Therapeutic itinerary and search for health care for cisgender lesbian and bisexual women: a look at breast and gynecological cancer

Author(s)

Carolina de Souza

• Document type: Doctoral Thesis
• Press: Ribeirão Preto.
• Institution: Universidade de São Paulo (USP). Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (PCARP/BC)
• Defense date: 2025-05-21

Examining board members

Manoel Antonio dos Santos; Cintia Bragheto Ferreira; Marislei Sanches Panobianco; Daniela Barsotti Santos

• Advisor: Manoel Antonio dos Santos

Abstract

A systematic review of the literature did not identify any research on breast or gynecological cancer that addressed the matter of care for non-heterosexual women affected by the disease. In this sense, it is important to think about the specificities that accompany the therapeutic itinerary of lesbian and bisexual women whose lives have been affected by cancer. It is also relevant to investigate what lesbian and bisexual women who have not experienced breast and gynecological cancer imagine is necessary during cancer treatment for non-heterosexual patients who have been diagnosed, to ensure they have access to adequate health care. Considering these assumptions, this study aimed to understand the meanings constructed by lesbian/bisexual women diagnosed with breast or gynecological cancer during their therapeutic itineraries, as well as by those without a cancer diagnosis through their health care trajectories. This is a qualitative, descriptive-exploratory, cross-sectional study whose theoretical framework is feminist gender studies from a health perspective. Ten women who self-identified as lesbians and one bisexual woman took part in the study. The sample consisted of four participants diagnosed with breast cancer and seven without a diagnosis of cancer. Semi-directed interviews were carried out with questions that sought to circumscribe the experiences of lesbian and bisexual women with and without a history of cancer in their search for care in health services. The interviews were conducted individually, mediated using technology, and lasted between 33 and 152 minutes. The audio-recorded content was transcribed verbatim and in its entirety. Subsequently, the data were organized based on reflexive thematic analysis and were analyzed and discussed with the support of feminist gender studies from a health perspective. Three empirical articles were produced to respond to the objectives of this research. Article 1 addressed only those participants who had not been diagnosed with cancer, focusing on their search for preventive examinations, which facilitate early disease detection, when treatment tends to be more effective. Participants reported visiting a gynecologist at least once and undergoing preventive exams. However, they emphasized that health professionals are inadequately prepared to address the needs of women who do not conform to heteronormative expectations. Article 2 looked specifically at the therapeutic itinerary of participants who had had breast cancer. The most common themes included waiting time for diagnosis, financial costs of treatment, utilization of public and/or private services, and participants\' experiences with the professionals who assisted them. All the participants reported uncomfortable situations experienced in health services, which reinforces the lack of preparation among professionals to deal with sexual diversity, an aspect that was also addressed in Article 1. Article 3 focused on the patients\' experiences during cancer treatment, as well as the meanings that undiagnosed lesbian women constructed about breast cancer. Notably, participants without a cancer diagnosis accurately described the challenging experiences reported by those who had faced cancer. The erasure of sexual orientation in medical appointments and the fear of being discriminated against in health services emerged in the reports of the participants in Article 3 and were also themes listed in Articles 1 and 2, aspects that warrant consideration in shaping public policy priorities and in the training of health professionals. (AU)

• FAPESP's process: 20/09464-3 - Therapeutic itinerary of lesbian women with Gynecological Cancer from a gender perspective
• Grantee: Carolina de Souza
• Support Opportunities: Scholarships in Brazil - Doctorate