To the Editor: The closet is a common lesbian response to prejudice, discrimination and stigma. Many rural lesbians choose to “pass” as heterosexual and keep their sexuality secret.1,2 Research shows that this secrecy is fuelled by the fear of violence, including harassment, ostracism and rejection,2 and it is unlikely that a lesbian will disclose her sexuality to a doctor unless she feels safe. Without full disclosure, health care planning and delivery may be inadequate or inappropriate. This adds to the disadvantages already faced by rural doctors and their patients in a rural environment with demonstrated shortcomings in the form of fewer resources, greater distances and poorer health outcomes relative to urban areas.3
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