Encounters in the medical context. Issues of gender and sexuality

Abstract

A multidisciplinary approach in medicine is pivotal in order to understand the health implications of gender differences and sexual identity/orientation..The general aim of this thesis was to study how gender and sexuality are constructed in the medical context using examples from the following settings: an intervention programme, medical faculty and medical consultation. The specific aims were to assess the long-term effects of a cardiovascular disease (CVD) risk-factor control intervention in women, to study actively participating women's experience of being at risk, to study faculty course organizers' views of a gender perspective on their scientific field, to study general practitioners' (GPs') awareness and knowledge of sexual identity matters in the consultation setting, and to bring up the relative invisibility of lesbian women.Material and methods. Both quantitative and qualitative methods were used in the studies. Female participants and non-participants in a 1985-87 life-style intervention program in Strömstad were compared regarding risk factors for CVD after eight years. A sample of the most actively participating women was chosen for interviews. Course organizers at the medical faculty in Göteborg took part in telephone interviews concerning gender issues in medical science. GPs in Göteborg answered a postal questionnaire, and a sample of these GPs took part in focus group interviews, concerning awareness and knowledge of sexual identity issues in the consultation setting.Results. Women with CVD risk factors handled knowledge and experience from intervention groups so that, after eight years, the participants lowered or kept control over several risk factors as compared to non-participants. Three core concepts in relation to living with risk factors were identified: there is no one but yourself to rely on, resisting invasion, and living with incompatibilities. Two core concepts in relation to gender in science were identified: diversity and boundaries within the medical field of knowledge, and women as the source of gender knowledge. A minority of GPs were aware of having lesbian women as patients and few of these knew of health issues. The relevance of bringing up sexual orientation issues was discussed. The role of consultation skills and how family and sexual orientation are discussed with patients was elaborated, showing the complexity of the GPs' opinions and experiences with patients.Conclusions. Community prevention programs designed for women can produce long-standing effects on CVD risk factor patterns but may be invasive and ambiguous, and a shift to health orientation is suggested. Gender issues in medical faculty are sometimes categorically referred to the spheres of ideology (non-science) and women. An active promotion of gender issues by the faculty, with special focus on male participation, is suggested. Heterosexism in society and lack of medical education on minority issues are suggested causes of low levels of awareness and knowledge about lesbian women as patients. Doctors need to transcend traditional concepts of family and sexuality to make non-heterosexual identities visible in the consultation.