Predictors of Disclosure of Sexual Orientation to Healthcare Providers among Lesbians and Bisexual Women

The Institute of Medicine (2011) has recently highlighted health disparities among U.S. women based on sexual minority status, reviewing evidence that compared to heterosexual women, lesbians and bisexual women report higher rates of substance use behaviors, have higher prevalence of obesity and breast cancer, and are less likely to seek preventative healthcare. Fear of disclosure of sexual orientation to healthcare providers may be among the factors that help explain these observed differences. The present study analyzes longitudinal data from interviews with 198 self-identified lesbians and bisexual women ages 19-58 (M = 32.42) on degree of disclosure of sexual orientation and its associations with self-reported health, psychological well-being, and minority stress. Results demonstrated that bisexual women were significantly less likely to have disclosed their sexual orientation to healthcare providers, with only 37% of bisexual women reporting they were “out to all providers” compared to 66% of lesbians. A multivariate linear regression model predicting disclosure of sexual orientation based on participants' levels of internalized homophobia, expectations of facing stigma, history of perceived discrimination, strength of lesbian or bisexual identity, and connectedness to the lesbian, gay, bisexual, and transgender community, explained 13% of the variance in degree of disclosure. Greater disclosure of sexual orientation was significantly related to better psychological well-being at 1-year follow-up. The author will discuss implications for healthcare policy at the level of providers and healthcare institutions, as well as for granting agencies and researchers developing interventions to reduce sexual minority health disparities among women.