overweight and a further fifth are obese. This is comparable with data for women in general, althoughwomen and obesity is of national concern. Those who reported that they thought theirhealth was ‘fair' or ‘poor' had on average a higher BMI. Those who reported that theyhad ‘excellent' or ‘good' health had a lower BMI.
Body Mass Index
Lesbian & bisexual women "My practice is run by a very young, super-fit married male GP who has made
it clear that he despairs of my failure to lose weight/exercise for hours daily/get
married and seems baffled by my inability to lead a ‘normal' life."

Half of lesbian and bisexual women say they exercise at least three times a week. Of those who exercise, three in five say they exercise for more than half an hour on each occasion. "I live in a very small village in a rural area of Wales - my partner and I are
completely open about our relationship. We are both active in the local community
for example I am chair of our fitness club. We are welcomed as a couple who
have something to contribute to village life."

8 The impact of discrimination Equal access to healthcare:
"I don't believe I have equal access to appropriate healthcare services as my
heterosexual counterparts – partly due to the continued lack of understanding of
specific lesbian health needs and at times of illness not always feeling emotionally
confident or sufficiently resilient to frequently have to cope with outing myself
each visit, facing a barrage of heterosexist and inappropriate questioning from
GP's and other health workers. Most of which results in me not bothering to seek
medical intervention or preventive healthcare advice until it's virtually not a choice.
I will self help and self treat as far as possible. The healthcare sector is alienating,
unsafe and does not meet my needs."

Madeleine, 44, London Since April 2007, it has been unlawful to discriminate against lesbian and bisexualwomen in the provision of public services. Despite this, half of lesbian and bisexualwomen reported some negative experience of healthcare in the last year.
"In the course of an interview about my pelvic floor muscles I mentioned to
a physiotherapist that I used a dildo and she refused to treat me after that!"
Morgan, 37, North West "My partner had an accident in Wales and the staff wouldn't recognise me as next
of kin until we made a fuss. My partner was not physically touched by the female
nurses during her six days stay. She had to wash herself or wait till the male
nurse came on."

Harriet, 59, London Coming out to a healthcare worker:
The healthcare needs of lesbians mean that healthcare practitioners should know the sexual orientation of a patient, yet half of respondents are not out to their GP orhealthcare practitioners. They are more likely to be out to their manager, their work colleagues, friends and family, than their GP. What proportion of people know you are lesbian or bisexual?
Out to at least half "I work in the NHS and even I don't feel comfortable coming out to my GP."
Louise, 49, North West "I have been in hospital twice for surgery in the past two years and I was not
comfortable coming out as I felt more vulnerable to possible poor treatment."
Assumptions of heterosexuality:
Two in five lesbian and bisexual women said that, in the last year, healthcare practitioners had assumed that they were heterosexual, and this meant they did notreceive the appropriate advice. "Despite being out to almost everyone I know, and comfortable with my sexuality,
I still can feel unsettled and intimidated by questions relating to my sexual history
that automatically relate to heterosexuality."

Eva, 57, South West "Healthcare workers continually assume I am heterosexual and ask inappropriate
questions about my relationships. I am often lectured about safe sex and
preventing pregnancy without being given a chance to say that I do not sleep with
men anymore."

Maya, 28, South West "I had cervical erosions and the doctor asked me if I had any problems with
penetrative sex. I said no, but what he meant and I meant were probably
different. The same with the practice nurse who does smears. There seems to
be a complete lack of awareness of anything except for heterosexual sex."

Shannon, 45, North West One in five felt that during the last year there was no opportunity to discuss sexual orientation, and they had some- I AM A LESBIAN!
times had to stop mid-procedure to correct assumptions. "I was about to have an x-ray in hospital. The nurses and radiographer
asked the routine question of whether there was any chance I could
be pregnant, to which I replied in the negative. Without giving me
the chance to explain further, they asked if I had a partner with
whom I was sexually active, which I confirmed. They started to
lecture me about the importance of being sure I was not pregnant
before being x-rayed, telling me that there was no way I could
possibly be sure I was not pregnant if I was having sex without
contraceptives. I was not given a chance to speak at any length
during this tirade and eventually had to shout ‘I AM A LESBIAN'
(in front of the entire casualty ward) to get them to stop telling me
off and give me the x-ray."

Tabitha, 25, London One in eight lesbian and bisexual women are not sure what their GP's policy is onconfidentiality. Although many respondents commented that they wanted their sexualorientation permanently recorded on their notes to ensure they receive appropriatecare, many expressed concern about how this information would be treated.
"I know the general NHS confidentiality policy, but I do not believe that information
about individuals is kept confidential within the GP practice. One member of
staff, who had no reason to know about my sexuality, talked about ‘people of
your persuasion' to me."

Paula, 35, Scotland "I think when you join a GP surgery their confidentiality policy should be made
clear. Also, I would like to know that if I disclosed my sexuality and asked them
not to write it on my records that they would follow my request."

"It would be good if a woman's sexual orientation could be noted on their health-
care records so that it is not automatically assumed that they are heterosexual.
BUT ONLY if all women could be assured that no-one with access to their records
would treat them differently/discriminate against them because of their sexuality."

Vicky, 28, South West One in ten lesbian and bisexual women stated that when they did come out to a healthworker, they were eitherignored or the healthworker continued to assume they wereheterosexual. This was particularly obvious when partnerswere excluded from consultations, or when healthcareworkers failed to recognise the status of civil partnership.
"Psychiatrist telling me not to worry if I got pregnant
on the medication I was on, when I had just told her
I had been in a relationship with my female partner for
over two years. Made me feel that there was no point
in talking to her."

Bea, 30, North West "I was an out-patient at hospital and they did not have a section to record that
I was in a civil partnership on their computer system. I was told that it went on
the computer as single."

Mandy, 34, North West "One of my midwives insisted on referring to my partner as my mother despite
explicit information to the contrary and when my baby was born said to her
‘Congratulations, Grandma.' My partner, who is younger than I am, was amused
but not best pleased."

"I recently had the unhappy experience of being with my partner when she
collapsed and an ambulance was called. It made me experience ‘lesbian
invisibility' in a more profound and upsetting way than ever before – I was almost
completely ignored initially. They didn't seem to click when I told them I was her
partner (we were civilly partnered last year) and it was only when we both said
that I was next of kin that they started to work it out. Their lack of awareness
made a bad situation that little bit worse."

Adele, 33, London Six per cent of lesbian and bisexual women say that in the last year healthcare workershave made inappropriate comments when they have told them their sexual orientation. "I went to my doctor with a stress-related illness and mentioned that coming out
to my family had been a recent source of stress. He responded by telling me that
his sister had recently come out, told me that he was still revolted by it, and said
that his family were operating a ‘don't ask don't tell' policy. He didn't seem to have
any awareness that this might have an impact on my reaction to him!"

"I experienced a homophobic response from a locum GP. She said she thought
homosexuality was a sin, but ‘would not treat me any different' because of her view."
Wendy, 60, London "When my late partner was diagnosed with cancer all the staff were tremendously
supportive and the fact we were a gay couple was accepted and we never felt we
were treated any differently."

Angharad, 33, Wales When lesbian and bisexual women said that they had had some positive experienceswhen accessing healthcare, this made a difference to how they felt about themselves and their relationship with the health sector. "I received brilliant treatment from NHS staff around our son's birth 18 months ago."
Maureen, 40, London "I have fab doctors. It is not a gay orientated surgery, they are very Christian,
family doctors, yet have no prejudice and treat us both with great respect, are
always friendly and up for a laugh."

Susan, 43, North West "GP very supportive about my sexuality. He said ‘Good for you!'"
Una, 24, Yorkshire and the Humber Just a quarter of respondents said that their health worker acknowledged they were lesbian or bisexual after they had come out and just one in fourteen said that their health worker had provided them with the opportunity to come out. Only one in eight said that they had been told that their partner was welcome to be present during a consultation.
"While having our child my partner was included throughout by all healthcare
Kirsty, 31, Scotland "My partner and I see the same GP and she usually asks how the other one is. She
sent us a card for our civil partnership and updates us on news of her gay son."
Samantha, 55, West Midlands "My GP overrode her surgery's closed list for new registrants to register my
partner, in order to keep us together as a family at that practice."
Clare, 42, London Getting the right information:
Just one in ten lesbian and bisexual women said that healthcare workers had specifically given them information relevant to their sexual orientation. "An excellent experience I had recently was when we approached our GP for a
referral to a fertility clinic. Although it was my partner undergoing the treatment
the GP involved me in the discussions at all times and gave really good advice on
how we should approach things."

Kelly, 31, South West "My GP told me that it didn't matter if I was a lesbian, I still might need a
Alex, 25, South Central "The practice nurse I saw to have my smear test was very willing to chat about
lesbian health issues."
Hannah, 35, London A quarter of lesbian and bisexual women also said that their GP had a clear policy on confidentiality, and one in eleven said that the GP surgery displayed a policy statingthat they would not discriminate against people because of their sexual orientation.
Posters and materials depicting same-sex relationships or lesbian and bisexual issueswere also seen as a positive sign within a health setting. "A poster in a toilet advising safer sex for lesbian women and a booklet in the
waiting room about lesbian relationships."
Laura, 49, London Two per cent of lesbian and bisexual women had attended a clinic specifically for them.
There are three clinics in Great Britain – two in London and one in Glasgow. "The Orange Clinic is totally brilliant. Every assumption was explicitly checked
out with me and the questions and service were totally tailored to my situation.
It was amazing to have something designed for me, rather than have to fit in as
best I could with something designed for straight people. Every city should have
a service like this."

Jenny, 24, London "I had an extremely positive experience at the lesbian, gay, bisexual and trans
sexual health clinic at Guys. After years of misdiagnosis by straight doctors
(including at a GUM clinic), who kept testing me for sexually transmitted infections,
a lesbian nurse realised I was allergic to silicone which my sex toy is made from.
That nurse revolutionalised my sex life!"

Robyn, 34, London "When I lived in London, I used both of the lesbian clinics, made a HUGE
difference. no assumptions being made about me, able to speak freely without
worrying that the doctor would be shocked or uncomfortable, or just simply
not understand what I was taking about."

Edith, 53, North West 10 Recommendations "Just make it less scary."
Ella, 21, North West Lesbian and bisexual women surveyed made a series of practical recommendations for the health sector.
1. Understand lesbian health needs
Only one in ten lesbian and bisexual women said that healthcare workers have giventhem information relevant to their sexual orientation. One in five lesbian and bisexualwomen have been told that they don't need a smear test.
"GPs and healthcare workers must show more interest in lesbian health issues.
At present it seems very focussed on pregnancy, contraception and STI prevention
which they generally perceive as being heterosexual women's issues. When I go to
the doctor, I feel like I'm not very important to them as a lesbian woman."

"Doctors should just be aware of differences between heterosexual and
non-heterosexual patients. One doctor said that because lesbians didn't have
penetrative sex they weren't at such high risk. She was just unaware of lesbian
sexual practice and how that might affect health."

Verity, 23, London 2. Train staff
Only three in ten lesbianand bisexual women said healthcare workers did not make inappropriate commentsabout their sexual orientation,nor had they asked inappropriate questions. One in fifty, equivalentto 37,000 lesbian andbisexual women, havebeen refused a smeartest even though theyrequested one.
"Compulsory and regular
training for all healthcare
workers. This means
training for qualified
staff, included in their
mandatory study days,
and proper training for
students in training."

"Training for nursing staff in critical care settings (such as intensive care) on the
needs of lesbians and sensitivity when talking with their partners when the patient
is unconscious or critically ill."

3. Don't make assumptions
Two in five lesbian and bisexual women said that in the last year healthcare workershad assumed they were heterosexual and one in five felt there was no opportunity todiscuss their sexuality. "I've found it helpful and easier to come out to healthcare professionals when
I have been asked open questions (rather than assumptions being made), for
example, asking whether I have a partner rather than asking if I have a boyfriend
allows me to open up."

Cindy, 24, West Midlands "Personally I have had very positive dealings with most GPs and hospital staff but
there is still this underlying assumption that when you bring your partner you have
either brought your sister or friend with you. Having to constantly out yourself as
lesbian to people who make this assumption, even when no malice is intended, is
stressful when you're already in a stressful situation due to a health problem."

Elizabeth, 41, South West 4. Explicit policies
Half of lesbian and bisexual women said they have had a negative experience of healthcare in the last year. Only one in eight have been told that their partner is welcome to attend consultations and only one in eleven say that their GP surgery displayed a non-discriminatory policy.
"We are invisible in most health research and so this carries over into services.
I would like to see diversity initiatives that encompass lesbian, gay and bisexual
issues on a similar level to race initiatives and legal requirements."

Verity, 28, London "Anti-discrimination policy statements placed in prominent places within each
healthcare setting."
Sheila, 48, London 5. Tell lesbians what they need to know
Despite the fact that eight in ten lesbian and bisexual women think they are in good health, lesbian and bisexualwomen are more likely to drink alcohol and take drugs compared to women in general. Three quarters of lesbian and bisexual women think they are not at risk from sexuallytransmitted infections.
"There is a general lack of information available for
lesbian and bisexual women. A greater awareness of
how sexual orientation affects health link between
cervical cancer and increased risk due to less likelihood
of having children, more likely to drink alcohol and
smoke is needed, and a more accessible and positive
approach from healthcare professionals is needed."

Christine, 24, Scotland "More access to literature, many lesbians such as myself do not know where to get
info about sexual health and safe sex, so it would be good to have an advertised
website or contact to go to."

6. Improve monitoring
One in ten lesbian and bisexual women stated that when they did come out to a healthcare worker they were either ignored, or the healthcare worker continued toassume that they were heterosexual and only one in fourteen had been given anopportunity to come out as lesbian or bisexual.
"For healthcare workers to ask whether you want your sexual orientation/current
relationship status recorded in your notes - or somehow remembered in a more
informal, private way - so you don't have to remind them every time you see them
that ‘actually, no, I don't need contraception, because my partner is female!'"

Sandra, 28, South West "Information should be provided for GPs followed by the addition of a sexual
orientation question on the GPs registration card. All orientation options should be
included along with a ‘prefer not to say' option. If the patient ticks ‘prefers not to
say' on registration, GPs should be trained not to assume anything and re-ask the
question if it becomes relevant to their medical care."

Vanessa, 38, London 7. Increase visibility
In the last year, one in five lesbian and bisexual women have harmed themselves in some way. Lesbian andbisexual women under the age of 20 are ten times more likely to have self-harmed compared to others. Five per cent have attempted to taketheir life in the last year, and womenunder the age of 20 are eight timesmore likely to have attempted to taketheir life. Increased visibility meanswomen will feel able to discuss theirhealth needs with a healthcare worker. "Simple things like gay-friendly
posters and leaflets in hospitals
and GP surgeries and information
on lesbian, gay and bisexual specific
services."

"If health workers made it obvious, for example, through posters or direct contact
with me, that patient sexuality was not an issue for them and that lesbians were
welcome, I might feel easier about visiting the GP for things like smears."

Trudy, 28, North West 8. Make confidentiality policies clear
One in eight lesbian and bisexual women are not sure what their GP's policy is on confidentiality. Half of lesbian and bisexual women are not out to their GP or healthcare worker.
"I think when you join a GP surgery, their confidentiality policy should be made
clear. Also, I would like to know that if I disclosed my sexuality and asked them not
to write it on my records that they would follow my request."

9. Make complaints procedures clear
Six per cent of lesbian and bisexual women say that healthcare workers have madeinappropriate comments when they did tell them their sexual orientation and half havehad a negative experience in the health sector in the last year.
"Clear and formal complaints procedures when you are treated differently and
negatively by a health profesional."
"GPs should be made to recognise our existence and it should be made easier to
complain without fear of backlash – being removed from doctors list."
Jessa, 34, West Midlands 10. Develop tailored services
Only two per cent of lesbian and bisexual women have attended a service tailoredtowards their needs. Nearly three quarters of lesbian and bisexual women who havenot been tested for sexually transmitted infections are too scared to get tested.
"I attended a health centre specifically aimed at gay people a few years ago
and that was excellent. I don't think lesbians need a separate healthcare
facility from gay men but one that employs healthcare professionals who
are gay-friendly and understand the lifestyles and healthcare needs of
both groups is important."

"As a disabled gay woman who uses a wheelchair I experience ‘double
discrimination'. People assume I am not a sexual being – furthermore they
presume I must have profound learning disabilities as my legs don't work!"

Sophia, 44, West Midlands In 2007, Stonewall and De Montfort University asked lesbian and bisexual women fromGreat Britain to complete a survey about their health. The survey received 6178 responsesmaking it the biggest survey of lesbian and bisexual women's health needs in Europe. Eighty one per cent of respondents said that they were lesbian, and sixteen per centsaid they were bisexual. Eighty five per cent of respondents live in England, nine percent in Scotland, and five per cent in Wales. Eighty two per cent of respondents are white British, and the rest are from ethnic minorities, which is comparable with thegeneral population. Respondents come from a wide age-range. The youngest respondentwas fourteen and the oldest was 84. Fourteen per cent of respondents say that theyhave a disability, including physical and mental disabilities. Further statistics are available for each strategic health authority or health board. They can be found at www.stonewall.org.uk/lesbianhealth and illustrated by Prescription for Change Lesbian and bisexual women's health check 2008

Source: http://lgbt.ie/attachments/_attachment_233_prescription_for_change_1.pdf

Doping_code_e.pdf

OLYMPIC MOVEMENT ANTI-DOPING CODE General Provisions The Offense of Doping and its Punishment International Anti-Doping Agency Accredited Laboratories Testing Procedures Entry into force and Modifications of the Olympic Movement Anti-Doping Code ANNEXES APPENDIX A Prohibited Classes of Substances and Prohibited Methods [Note: The following Appendices are maintained on a transitional basis

R0873 - customer artwork, package insert, 3m flu a+b test _50195_ - rev2r0 _34-8702-8078-1 [november 2009]_.doc

FOR INFORMATIONAL USE ONLY. Not to be used for performing assay. Refer to most current package insert accompanying your test 3M™ Rapid Detection Flu A+B Test IVD FOR IN VITRO DIAGNOSTIC USE INTENDED USE The 3M™ Rapid Detection Flu A+B Test is a qualitative immunochromatographic assay used to identify the presence of Influenza A and Influenza B nucleoprotein antigens in nasal wash, nasal aspirate, nasopharyngeal aspirate, and nasopharyngeal swab specimens from symptomatic patients. It is an in vitro diagnostic assay that aids in the rapid differential diagnosis of influenza viral infections in symptomatic patients. A negative test is presumptive and it is recommended these results be confirmed by cell culture. Negative results do not preclude influenza virus infection and should not be used as the sole basis for treatment or other management decisions.