Did you know? A survey of 132 medical schools in the U.S. and Canada found that schools spend an average of only five hours on LGBTQ2s+ health issues. Nine schools reported no hours of LGBTQ2S+ health taught during preclinical years and 44 reported no hours during clinical years.
LGBTQ2S+ youth have an increased risk of suicide, substance abuse, isolation and experiencing sexual violence; LGBTQ2S+ elders also face particular mental health risks. Experiences of homophobia, transphobia and the loss of community and family support that often come from disclosing (or not disclosing) sexual orientation and/or gender identity are crucial factors that impact health and wellbeing.
Sexual Trauma and Mental Health
Sexual violence (any unwanted act of a sexual nature that is imposed on another person) and the loss of safety and bodily autonomy that survivors experience can have many mental health effects, like depression, anxiety, post-traumatic stress disorder, personality disruption, attachment disruption, and addiction.
Survivors of sexual violence are more likely than the average person to attempt suicide. This is in part because in addition to the violence itself, survivors must also contend with pervasive myths about sexual assault that can further isolate and stigmatize them.
Intimate Partner Violence and Reproductive Coercion
The health impacts of intimate partner violence on survivors/victims and their families is devastating. Intimate partner violence is the most common form of violence against women globally and is associated with many health issues, including injuries, chronic diseases, substance abuse, reproductive health problems, HIV and AIDS, and low birth weight. The mental health consequences of intimate partner violence can be severe and include Post Traumatic Stress Disorder (PTSD), depression, anxiety, and eating disorders.
While we often discuss intimate partner violence and reproductive coercion as issues only affecting cis-women, intimate partner violence is common in LGBTQ2S+ communities and it may also include behaviours that draw on the experiences of LGBTQ individuals, such as “outing” or restricting a person’s access to items that are central to their gender or sexual identity.
Intimate partner violence increases the risk of mental health issues and not being able to control our own sexual and reproductive lives, including deciding when to be pregnant, when and how to use birth control, if or when to access abortion, how and when to practice safer sex, protect ourselves from HIV infection, etc.
Reproductive coercion is a form of intimate partner violence, where behaviour concerning reproductive health (like contraceptive use and pregnancy) is used to maintain power, control, and domination within a relationship and over a partner.
The most common forms of reproductive coercion include sabotage of contraceptive methods, pregnancy coercion, and pregnancy pressure. Birth control sabotage is active interference with a partner’s contraceptive methods in an attempt to promote pregnancy. Examples include hiding, withholding, or destroying a partner’s oral contraceptives; breaking or poking holes in a condom on purpose or removing a condom during sex; not withdrawing when that was the agreed upon method of contraception; and removing vaginal rings, contraceptive patches, or intrauterine devices (IUDs). Pregnancy pressure involves behaviour intended to pressure a partner to become pregnant when they do not wish to become pregnant. Pregnancy coercion involves coercive behaviour such as forced sex (sexual assault), threats, or violence actions toward a partner who does not comply with the perpetrator’s wishes regarding the decision to terminate or continue a pregnancy. Examples of pregnancy pressure and coercion include: threatening to hurt a partner who does not agree to become pregnant, forcing a partner to carry a pregnancy to term against their wishes through threats or acts of violence, forcing a partner to terminate a pregnancy when they do not want to, or injuring a partner in a way that may cause a miscarriage.
If you are experiencing intimate partner violence or reproductive coercion, you can seek support from a trusted health care provider, sexual health care centers or regional confidential crisis lines.
Confidential Crisis Lines
In case of a crisis (toll-free)
Klinic Crisis Line: 1-888-322-3019 or http://klinic.mb.ca/
Kids Help Phone: 1-800-668-6868 or http://www.kidshelpphone.ca/teens/home/splash.aspx
Call (toll-free): 1-800-268-9688
Call (toll-free): 1-877-330-6366
Pro-choice pregnancy options counselling and referrals
Choice in Health
Call (toll-free): 1-866-565-9300
Exhale (pro-choice post-abortion counselling toll-free)
Call (toll-free): 1-866-439-4253
Action Canada for Sexual Health and Rights
Call (toll-free): 1-888-642-2725
Email: [email protected]
Sexual health and service provider directory
Action Canada for Sexual Health and Rights
Call (toll-free): 1-888-642-2725
Sexual assault and domestic abuse crisis lines (toll-free)
Assaulted Women’s Helpline: 1-866-863-0511
British Columbia: 1-877-392-7583
Nova Scotia: 1-877-521-1188
Nunavut and Northwest Territories: 1-800-265-3333
Ontario directory: http://www.sexualassaultsupport.ca/support
Yukon (accepts collect calls outside of Whitehorse): 867-668-5733
General directory of health and social service support services
The Stigma of Mental Health Diagnoses
Stigma around mental health and sexuality has meant that many people who experience mental health conditions are stereotyped as either hypersexualized, asexual, or undeserving/unfit to engage in sexual or romantic relationships.
This stigma impacts how patients with mental health conditions are treated in health care settings and may also impact a patient’s sexual risk-taking. The sexual and reproductive health needs of people with mental health conditions are often neglected because of these stereotypes.
Combined with either limited or a total lack of “sex-ed” and unmet health care needs, stigma creates health disparities among those living with mental health conditions.
Health Impacts of Colonialism and Racism
Canada has a long (and ongoing) history of controlling the reproductive abilities of Indigenous peoples. As recently as 2017, a report in Saskatoon exposed the experience of Indigenous women being coerced into tubal ligations (a method of permanent birth control).
Canada’s sterilization policies have had detrimental effects on Indigenous peoples and communities. One example of the intersection of mental health and sexual health in this context is how large numbers of Indigenous men and women were sterilized for being “mentally unfit.” This was determined by the State under a number of reasons, including not conforming to colonial notions of sexual mores, ways of living, customs and behaviours, etc. as well as allowing for the transfer of land/property from Indigenous peoples to the federal government and/or the provinces through a designation of mental incompetence.
Health care in Canada has also been marked by historical and contemporary racism and discrimination, including the testing of contraceptives of non-consenting racialized individuals across North America, the conducting of experiments on enslaved Black women in the United States, and the early history of the family planning movement as attempting to limit “deviant” populations through population control.
Coupled with ongoing racial discrimination in health care and a lack of culturally competent health care, many Black, Indigenous and racialized individuals experience distrust in the health care system or delay accessing care.
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