What challenges do lesbian women face in the health care system?
What are important health issues for lesbians to discuss with their doctors or nurses?
Are lesbian and bisexual women at risk of getting sexually transmitted infections (STIs)?
What can lesbian women do to protect their health?
More information

What challenges do lesbian women face in the health care system?

Lesbians and bisexual women face unique problems within the health care system that can hurt their health. Many health care professionals have not had enough training to know the specific health issues that lesbians and bisexuals face. They may not ask about sexual orientation when taking personal health histories. Health care professionals may not think that a lesbian or bisexual woman, like any woman, can be a healthy, normal female.

Things that can stop lesbians and bisexual women from getting good health care include:

• Being scared to tell your doctor about your sexuality or your sexual history
• Having a doctor who does not know your disease risks or the issues that affect lesbians and bisexual women
• Not having health insurance. Many lesbians and bisexuals don't have domestic partner benefits. This means that one person does not qualify to get health insurance through the plan that the partner has (a benefit usually available to married couples).
• Not knowing that lesbians are at risk for STIs and cancer

For these reasons, lesbian and bisexual women often avoid routine health exams. They sometimes even delay seeking health care when feeling sick. It is important to be proactive about your health, even if you have to try different doctors before you find the right one. Early detection — such as finding cancer early before it spreads — gives you the best chance to do something about it. That's one example of why it’s important to find a doctor who will work with you to identify your health concerns and make a plan to address them.

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What are important health issues for lesbians to discuss with their doctors or nurses?

Heart Disease. Heart disease is the No. 1 killer of all women. The more risk factors you have, the greater the chance that you will develop heart disease. There are some risk factors that you cannot control, such as age, family health history, and race. But you can protect yourself from heart disease by not smoking, controlling your blood pressure and cholesterol, exercising, and eating well. These things also help prevent type 2 diabetes, a leading cause of heart disease. Lesbians and bisexual women have a higher rate of obesity, smoking, and stress. All of these are risk factors for heart disease. As such, lesbians and bisexual women should talk with their doctors about how to prevent heart disease.

Cancer. The most common cancers for all women are breast, lung, colon, uterine, and ovarian. Several factors put lesbian and bisexual women at higher risk for developing some cancers. Remember:

• Lesbians are less likely than heterosexual women to have had a full-term pregnancy. Hormones released during pregnancy and breastfeeding are thought to protect women against breast, endometrial, and ovarian cancers.
• Lesbians and bisexual women are less likely to get routine screenings, such as a Pap test, which can prevent or detect cervical cancer. The viruses that cause most cervical cancer can be sexually transmitted between women. Bisexual women, who may be less likely than lesbians to have health insurance, are even more likely to skip these tests.
• Lesbians and bisexual women are less likely than other women to get routine mammograms and clinical breast exams. This may be due to lesbians' and bisexuals' lack of health insurance, fear of discrimination, or bad experiences with health care professionals. Failure to get these tests lowers women's chances of catching cancer early enough for treatments to work.
• Lesbians are more likely to smoke than heterosexual women are, and bisexual women are the most likely to smoke. This increases the risk for lung cancer in all women who have sex with women.

Depression and Anxiety. Many factors cause depression and anxiety among all women. However, lesbian and bisexual women report higher rates of depression and anxiety than other women do. Bisexual women are even more likely than lesbians to have had a mood or anxiety disorder. Depression and anxiety in lesbian and bisexual women may be due to:

• Social stigma
• Rejection by family members
• Abuse and violence
• Unfair treatment in the legal system
• Stress from hiding some or all parts of one's life
• Lack of health insurance

Lesbians and bisexuals often feel they have to hide their sexual orientation from family, friends, and employers. Bisexual women may feel even more alone because they don't feel included in either the heterosexual community or the gay and lesbian community. Lesbians and bisexuals can also be victims of hate crimes and violence. Discrimination against these groups does exist, and can lead to depression and anxiety. Women can reach out to their doctors, mental health professionals, and area support groups for help dealing with depression or anxiety. These conditions are treatable, and with help, women can overcome them.

Polycystic Ovarian Syndrome. PCOS is the most common hormonal problem of the reproductive system in women of childbearing age. PCOS is a health problem that can affect a woman's:

• Menstrual cycle (monthly bleeding)
• Fertility (ability to get pregnant)
• Hormones
• Insulin production
• Heart
• Blood vessels
• Appearance

Five to 10 percent of women of childbearing age have PCOS. Lesbians may have a higher rate of PCOS than heterosexual women.

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Are lesbian and bisexual women at risk of getting sexually transmitted infections (STIs)?

Women who have sex with women are at risk for STIs. Lesbian and bisexual women can transmit STIs to each other through:

• Skin-to-skin contact
• Mucosa contact (e.g., mouth to vagina)
• Vaginal fluids
• Menstrual blood
• Sharing sex toys

Some STIs are more common among lesbians and bisexual women and may be passed easily from woman to woman (such as bacterial vaginosis). Other STIs are much less likely to be passed from woman to woman through sex (such as HIV). When lesbians get these less common STIs, it may be because they also have had sex with men, especially when they were younger. It is also important to remember that some of the less common STIs may not be passed between women during sex, but through sharing needles used to inject drugs. Bisexual women may be more likely to get infected with STIs that are less common for lesbians, since bisexuals have typically had sex with men in the past or are presently having sex with a man.

Common STIs that can be passed between women include:

• Bacterial vaginosis (BV). BV is more common in lesbian and bisexual women than in other women. The reason for this is unknown. BV often occurs in both members of lesbian couples. The vagina normally has a balance of mostly "good" bacteria and fewer "harmful" bacteria. BV develops when the balance changes. With BV, there is an increase in harmful bacteria and a decrease in good bacteria. Sometimes BV causes no symptoms. But over one-half of women with BV have vaginal itching or discharge with a fishy odor. BV can be treated with antibiotics.



• Human papillomavirus (HPV). HPV can cause genital warts. If left untreated, HPV can cause abnormal changes on the cervix that can lead to cancer. Most people don't know they're infected with HPV because they don't have symptoms. Usually the virus goes away on its own without causing harm. But not always. The Pap test checks for abnormal cell growths caused by HPV that can lead to cancer in women. If you are age 30 or older, your doctor may also do an HPV test with your Pap test. This is a DNA test that detects most of the high-risk types of HPV. It helps with cervical cancer screening. If you’re younger than 30 years old and have had an abnormal Pap test result, your doctor may give you an HPV test. This test will show if HPV caused the abnormal cells on your cervix.
  
  Both men and women can spread the virus to others whether or not they have any symptoms. Lesbians and bisexual women can transmit HPV through direct genital skin-to-skin contact, touching, or sex toys used with other women. Lesbians who have had sex with men are also at risk of HPV infection. This is why regular Pap tests are just as important for lesbian and bisexual women as they are for heterosexual women.
  
  There is no treatment for HPV, but a healthy immune (body defense) system can usually fight off HPV infection. Two vaccines (Cervarix and Gardasil) can protect girls and young women against the types of HPV that cause most cervical cancers. The vaccines work best when given before a person's first sexual contact, when she could be exposed to HPV. Both vaccines are recommended for 11 and 12-year-old-girls. But the vaccines also can be used in girls as young as 9 and in women through age 26 who did not get any or all of the shots when they were younger. These vaccines are given in a series of 3 shots. It is best to use the same vaccine brand for all 3 doses. Ask your doctor which brand vaccine is best for you. Gardasil also has benefits for men in preventing genital warts and anal cancer caused by HPV. It is approved for use in boys as young as 9 and for young men through age 26. The vaccine does not replace the need to wear condoms to lower your risk of getting other types of HPV and other sexually transmitted infections. If you do get HPV, there are treatments for diseases caused by it. Genital warts can be removed with medicine you apply yourself or treatments performed by your doctor. Cervical and other cancers caused by HPV are most treatable when found early. There are many options for cancer treatment.



• Pubic lice. Also known as crabs, pubic lice are small parasites that live in the genital areas and other areas with coarse hair. Pubic lice are spread through direct contact with the genital area. They can also be spread through sheets, towels, or clothes. Pubic lice can be treated with creams or shampoos you can buy at the drug store.



• Trichomoniasis “Trich”. Trichomoniasis is caused by a parasite that can be spread during sex. You can also get trichomoniasis from contact with damp, moist objects, such as towels or wet clothes. Symptoms include:
  • Yellow, green, or gray vaginal discharge (often foamy) with a strong odor
  • Discomfort during sex and when urinating
  • Irritation and itching of the genital area
  • Lower abdominal pain (in rare cases)

  Trichomoniasis can be treated with antibiotics.

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  What can lesbian women do to protect their health?

  • Find a doctor who is sensitive to your needs to help you get regular check ups. The Gay and Lesbian Medical Association provides online health care referrals. You can access its Provider Directory or contact the Association at (202)600-8037.
  • Get a Pap test. The Pap test finds changes in your cervix early, so you can be treated before a problem becomes serious. Begin getting Pap tests at age 21. In your 20s, get a Pap test every two years. Women 30 and older should get a Pap test every three years. If you are HIV-positive, your doctor may recommend more frequent testing.
  • Get an HPV test. Combined with a Pap test, an HPV test helps prevent cervical cancer. It can detect the types of HPV that cause cervical cancer. Talk to your doctor about an HPV test if you've had an abnormal Pap or if you're 30 or older.
  • Talk to your doctor or nurse about other screening tests you may need. You need regular preventive screenings to stay healthy. Lesbian and bisexual women need all the same tests that heterosexual women do. Learn more about what tests you need, based on your age.
  • Practice safer sex. Get tested for STIs before starting a sexual relationship. If you are unsure about a partner's status, practice methods to reduce the chances of sharing vaginal fluid, semen, or blood. If you have sex with men, use a condom every time. You should also use condoms on sex toys. Oral sex with men or with women can also spread STIs, including, rarely, HIV. HIV can potentially be passed through a mucous membrane (such as the mouth) by vaginal fluids or blood, especially if the membrane is torn or cut.
  • Eat a balanced, healthy diet. Your diet should include a variety of whole grains, fruits, and vegetables. These foods give you energy, plus vitamins, minerals, and fiber. Reduce the amount of sodium you eat to less than 2,300 mg per day.
  • Drink moderately. If you drink alcohol, don't have more than one drink per day. Too much alcohol raises blood pressure and can increase your risk for stroke, heart disease, osteoporosis, many cancers, and other problems.
  • Get moving. An active lifestyle can help any woman. You will benefit most from about 2 hours and 30 minutes of moderate-intensity aerobic physical activity each week. More physical activity means additional health and fitness benefits. On two or more days every week, adults should engage in muscle-strengthening activities, such as lifting weights or doing squats or push-ups.
  • Don't smoke. If you do smoke, try to quit. Avoid second hand smoke as much as you can. Read more about quitting.
  • Try different strategies to deal with your stress. Stress from discrimination and from loneliness is hard for every lesbian and bisexual woman. Relax using deep breathing, yoga, meditation, and massage therapy. You can also take a few minutes to sit and listen to soft music or read a book. Talk to your friends or get help from a mental health professional if you need it.
  • Get help for domestic violence. Call the police or leave if you or your children are in danger. Call a crisis hotline or the National Domestic Violence Hotline at 800-799-SAFE or TDD 1-800-787-3224, which is available 24 hours a day, 365 days a year, in English, Spanish, and other languages. The helpline can give you the phone numbers of local hotlines and other resources.
  • Build strong bones. Take the following steps to help build strong bones and prevent osteoporosis:
    • Exercise
    • Get a bone density test
    • Get enough calcium and vitamin D each day
    • Reduce your chances of falling by making your home safer. For example, use a rubber bathmat in the shower or tub and keep your floors free from clutter.
    • Talk to your doctor about medicines to prevent or treat bone loss
  • Know the signs of a heart attack. Women are less likely than men to believe they are having a heart attack and more likely to delay in seeking treatment. For women, chest pain may not be the first sign your heart is in trouble. Before a heart attack, women have said that they have unusual tiredness, trouble sleeping, problems breathing, indigestion, and anxiety. These symptoms can happen a month or so before the heart attack. During a heart attack, women often have these symptoms:
    • Pain or discomfort in the center of the chest.
    • Pain or discomfort in other areas of the upper body, including the arms, back, neck, jaw, or stomach.
    • Shortness of breath
    • A cold sweat
    • Nausea
    • Light-headedness
  • Know the signs of a stroke. The signs of a stroke happen suddenly and are different from the signs of a heart attack. Signs you should look for are:
    • Weakness or numbness on one side of your body
    • Dizziness
    • Loss of balance
    • Confusion
    • Trouble talking or understanding speech
    • Headache
    • Nausea
    • Trouble walking or seeing
    
    Remember: Even if you have a “mini-stroke,” you may have some of these signs.

  For More Information

  Centers for Disease Control and Prevention (CDC)
  Phone: 1-800-232-4636 (TDD: 1-888-232-6348)
  www.cdc.gov
  

  Office on Violence Against Women, DOJ
  Phone: (202)307-6026 (TDD: 202-307-2277)
  www.ovw.usdoj.gov/

  Gay and Lesbian Medical Association (GLMA)
  Phone: (202)600-8037 or (415)255-4547
  www.glma.org

  American Psychological Association
  Phone: 1-800-374-2721 or (202)336-5500 (TDD: 202-336-6123)

  Lesbian Health and Research Center
  Phone: 415-502-5209
  www.lesbianhealthinfo.org/index.html

  The Mautner Project
  Phone: Phone: 866-628-8637 or (202)332-5536
  www.mautnerproject.org

  National Center for Lesbian Rights
  Phone: (415)392-6257
  www.nclrights.org/site/PageServer

  National Resource Center on LGBT Aging, AOA, HHS
  Phone: (212)741-2247
  www.lgbtagingcenter.org/