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Lesbian Health

Many lesbians have specific medical needs and concerns that are often ignored or diminished by health care providers who:

  • either assume the patient is heterosexual and miss opportunities to define the health risks that may be specific to lesbians
  • make an assumption that the lesbian patient has only had sexual relations with other women, thus erroneously not offering routine screening and preventive care nor disseminating information about HIV and STDs (sexually transmitted diseases) based on the faulty premise that STDs can only be passed between men and women or men and men
  • are uncomfortable eliciting important information about the patient's health history (including sexual history) because of personal bias, ignorance, or embarrassment, missing important clues to the patient's familial predisposition to disease and what current life stresses (shared by almost all denigrated minorities) may be causing physical symptoms and/or emotional problems that could be treated either by the health care provider or by referral

As society at large views lesbians with a prejudiced and often stereotyped (if not hostile) eye, so, unfortunately, do many health care providers. That is why it is important for the lesbian patient to empower herself and find a health care provider with whom she can communicate honestly and completely and not feel judged, humiliated or discriminated against and can feel assured that her specific medical needs will be addressed in a fair, sensitive and thorough manner.

This is important as it is believed that many lesbians decide not to seek medical care because of fear of a medical system that is discriminatory. Problems sited by lesbians which they have experienced within the health care system include:

  • suggestions that the patient change her sexual orientation
  • dismissal of the patient's significant other as anyone more than a friend who should have no voice in decisions concerning the patient's treatment
  • a feeling that they have had quick and incomplete treatment with no suggestion of routine or indicated follow-up visits because of the difficulty on the part of the health care provider in relating to the patient
  • gruffness or actual hostile words from the health care provider or other workers in the health care setting
  • experiencing a physical exam that seems needlessly harsh and ungentle
  • since the lesbian patient is denied coverage (except under rare circumstances) under the health plan of her significant other, she has a lesser access to health insurance than her heterosexual counterpart who is covered under the policy of her spouse
  • a feeling that revelation of her sexual identity will not remain confidential, opening the door to personal, professional and sometimes even legal problems

It is little wonder then that under a third of lesbian patients reveal their sexual identity to a health care provider. Thus they are not queried about or treated for specific physical and/or psychological problems that may affect the lesbian patient. And in a catch-22 situation, the lesbian patient who does not reveal her sexual identity may be told by an uninformed health care provider, who through personal bias does not really want to learn anything about a lesbian's medical needs or the reality of most lesbians' sexual histories, that she is not at risk for certain cancers or STDs because she is a lesbian.

In reality 75 to 90% of lesbians have had a history of sexual relations with men, not unlike the heterosexual woman, including a history of multiple male partners. Often these sexual experiences with males have been at a young age before the lesbian has accepted her true sexual identity, putting her at the same risk for cervical cancer as the heterosexual female. Risk factors for cervical cancer include:

  • multiple sexual partners
  • intercourse at an early age
  • HPV (human papilloma virus) infection
  • STD transmission

Yet the lesbian patient will often be told out of ignorance about lesbian sexual histories (or because the health care provider wants to quickly finish up the medical interview) that she does not need to be screened for cervical cancer or have pelvic examinations. But in reality periodic cervical screening and pelvic examinations are absolutely indicated and the lesbian patient must insist on them if told otherwise.

Currently there is a difference in the amount of time between having Pap smears for lesbians and for heterosexual women. Cervical screening for all women is important -- but findings have suggested that heterosexual women have Pap smears on a nine-month average while lesbians have Pap smears every twenty to thirty-five months. Additionally, lesbians have less breast exams (both in a clinical setting and self-examination) and fewer mammograms than heterosexual women though the incidence of breast cancer is not thought to be less in the lesbian patient than in the heterosexual patient. A delay in childbearing is thought to be one of the risk factors for breast cancer and many lesbians have not had children. That is why it is important for the lesbian patient to follow-up on breast exam as well as pelvic examination and cervical screening on an appropriate schedule with her health care provider or gynecologist.

All women, regardless of sexual identity, are recommended for screening (at different times in the patient's life) for, among others:

  • cancer
  • hypercholesterolemia
  • coronary artery disease
  • osteoporosis
  • hypertension
  • diabetes
  • anemia

All women should have access to information about and should be comfortable discussing with a health care provider:

  • benign diseases of the breast
  • STDs
  • vaginitis
  • PIV (pelvic inflammatory disease)
  • vulvovaginitis (including candidiasis)
  • condylomata acuminata
  • dysmenorrhea
  • postmenopausal management
  • chronic pelvic pain

A number of women know they are at risk for certain diseases or conditions through genetic predisposition or family history. It is unfortunate that some lesbians have no idea if they are at risk for certain illnesses because of alienation from their families of origin, often as teenagers, with the result that they are unable to ask questions to their blood relatives about their medical histories.

Alienation from families, low self-esteem, external and internal homophobia may result in difficulty maintaining adequate interpersonal relationships and insecurity in professional life for a number of lesbians. Stress may cause such physical symptoms as:

  • headaches
  • backaches
  • stomach upsets including diarrhea and constipation as well as ulcers

Being able to be honest about your sexual identity with an understanding, nonjudgmental health care provider and to talk about what is going on in your life may help to treat the underlying problem causing the above physical complaints. For instance, alcoholism and substance abuse problems are thought to be higher among lesbians than heterosexual women, not a surprise given their marginalization in U.S. society. Depression may need to be treated. It is estimated that 18% of lesbians have attempted suicide at one time in their lives and that twice as many have contemplated it. This number is higher than for adult gay males and is roughly equivalent to the number of suicides attempted by gay youths. Regular counseling or therapy should yield important benefits. Many lesbians need to be made aware of support groups and community networks that will help turn around a feeling of isolation and foster a spirit of belonging to a welcoming community, especially those lesbians alienated from their parents or their children. Sometimes older lesbians may feel isolated.

Teenage lesbians estranged from their families can fall prey to life on the street where drugs, rape, violence and disease are commonplace. Some, like heterosexual women, have suffered sexual abuse as children or are currently in relationships, also like heterosexual women, where there is verbal abuse or physical violence. Referrals to local services to aid in abusive situations may be crucial. To be able to discuss issues of medical or emotional health and well-being with a knowledgeable health care provider can help shape, rebuild or even save lives.

The fabrication that lesbian patients are somehow immune to HIV and other STDs needs to be addressed. Some lesbians do get HIV, mostly in the same way heterosexuals do -- through unsafe sexual practices with men. The use of unclean sex toys may also lead to HIV. Also lesbians who are IV drug users and share needles are as much at risk for HIV as anyone else who does so and lesbians have contracted the virus this way. (See article on the Pyramid of Safer Sex.)

It is believed that cases of AIDS have been the result of female-to-female transmission, although data on the subject is unclear and studies are currently underway to provide more information about this possible mode of transmission. It is understood that female-to-female transmission of the following diseases are possible:

  • hepatitis A
  • herpes
  • candida
  • chlamydia
  • trichomonas

It is thought that genital-to-genital oral sex may not be safe because of exposure to blood or contaminated sexual fluids and using a latex barrier to keep out of contact with blood or contaminated fluids is recommended for sexual partners who do not know each other's past or current sexual history and health status. The greater number of partners you have, the greater at risk you are for STDs. If you or your partner think you may have an STD or feel you are at risk for an STD, please see your health care provider promptly. Often the presence of one STD indicates that another may be present as well. And if you are having repeated vaginal infections please see your health care provider. If you are sexually active and have not taken safe or safer sex precautions there is a possibility HIV may be the cause of the recurrent infections. It is wise for lesbians as it is for the entire segment of the U.S. population to engage in safe or safer sex practices.

If you are uncertain about how STDs are transmitted, or feel you have an STD, or if you need to discuss a specific medical problem, need counseling or a referral to a therapist, have questions concerning cancer screening or would like to be screened, please see a nonjudgmental health care provider who is sensitive to lesbian health concerns and knowledgeable about community services available to the lesbian patient.