Diversity and LGBTQ+ Issues in Obstetrics and Gynecology: Are We Finally Waking Up?

Mark B. Woodland, MS, MD, FACOG

The evolution of acceptance of LGBTQ+ issues and concerns in the clinical learning environment and our own obstetrics and gynecology patient care and professional community has truly been amazing as I look back over my professional career. It is even more remarkable when I think back to the early part of my career, when I presented as the typical privileged white male when going around the table during department, committee, or leadership introductions. While others introduced themselves in matter-of-fact heteronormative conversation about themselves, their spouses, and their families, I masked my personal situation by concealing certain details so that I did not make anyone feel uncomfortable or open myself to unwarranted scrutiny.

In my talks on diversity now, my personal story still starts out as being a privileged white male, because I do think it is important that I fairly represent those aspects of my life that I have experienced compared to others. However, many of these privileges went away as soon as I admitted to being a gay man. No longer did I experience the "hetero-privilege" of being open about myself, my spouse, or my family. Readers must remember back 20 to 30 years to a society that was relatively comatose to these issues. In the early 1980s when I was a medical student, it was illegal in most areas of this country for me to have sex with who I wanted to have sex with, not to mention to marry or have children with that person. I'll never forget when my partner and I adopted our first child in 1999; not only was it illegal to have two men adopt the same child in Pennsylvania, but also the judge would not allow us to hyphenate our soon-to-be son's last name because it represented our homosexual relationship and he felt compelled to have it on record how he felt about our "morally despicable" relationship.

These aggressions and biases toward my personal life spilled over into my professional life. When invited to professional functions, I always considered what the ramifications of bringing another man with me were. Who would be accepting and who would be offended? When applying for new positions or jobs, should I mention my family life or structure, or should I just keep it sort of vague and not lie about myself as to not raise issues that might not be well accepted or tolerated in a specific institution or department? When my patients wanted to know more about my "wife," should I correct them and say husband, or keep the conversation gender neutral and instead talk about my "spouse" and our children so I didn't create an uncomfortable situation?

I recognize that discrimination is not limited to sexuality or gender identity and that it may even be more predominant in racial and ethnic considerations. However, I also recognize the power diversity adds to almost all aspects of life. Certainly, during my career as a program director, I realized the importance of diversity as I was recruiting new residents each year. Initially, that included diversity as it applied to gender, but I soon began to include background in education, distance traveled to a career in medicine, geographic location, and race and ethnicity. Interestingly, while the importance of a holistic process was not minimized, the attributes we had to consider to maintain the diversity in our program changed even as we got to know the class we had just recruited.

As a department chair, I still recognize the importance of diversity, especially as we build our clinical care teams in our interprofessional clinical learning environment and realize the inequities that a lack of diversity and inclusion inadvertently promotes. Hopefully our obstetrics and gynecology clinical learning environment stays vigilant in not only recognizing the importance of diversity and inclusion but also the risks that intolerance and lack of respect create. Are we finally waking up to LGBTQ+ issues and concerns? As an optimist, I sincerely hope that we become insomniac to these issues as we move the obstetric and gynecologic patient care and professional communities into the future.