The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations

Abstract

Objective: Our goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection.

Methods: Data were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses' Health Study 3 between the follow-up period of 1996-2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI).

Results: Provider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001).

Conclusion: Provider-patient communication may benefit sexual minority women's contraceptive practices and engagement with STI testing.

Practice implications: Differences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters.

Keywords: Health communication; Reproductive health services; Sexual and gender minorities; Sexual health.