Health

Physical

In terms of medical issues, lesbians are referred to as women who have sex with women (WSW) due to the misconceptions and assumptions about women’s sexuality and some women’s hesitancy to disclose their accurate sexual histories even to a physician.[146] Many self-identified lesbians neglect to see a physician because they do not participate in heterosexual activity and require no birth control, which is the initiating factor for most women to seek consultation with a gynecologist when they become sexually active.[147] As a result, many lesbians are not screened regularly with pap smears. The U.S. government reports that some lesbians neglect seeking medical screening in the U.S.; they lack health insurance because many employers do not offer health benefits to domestic partners.[148]

The result of the lack of medical information on WSW is that medical professionals and some lesbians perceive lesbians as having lower risks of acquiring a sexually transmitted disease or types of cancer. When women do seek medical attention, medical professionals often fail to take a complete medical history. In a recent study of 2,345 lesbian and bisexual women, only 9.3% had claimed they had ever been asked their sexual orientation by a physician. A third of the respondents believed disclosing their sexual history would result in a negative reaction, and 30% had received a negative reaction from a medical professional after identifying themselves as lesbian or bisexual.[149] A patient’s complete history helps medical professionals identify higher risk areas and corrects assumptions about the personal histories of women. In a similar survey of 6,935 lesbians, 77% had had sexual contact with one or more male partners, and 6% had that contact within the previous year.[149][note 12]

Heart disease is listed by the U.S. Department of Health and Human Services as the number one cause of death for all women. Factors that add to risk of heart disease include obesity and smoking, both of which are more prevalent in lesbians. Studies show that lesbians have a higher body mass and are generally less concerned about weight issues than heterosexual women, and lesbians consider women with higher body mass indexes to be more attractive than heterosexual women do. Lesbians are more likely to exercise regularly than heterosexual women, and lesbians do not generally exercise for aesthetic reasons, although heterosexual women do.[150] Research is needed to determine specific causes of obesity in lesbians.[148][149]

Lack of differentiation between homosexual and heterosexual women in medical studies that concentrate on health issues for women skews results for lesbians and non-lesbian women. Reports are inconclusive about occurrence of breast cancer in lesbians.[149] It has been determined, however, that the lower rate of lesbians tested by regular pap smears makes it more difficult to detect cervical cancer at early stages in lesbians. The risk factors for developing ovarian cancer rates are higher in lesbians than heterosexual women, perhaps because many lesbians lack protective factors of pregnancy, abortion, contraceptives, breast feeding, and miscarriages.[151]

Safer Sex Recommendations for

Women Who Have Sex with Women

• Avoid contact with a partner’s menstrual blood and with any visible genital lesions.

• Cover sex toys that penetrate more than one person’s vagina or anus with a new condom for each person; consider using different toys for each person.
• Use a barrier (e.g., latex sheet, dental dam, cut-open condom, plastic wrap) during oral sex.
• Use latex or vinyl gloves and lubricant for any manual sex that might cause bleeding.[149]

Some sexually transmitted diseases are communicable between women, including Human Papilloma Virus (HPV)—specifically genital warts—squamous intraepithelial lesions, trichomoniasis, syphilis, and Herpes simplex virus (HSV). Transmission of specific sexually transmitted diseases among women who have sex with women depends on the sexual practices women engage in. Any object that comes in contact with cervical secretions, vaginal mucosa, or menstrual blood, including fingers or penetrative objects may transmit sexually transmitted diseases.[152] Orogenital contact may indicate a higher risk of acquiring HSV,[153] even among women who have had no prior sex with men.[154] Bacterial vaginosis (BV) occurs more often in lesbians, but it is unclear if BV is transmitted by sexual contact; it occurs in celibate as well as sexually active women. BV often occurs in both partners in a lesbian relationship;[155] a recent study of women with BV found that 81% had partners with BV.[156] Lesbians are not included in a category of frequency of Human Immunodeficiency Virus (HIV) transmission, although transmission is possible through vaginal and cervical secretions. The highest rate of transmission of HIV to lesbians is among women who participate in intravenous drug use or have sexual intercourse with bisexual men.[157][158]

Mental

Since medical literature began to describe homosexuality, it has often been approached from a view that sought to find an inherent psychopathology as the root cause, influenced by the theories of Sigmund Freud. Although he considered bisexuality inherent in all people, and most have phases of homosexual attraction or experimentation, exclusive same-sex attraction he attributed to stunted development due to trauma or parental conflicts.[159][note 13] Much literature on mental health and lesbians centered on their depression, substance abuse, and suicide. Although these issues exist among lesbians, discussion about their causes shifted after homosexuality was removed from the Diagnostic and Statistical Manual in 1973. Instead, social ostracism, legal discrimination, internalization of negative stereotypes, and limited support structures indicate factors homosexuals face in Western societies that often adversely affect their mental health.[160] Women who identify as lesbian report feeling significantly different and isolated during adolescence;[160][161] these emotions have been cited as appearing on average at 15 years old in lesbians and 18 years old in women who identify as bisexual.[162] On the whole, women tend to work through developing a self-concept internally, or with other women with whom they are intimate. Women also limit who they divulge their sexual identities to, and more often see being lesbian as a choice, as opposed to gay men, who work more externally and see being gay as outside their control.[161]

Anxiety disorders and depression are the most common mental health issues for women. Depression is reported among lesbians at a rate similar to heterosexual women,[163] although Generalized Anxiety Disorder is more likely to appear among lesbian and bisexual women than heterosexual women.[160][note 14] Depression is a more significant problem among women who feel they must hide their sexual orientation from friends and family, or experience compounded ethnic or religious discrimination, or endure relationship difficulties with no support system.[164] Men’s shaping of women’s sexuality has proven to have an effect on how lesbians see their own bodies. Studies have shown that heterosexual men and lesbians have different standards for what they consider attractive in women. Lesbians who view themselves with male standards of female beauty may experience lower self-esteem, eating disorders, and higher incidence of depression.[150] More than half the respondents to a 1994 survey of health issues in lesbians reported they had suicidal thoughts, and 18% had attempted suicide.[165]

A population-based study completed by the National Alcohol Research Center found that women who identify as lesbian or bisexual are less likely to abstain from alcohol. Lesbians and bisexual women have a higher likelihood of reporting problems with alcohol, as well as not being satisfied with treatment for substance abuse programs.[166] Many lesbian communities are centered in bars, and drinking is an activity that correlates to community participation for lesbians and bisexual women.[167]