One day I was caught by a big question: why don't we talk about health and sexuality for lesbian and bisexual women? Are the risks the same? Why has no doctor ever told me how exposed I could be and never taught me how to prevent it?
From a personal indignation, this project was born. Why couldn't any gynecologist I went to advise me on the care I should have when relating to another woman? Was I just unlucky all my life or was this a common situation? I rolled up my sleeves and started the most intense and transformative journey of my life.
The discovery: sex between women is still a taboo and we don't talk about it.
Research began. I delved into the computer in search of academic articles, reports, or any other material that discussed public health issues for lesbian and bisexual women. The first blow came: I discovered that there are almost no government efforts to serve this population.
The "Survey of Knowledge, Attitudes and Practices in the Brazilian Population" (PCAP), conducted by the Ministry of Health in 2013, found by sampling that the lesbian population is approximately 3,125,300 women. This is the only available data on this population, and there is no similar survey on bisexual women.
How can we talk about health, prevention, and awareness without knowing exactly the needs and specificities of this group? We reached the fundamental point of the project: the lack of dialogue, attention, and awareness of the dangers that homosexual and bisexual women are exposed to in the face of STDs.
As the journey progressed, I began to have small clues about how medicine deals with this issue. Although there are initiatives and groups that fight for humanized care within offices, the doctor-patient dialogue sometimes becomes impersonal and distant. In one of the studies I used as a basis in the investigative process, the following sentence caught my attention:
“[…]The sexual health of women remained [...] subsumed under the concern with reproduction throughout the trajectory of women's health care policies.” (ALMEIDA, 2005, p. 302)
In this quote, it is clear that the focus of medicine regarding women's bodies is reproduction. So, how do we treat the relationship between two women?
At this point, I understood that the problem went beyond issues of education or government initiatives focused on the population of women who have relationships with women. I realized that doctors would also be one of the main audiences for this project.
The above sentence also makes us reflect on the objectification of women's bodies and the annulment of female desires, as if in some way we women did not have the right to enjoy pleasures and were only meant for reproductive roles.
Listening to Learn
After extensive contextual and investigative research, I moved on to the second stage: talking to women who have relationships with women and gynecologists to better understand each one's reality regarding the topic.
Facing Them
First, I spoke with seven women who agreed to share their stories with me. How do you talk about such an intimate topic with someone you've never met before? Breaking down the barrier of lack of intimacy was the biggest challenge of this stage.
To facilitate and standardize this process, an interview script was carefully thought out and structured. Divided into three parts, the conversation started with a bit of each person's history, addressing topics such as the process of discovering sexuality, family relationships, and acceptance by family members. Later, questions about sexuality and knowledge about best practices for protection during sexual intercourse dominated the conversation.
Then the problems we, women, faced appeared. I say "we" because I realized that the obstacles and discomforts were the same as mine.
In doctors' offices, there was a lack of empathy, discomfort, and an overall negative doctor-patient relationship. The result was frequent doctor changes or abandonment of necessary care. Some stopped going to the gynecologist to avoid embarrassing situations.
Outside, the insecurities were even greater. Due to the difficulty of accessing reliable information, most of the interviewees were not sure of the risks they faced and did not know how to protect themselves properly. As a result, they did not use any type of protection during their relationships.
But what about the doctors?
It was essential to talk to this audience to try to understand why there is a lack of attention within doctors' offices and the difficulties in dealing with this population.
The discovery was that, often, doctors do not know how to treat these patients due to lack of information. I talked to two doctors and a student in their last year of medical school. The mapped panorama was that little is said about LGBTQ+ health and sexuality within medical schools. Students do not receive the necessary information on how to deal with this population. On the other hand, those who are interested end up paving their own paths to acquire more in-depth knowledge.
Initial conclusions
After the round of interviews, it was possible to identify some flaws and opportunities to develop a new service. The intention was to create a safe environment where it was possible to find information, services, and specialized support.
Getting to know the target audience
As the solution is technology-based, it was important to understand how Brazilian women relate to technology and what their digital habits are. I then conducted a quantitative survey to understand these relationships.
ombining the initial conversations and the research presented above, it was possible to identify 4 archetypes of women who could use the service. These are also known as "extreme users". The women were divided as follows: Discreta, Desencanada, Assumida e Hetero.
Using these definitions, I created a timeline of each profile's life, with important points for each one. I crossed the moments when situations repeated themselves in each archetype and created an opportunity map. This diagram was the guiding principle for the rest of the service development.
For some women, going to the gynecologist can be an extremely uncomfortable moment surrounded by insecurities when they should actually feel safe and comfortable in talking to the professional.
The gynecologist-patient relationship should be based on open and sincere dialogue without judgment. But, as analyzed during research, this is not generally the scenario we have.
Definitions - pleasure, Gina
The discomfort in realizing that women, especially lesbians and bisexuals, in moments that should be treated with respect, were treated abusively and/or prejudiced, gave rise to the idea of creating a community with the aim of connecting women with qualified, empathetic, and constantly updated health professionals.
Thus, a service that transforms the user experience of Brazilian women in relation to health took shape and gave life to "Gina," a multilateral digital platform that encompasses various aspects of women's health care.
"We fight for women's emancipation. We believe that health is one of the ways to empower Brazilian women, and therefore we offer all the necessary support for women to feel safe when dealing with their bodies. We talk about sex without taboos and prejudices. We are the revolution of women's health in Brazil."
Personas and User Journeys
After structuring all of these elements, it was possible to create the personas and user journeys for each one, as well as the doctor persona. Below is one of the profiles created:
Development
After all the scenario was constructed and mapped out, it was time to develop the service.
The proposal was to create a platform that intelligently and easily connected gynecologists and women looking for these professionals. Therefore, initially, the core of the service was to create an assertive search function based on each user's preferences.
In addition to this function, the platform would be a reliable repository of information and tips. During the research, the need for an accessible place where reliable references on preventive methods, risks, health care, etc. could be found was identified.
I also designed a chatbot capable of making small diagnoses and referring the user to the most suitable professional. In addition, Gi (the name of the little robot) is prepared to answer various questions about health care, prevention methods, and everything else.
This function is also important because it does not force the user to identify themselves to obtain information. This is an important point for those who still have some difficulty or obstacle in assuming their sexuality.
A tool for women to track their menstrual cycle, a drive to archive and organize medical exams are some of the other features designed for the service. The idea is to centralize everything related to women's healthcare in one place.
For doctors, the main features designed were a solution for agenda management - something that was identified as the biggest pain point for doctors in interviews - and an exclusive section for professional updating and improvements through knowledge pills. In this sense, preparing the doctor to serve the most diverse profiles and ensuring that he/she is always up-to-date in a simple, fast and efficient way is essential.
Instead of developing a native application, I chose to follow the Web App strategy. As I explained in this article, Progressive Web Apps (PWA) are a great way to develop responsive platforms that function like apps on smartphones.
In addition, they are a really good alternative to overcome the issue of recurrent downloading and uninstallation of applications since it is not necessary to download to use. We cannot forget that users tend to quickly uninstall apps that are not used frequently.
Regarding performance, PWAs tend to be as fast and secure as native apps since they can store information in the cache. They also allow the use of push notifications, for example. In short, they leave nothing to be desired when compared to a native application.
Okay, but what's the look of this business?
After deciding on the features and technologies, I started designing the navigation flows, wireframes, and screens. Over 100 screens were designed for desktop, tablet, and smartphone versions.
Wireframes
To validate the navigation flow and test the features, a low-fidelity prototype of the wireframes was developed.
I conducted the first round of usability testing. The flows were correct and the functionalities made sense to the users. Therefore, I started designing the final layout of the screens and the visual identity.
Visual Identity and Style Guide
To make it easier, standardize and ensure consistency across all screens and versions, I created a small design library.
Visual ID
Finally, I applied the visual identity to the wireframes that had been designed. Below you can see the final screens and the promotional video.
By Helena Duppre - All rights reserved
Conclusion
When talking to other women who have relationships with women about health and sexuality, I realized that I was not alone in experiencing unpleasant and embarrassing moments. It began to understand and confirm most of its hypotheses regarding the subject.
Why don't we talk about the health and sexuality of women who have relationships with women? Do lesbians really not run the risk of getting infected with diseases such as HPV, syphilis, and even HIV? What was confirmed is that these questions and the lack of dialogue revolve around points based on taboos, prejudices, and lack of information.
Opening up space for discussions on the subject within higher medical courses and during the training of health professionals is a fundamental factor for changing women's health care. We need more empathetic, human, and prejudice-free experts who roll up their sleeves and seek to see new possibilities within medicine.
It is also necessary to listen to others to understand their reality and, thus, have the sufficient and correct inputs to create something truly relevant to society. Well, wouldn't this be the current role of design?
Design, in turn, becomes increasingly vital to today's society. The thinking and perspective of those designers who are truly willing to observe and reflect on new paths of society begin to effectively transform communities around the world.