What actions would you take to provide more sensitive and effective care for women who are lesbian, bisexual, or transgender?

Betty is 45 years old, self-employed, divorced three times, and mother of three boys and one daughter. Two years ago, her last husband died of lung cancer at age 54.

She was referred to the local clinic because she has been feeling depressed. During the interview, Betty informs the community health nurse that she is tired of living the old way, and she is now involved with a woman and considers herself a lesbian. She admits that she has been sexually involved with both men and women during the past three years. She indicates that she is afraid she might have cancer because her mother died of breast cancer five years ago at the age of 67. She does not have health insurance. Betty stated that she is embarrassed to get a pap smear because she heard that gay women do not need to get a pap smear since they are not having “real sex” vaginally.