Skip to main content
SpringerLink
Log in

Internalized Homophobia, Disclosure, and Health

  • Chapter
Lesbian, Gay, Bisexual, and Transgender Healthcare

Abstract

Heterosexism and homophobia are unconscious or conscious inconsideration or negative feelings, respectively, toward someone whose sexual orientation is not heterosexual. The internalization of these concepts results when lesbian, gay and bisexual people harbor these same socially constructed feelings toward themselves and others who do not have a heterosexual orientation. The same types of inconsideration and negativity can also be aimed toward people who do not conform to binary gender roles or toward those who transition from birth gender to a differing gender. This chapter highlights the differences in isms and phobias along with causes, manifestations and ways to avoid instilling these into your practice. Further, facilitators and barriers to disclosure of sexual identity in the healthcare environment will be discussed in the context of creating safe and trusting relationships to promote better health outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sears JT, Williams WL, editors. Overcoming heterosexism and homophobia: strategies that work. 1st ed. New York: Columbia University Press; 1997.

    Google Scholar 

  2. Herek GM. The context of anti-gay violence: notes on cultural and psychological heterosexism. J Interpers Violence. 1990;5:316–33.

    Article  Google Scholar 

  3. Herek GM, Cogan JC, Gillis JR, Glunt EK. Correlates of internalized homophobia in a community sample of lesbians and gay men. J Gay Lesbian Med Assoc. 1998;2(1):17–26.

    Google Scholar 

  4. Balsam KF, Molina Y, Beadnell B, Simoni J, Walters K. Measuring multiple minority stress: the LGBT People of Color Microaggressions Scale. Cultur Divers Ethnic Minor Psychol. 2011;17(2):163–74. doi:10.1037/a0023244.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Sue DW, Capodilupo CM, Torino GC, Bucceri JM, Holder AM, Nadal KL, Esquilin M. Racial microaggressions in everyday life implications for clinical practice. Am Psychol. 2007;62(4):271–86. doi:10.1037/0003-066X.62.4.271.

    Article  PubMed  Google Scholar 

  6. Platt LF, Lenzen AL. Sexual orientation microaggressions and the experience of sexual minorities. J Homosex. 2013;60(7):1011–34. doi:10.1080/00918369.2013.774878.

    Article  PubMed  Google Scholar 

  7. Shavers VL, Fagan P, Jones D, Klein WMP, Boyington J, Moten C, Rorie E. The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health. 2012;102(5):953–66. doi:10.2105/AJPH.2012.300773.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Shelton K, Delgado-Romero EA. Sexual orientation microaggressions: the experience of lesbian, gay, bisexual, and queer clients in psychotherapy. J Couns Psychol. 2011;58(2):210–21. doi:10.1037/a0022251.

    Article  PubMed  Google Scholar 

  9. Thoits P. Self-labeling processes in mental illness: the role of emotional deviance. Am J Sociol. 1985;91(2):221–49.

    Article  Google Scholar 

  10. Hatzenbuehler ML, Nolen-Hoeksema S, Dovidio J. How does stigma get under the skin? The mediating role of emotion regulation. Psychol Sci. 2009;20(10):1282–9. doi:10.1111/j.1467-9280.2009.02441.x.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013;103(5):813–21. doi:10.2105/AJPH.2012.301069.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Risher K, Adams D, Sithole B, Ketende S, Kennedy C, Mnisi Z, Baral SD. Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland. J Int AIDS Soc. 2013;16(3 Suppl 2):18715. doi:10.7448/IAS.16.3.18715.

    PubMed Central  PubMed  Google Scholar 

  13. Moskowitz GB. On the control over stereotype activation and stereotype inhibition. Soc Pers Psychol Compass. 2010;4(2):140–58.

    Article  Google Scholar 

  14. Blair IV, Steiner JF, Havranek EP. Unconscious (implicit) bias and health disparities: where do we go from here? Perm J. 2011;15(2):71–8.

    PubMed Central  PubMed  Google Scholar 

  15. USDHHS. Better health and well-being. 2012. http://www.hhs.gov/lgbt/health-update-2011.html. Retrieved 14 Jan 2014.

  16. Buchmueller T, Carpenter CS. Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. Am J Public Health. 2010;100(3):489–95.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Ponce NA, Cochran SD, Pizer JC, Mays VM. The effects of unequal access to health insurance for same-sex couples in California. Health Aff. 2010;29(8):1–10.

    Article  Google Scholar 

  18. Giles J. Sex hormones and sexual desire. J Theory Soc Behav. 2008;38(1):45–66. doi:10.1111/j.1468-5914.2008.00356.x.

    Article  Google Scholar 

  19. Alsop R, Fitzsimons A, Lennon K. Theorizing gender. Malden, MA: Blackwell; 2002.

    Google Scholar 

  20. Herek GM. On heterosexual masculinity: some psychical consequences of the social construction of gender and sexuality. Am Behav Sci. 1986;29(5):563–77. doi:10.1177/000276486029005005.

    Article  Google Scholar 

  21. Soldin OP, Chung SH, Mattison DR. Sex differences in drug disposition. J Biomed Biotechnol. 2011;20(1):14. doi:10.1155/2011/187103.

    Google Scholar 

  22. Fogel SC. Identifying facilitators and barriers to disclosure of sexual identity to healthcare providers. Kans Nurse. 2005;80(9):1–3.

    PubMed  Google Scholar 

  23. St Pierre M. Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature. J Lesbian Stud. 2012;16(2):199–219. doi:10.1080/10894160.2011.604837.

    Article  PubMed  Google Scholar 

  24. Durso LE, Meyer IH. Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sex Res Soc Policy. 2013;10(1):35–42. doi:10.1007/s13178-012-0105-2.

    Article  Google Scholar 

  25. Austin EL. Sexual orientation disclosure to health care providers among urban and non-urban southern lesbians. Women Health. 2013;53(1):41–55. doi:10.1080/03630242.2012.743497.

    Article  PubMed  Google Scholar 

  26. Ranji U, Beamesderfer A, Kates J, Salganicoff A. Health and access to care and coverage for lesbian, gay, bisexual, and transgender individuals in the U.S. The Henry J. Kaiser Family Foundation. 2014. http://kaiserfamilyfoundation.files.wordpress.com/2014/01/8539-health-and-access-to-careand-coveragefor-lesbian-gay-bisexual-and-transgender-individuals-in-the-u-s.pdf. Accessed 3 Mar 2014.

  27. Stevens PE. Protective strategies of lesbian clients in healthcare environments. Res Nurs Health. 1994;17:217–29.

    Article  CAS  PubMed  Google Scholar 

  28. Reagan P. The interaction of health professionals and their lesbian clients. Patient Couns Health Educ. 1981;28:21–5.

    Article  Google Scholar 

  29. Smith EM, Johnson SR, Guenther SM. Health care attitudes and experiences during gynecologic care among lesbians and bisexuals. Am J Public Health. 1985;75:1085–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Cochran SD, May VM. Disclosure of sexual preference to physicians by black lesbian and bisexual women. West J Med. 1988;149:616–9.

    PubMed Central  CAS  PubMed  Google Scholar 

  31. Tiemann K, Kennedy S, Haga M. Rural lesbians’ strategies for coming out to health care professionals. J Lesbian Stud. 1998;2(1):61–75.

    Article  CAS  PubMed  Google Scholar 

  32. Stevens PE, Hall JM. Stigma, health beliefs and experiences with health care in lesbian women. Image J Nurs Sch. 1988;20(2):69–73.

    Article  CAS  PubMed  Google Scholar 

  33. Lehmann JB, Lehmann CU, Kelly PJ. Development and health care needs of lesbians. J Womens Health. 1998;7:379–87.

    Article  CAS  PubMed  Google Scholar 

  34. IOM (Institute of Medicine). The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: National Academies Press; 2011.

    Google Scholar 

  35. Stevens PE. Structural and interpersonal impact of heterosexual assumptions on lesbian health care clients. Nurs Res. 1995;44:25–30.

    Article  CAS  PubMed  Google Scholar 

  36. Leninger M, McFarland M. Transcultural nursing: concepts, theories, research and practice. 3rd ed. New York: McGraw-Hill; 2002.

    Google Scholar 

  37. American Medical Association. AMA policy H-160.991, health care needs of the homosexual population. http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/ama-policy-regarding-sexual-orientation.shtml. Accessed 27 Jan 2014.

  38. Cole SW, Kemeny ME, Taylor SE, Visscher BR. Elevated health risk among gay men who conceal their homosexual identity. Health Psychol. 1996;15:243–51.

    Article  CAS  PubMed  Google Scholar 

  39. Dardick L, Grady KE. Openness between gay persons and health professionals. Ann Intern Med. 1980;93:115–9.

    Article  CAS  PubMed  Google Scholar 

  40. Simkin RJ. Lesbians face unique health care problems. Can Med Assoc J. 1991;145:1620–3.

    CAS  Google Scholar 

  41. Taylor B. ‘Coming out’ as a life transition: homosexual identity formation and its implication for health care practice. J Adv Nurs. 1999;30:520–5.

    Article  CAS  PubMed  Google Scholar 

  42. Trippet SE, Bain J. Reasons American lesbians fail to seek traditional health care. Health Care Women Int. 1992;13:145.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Nursing, Vanderbilt University, 307 Godchaux Hall, 221 21st Avenue South, Nashville, TN, 37240, USA

    Sarah C. Fogel Ph.D., R.N., F.A.A.N.

Authors
  1. Sarah C. Fogel Ph.D., R.N., F.A.A.N.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah C. Fogel Ph.D., R.N., F.A.A.N. .

Editor information

Editors and Affiliations

  1. Program for LGBTI Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Kristen Eckstrand

  2. Program for LGBTI Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Jesse M. Ehrenfeld

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Fogel, S.C. (2016). Internalized Homophobia, Disclosure, and Health. In: Eckstrand, K., Ehrenfeld, J. (eds) Lesbian, Gay, Bisexual, and Transgender Healthcare. Springer, Cham. https://doi.org/10.1007/978-3-319-19752-4_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19752-4_4

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19751-7

  • Online ISBN: 978-3-319-19752-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation