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Wednesday, January 18, 2012

Lesbian health

Authors :
Patricia Robertson MD Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco,
CA Kai-Wen Chuang, BA

Introduction

Lesbian health issues are different from female heterosexual health issues in some ways, and similar in others. Some of these differences are well-researched, such as lesbians smoking at higher rates than heterosexual women, and some differences are still being studied. In 1999, the National Institute of Medicine identified lesbians as an underserved health minority. The following sections will provide guidelines on how to achieve your best health possible, an approach to finding a sensitive health care provider, and information about selected diseases. Be sure to share this information with your lesbian friends, as many lesbians delay seeking health care due to previous negative experiences with the health care system. This delay sometimes leads to shortened lives by missing important screening tests and opportunities to treat.

    Who falls under the category of lesbian?  Out of all of the women who self-identify as lesbian (primarily attracted sexually to women), 70% are exclusively sexually active with women and 30% are sexually active with both women and men. Some lesbians prefer a feminine appearance, and others prefer a masculine appearance, but the majority of lesbians are in-between in appearance. There should be no assumptions as to whether someone is a lesbian based on appearance, or whether someone is heterosexual based on appearance.

Bisexual women, in contrast to lesbians, are attracted to members of both sexes and usually engage in sexual relationships with men and/or women. Bisexual health issues have not been well-researched. However, of those limited studies that examine bisexual health issues, some demonstrate similarity to lesbian health issues, and others indicate that bisexual women experience longer delays to health care and have higher rates of depression.

Finding a sensitive health care provider is very important. Although many lesbians are not “out” to their doctors, it is important that you feel comfortable sharing with your provider honestly who you are, what kinds of sexual relationship you have, and if partnered, who your partner is so that if you are hospitalized, your partner can be respected and included in your care. From your health provider’s standpoint, there is no need to waste money by doing inappropriate tests (like a pregnancy test if you are only seeing women, or yearly tests for sexually transmitted infections if you have been in a monogamous relationship for many years). If you do not wish your sexual identity to be written in your medical records, you have the right to let your provider know that, and remind them, when appropriate, that you are a lesbian if they don’t have it recorded anywhere. If you notice that your provider is uncomfortable when you “come out,” you might want to consider changing providers to someone who takes care of a significant number of lesbians and possesses competency and sensitivity in lesbian health issues. Your provider does not have to be a lesbian herself; in fact, some research shows that many lesbians don’t care and don’t want to know the sexual orientation of their health provider. You just need to select a provider who is knowledgeable about lesbian health issues and supportive of you in your identity. In the United States and Canada, there is a national directory of providers who are comfortable providing care to lesbians and other members of the Lesbian, Gay, Bisexual, and Transsexual (LGBT) community: www.glma.org
In large cities, there may be a LGBT community center that includes some medical care (NYC: www.callen-lorde.org, Boston: www.fenwayhealth.org, San Francisco: www.lyon-martinhealthservices.org), and Los Angeles (www.lagaycenter.org).

Some managed care organizations also keep LGBT-sensitive provider lists, such as Kaiser Permanente. And of course, direct referrals from your lesbian friends who might have already identified a sensitive lesbian health provider can also be helpful. Sometimes you may feel captured in a system in which you have no choices for a provider, such as a student health center. If you find yourself in this situation, a good approach is to e-mail the director of the center and relay your concerns and ask for a lesbian-sensitive provider. Most of the time, adjustments can be made when requests are specific. Your concerns may highlight the lack of lesbian sensitivity in a health system, and hopefully will encourage system-wide staff training in lesbian health sensitivity.

Sometimes finances are an issue in accessing health care, and you may be limited in your choices if this is an issue for you. If you are in an urban area, sometimes there is a free clinic or a subsidized health center by the city, or services at some health centers on a sliding scale. Even Planned Parenthood sees lesbians as “women of reproductive age,” and you can usually get an annual screening exam there for free or at a deep discount. Sometimes lesbians have unintended pregnancies when they have sexual relationships with men, and it is always worthwhile to be informed about the latest birth control methods. There is also often a county hospital with ambulatory services for women without insurance. These county hospitals are often staffed with physicians and providers committed to providing medical care to the underserved, which usually means that the providers are open and accepting to all patients, regardless of payment source or sexual orientation. 

Health Screening

Your health matters, not only to you but to your family, friends, and partner, if you are partnered. So it is very important to take care of yourself, and to obtain Pap smears and other screening tests regularly. Here is  a recommended  schedule of health examinations:

Every Year: an annual screening exam with a health practitioner that includes a clinical breast exam, appropriate immunizations, and screening tests individualized by your practitioner.

Usual immunizations for adults (www.cdc.gov):

Vaccine
When
Dose/Frequency
Comments
Tetanus, diphtheria, pertussis (Tdap)
  Once every 10 years
 
Hepatitis B (HBV)
Usually age 12
3 doses over 4 months
 
Human Papilloma Virus (HPV)
Ideally prior to the onset of sexual activity (ages 11-26)
3 doses over 6 months
The HPV can pass between female sexual partners, and it can cause warts or cervical cancer.
Measles, Mumps, and Rubella (MMR)
Between 19-49
    years old
1-2 doses
 
Varicella (chickenpox)
  2 doses over 8 weeks
Not necessary if you had chickenpox already
Influenza
Starting at age 50
Once every year
May start younger if you have other risk factors, such as working in daycare or hospitals
Zoster
Age 60 and older
Once total
 
Pneumococcal
Age 65 and older
Once total
 

Screening Tests for Adult Women (www.cdc.gov, www.ahrq.gov):

Three Years after the start of sexual activity - Pap Smears should be obtained beginning 3 years after you start having sex with either women or men but no later than 21 years of age, then every year until you are 30. After that, if you have had three normal Pap smears in a row, you can get a Pap every two to three years. If your health practitioner tells you that you don’t need Pap smears because you are a lesbian, you need to inform them that they are wrong, that lesbians do get cervical cancer and that the HPV virus can pass from woman-to-woman.
Every 1 – 2 years - Blood Pressure Screening
At Age 35- Thyroid Blood Test: You should get a TSH every five years.
At Age 40 -Mammograms: You should get a baseline mammogram. If that is normal, you should get a mammogram every 1 – 2 years, and than at age 50, every year. Lesbians are at higher risk for breast cancer than heterosexual women, but all women are at high risk, so being diligent about this schedule is really important.
At Age 45 - Heart Disease Screening: fasting lipid profile; starting earlier if other risk factors for heart disease.
At Age 50 - Colon Cancer Screening: Yearly patient-collected stool samples, or flexible sigmoidoscopy every 5 years, or double-contrast barium enema every 5 years, or colonoscopy every 10 years; African American women should begin screening at the age of 45.

Relationships

About 70% of lesbians are partnered. Some of these relationships are monogamous, and some are “polyamorous,” which involve more than one partner. Many lesbians are single. In terms of your health care, you need to know that you can invite a friend or your partner to be with you during a health care visit if you would prefer, including during a pelvic exam. However, most practitioners prefer a few minutes alone with their patient to screen for sensitive information, so it is important to also be prepared that your partner or friend may be asked to leave for a few minutes. Because so many lesbians are “disowned” or are victims of hate crimes from members of their biologic family, many clinicians are aware that lesbians often also have “families of choice”: partners and/or close friends who are involved in their patient’s medical care. If both you and your partner see the same health provider, confidentiality should be provided by the health provider for each of you.

Many times there can be stress in a relationship, often due to communication issues. If these cannot be worked out, there are skilled professionals in the community who can help you. Many lesbians prefer to seek help from lesbian professionals, as seeing a heterosexual professional may involve some time to educate them about typical lesbian issues. On the other hand, seeing a provider outside the lesbian community may provide some needed objectivity. If you do seek counseling, it is important that you realize that a lesbian mental health professional is bound by the same ethical guidelines as a heterosexual mental health professional in terms of boundaries. Sometimes this is not respected and there have been incidents of ethics being violated. If you are in a large city, there may be an umbrella LGBT mental health organization which has identified sensitive mental health providers in the community. There are also national organizations of mental health professionals who have active LGBT interest units. You are the best judge of whether or not a therapist is effective. If by the completion of the second session, you are not comfortable, you might decide to try someone else.

Domestic Violence (Interpersonal Violence)

There is always a chance of domestic violence in any relationship, and in lesbian relationships it can also happen. Some of the characteristics are the same as in a heterosexual relationship: a power differential (often the older woman is the perpetrator), substance use such as alcohol, a history of domestic violence in the past. However, in lesbian relationships, there are some differences: sometimes in one relationship the woman is the victim, and in the next relationship, she is the abuser. There is no known effective treatment for the perpetrator, although medications such anti-depressants and group therapy have been tried. The safest approach for the victim is to detach from the relationship. However, this can be difficult as typically shelters are not prepared for victims of lesbian domestic violence, and staff members are not adequately trained. Threats of “outing” the victim at work or with the Immigration and Naturalization Service can also be used. Exiting the relationship is typically a time of increased danger, and should be done carefully with planning. Abuse can be physical, and can also be emotional without the physical abuse present (e.g., isolation from friends, disrespectful comments in front of others). CUAV, Communities United Against Violence, provides resources for lesbians in these relationships (www.cuav.org).

Sexually Transmitted Infections

Some sexually transmitted infections can be transmitted between lesbians.
The Human Papilloma Virus (HPV) can be transmitted woman-to-woman, but so can many other viruses through mucous membrane contact or other sexual contact. If you are under the age of 26, you should get vaccinated, as that will decrease your risk of acquiring certain viral types of HPV that can cause cervical cancer later in your life. The HPV virus can also cause genital warts, which can be treated by your doctor or nurse practitioner.
The Herpes virus can also be transmitted sexually, so if you have any lesions on your mouth or in your genital area, you should abstain from oral or genital contact at that time. Shedding of the virus can also happen from the cervix even though your lesion might happen to be elsewhere, such as on your buttocks. Shedding can also happen when you don’t have an obvious lesion, so some women take a daily pill of either Acyclovir or Valtrex, which decreases shedding as well as the frequency of outbreaks.
About 20% of our population has Herpes, so you aren’t alone if you have Herpes. It is very important to disclose that you have genital Herpes to your potential sexual partner, even thought it may be awkward (remember that there is a 1 in 5 chance that she also has genital Herpes).
Some types of vaginitis can be transmitted woman-to-woman, and some aren’t. Trichomonas is a very contagious protozoa that can even be picked up from towel-sharing as well as sexual activity. If you or your partner has a diagnosis of Trich (often accompanied by a greenish vaginal discharge), both of you need to be treated at the same time, usually with Flagyl, a powerful antibiotic.
Another type of vaginitis is Bacterial Vaginosis (BV), which often causes a yellow vaginal discharge with a “fishy” odor. It means that the bacteria which don’t require oxygen to grow (the anaerobic bacteria) have overgrown the aerobic bacteria require oxygen) in the vagina and there is an imbalance. One study of lesbians revealed that if one member of the lesbian couple has BV, there is a 23% chance the other member of the couple will have it. However, if your partner does not have symptoms, she doesn’t need to be treated automatically. If your symptoms recur after treatment, then she should be checked.
The most common cause of vaginitis is a yeast infection (candida). Typically, in this case, there is itchy outer vulva with cottage-cheese type discharge from the vagina. This can be treated with over-the-counter medications such as Monistat or Gyne-Lotrimin. Contributing factors to yeast overgrowth might be recent antibiotic use, diabetes, or wet swimsuit/gym apparel worn for long periods of time. Usually yeast vaginitis it not transmitted through sexual activity. However, if you are using sex toys, don’t share them with your partner/s, and remember to wash them and let them dry completely, after each use.
Chlamydia and gonorrhea are most likely not transmissible sexually between women. If there is an active syphilis lesion, and there is mucous membrane contact, this is potentially transmissible if a lesion is present. Woman-to-woman HIV transmission has not been directly documented: however it is theoretically possible. As a group, lesbians have been shown to have a higher rate of HIV than heterosexual women: this may be because of the 10% rate of IV drug use in the past/present found in some surveys of lesbians, and the sharing of needles, as well as the occasional sexual activity of lesbians with their gay male friends who are at significant risk of carrying HIV. Safer sex practices for lesbians include not having sex during menstruation or minimizing trauma during sex. The only barrier studied to decrease transmission of the HIV virus is the condom, so if you are in a high risk situation with an HIV positive lesbian partner, you might decide to use a female condom or cut-up a male condom for sexual contact.
Just as in heterosexual couples, it is recommended prior to the initiation of a sexual relationship with a new partner, that an HIV test be done for each member of the couple, that barrier protection then be used for 6 months, that repeat HIV testing then be done at the 6-month mark, and if both partners have been monogamous for the past 6 months and plan to be in the future, and are negative for HIV at the 6-month mark, that barrier protection is not necessary at that time.

Parenthood

About 50% of lesbian plan to become parents, and about 30% of them become biologic parents. Many other lesbians become co-parents, foster parents, or adoptive parents. The children who are parented by lesbian mothers have the same outcomes as those with heterosexual parents, documented by multiple studies. There is one long-term study of these children by Dr. Nanette Gartrell and her research team (www.nllfs.org)
Many lesbians wait “too long” to become biologic parents (late 30s, 40s) and are often disappointed to find out that they might not be able to conceive, or they might have multiple miscarriages. If you are planning to become a biologic parent, you should be pro-active about the timing of pregnancy, taking into account your biologic clock. Some lesbians choose pregnancy while partnered, and others choose pregnancy as an intentional single parent. Be sure to mention your pregnancy plans to your health practitioner before you get pregnant so certain pre-conception tests can be done ahead of time, like being sure that you are immune to the German measles (if you aren’t, you have to wait three months after the vaccine to conceive.) You also need to start prenatal vitamins three months ahead of conception, to decrease the risk of birth defects.
There are many choices in terms of method of conception. Do you want to use an anonymous donor through a sperm bank? If you do that, do you want your child to have the option to meet the donor once your child reaches 18? Do you want to ask a known donor to contribute sperm? Do you want to co-parent with a gay man or a straight man? If you are partnered, do you want to ask your partner’s brother to donate sperm so that your partner will be biologically related to the child (aunt)? If you are partnered, do you want “co-maternity” in which one of you will donate an egg, have it fertilized with the sperm, and the other partner carry the pregnancy?
The legal ramifications also have to be considered, as in each state, the laws are different. You should seek counsel before you conceive to be sure that custody issues are planned. The National Center for Lesbian Rights has a packet to get you started (www.nclr.org).
Most lesbians conceive in the first three months of inseminations. If a lesbian is older (over 35) and has not conceived after 3 months of well-timed inseminations, then she should consider a referral to an infertility specialist. If younger than 35, the referral is most appropriate if no conception has occurred after 6 months. However, some insurance companies have lesbians lumped in the same category as heterosexual couples, and will not allow a referral unless there is no conception after 12 cycles of insemination.
Once pregnant, you need to consider where you will receive your obstetric care. If you have an existing relationship with an ob-gyn practice, you may decide to continue your prenatal care there. If you want a home birth, you need to investigate who might be with you at the birth as a health professional as well as having a back-up plan if labor doesn’t go as planned. If you are going to deliver at a free-standing birth center or a hospital, you need to go on a tour of the birthplace, and ask about their experience with same-sex couples or single lesbians. You need to feel comfortable. Occasionally, in large cities, there are lesbian childbirth classes, but most lesbians will be in class with heterosexual couples or single mothers. In that case, you need to find a childbirth class provider who has experience working with pregnant lesbians.
Sharing the news of your pregnancy with your biologic family and with your “in-laws” if partnered, can be joyful or anxiety-provoking especially if your family has had issues with your “coming out.” In Dr. Gartrell’s study, only 3% of grandparents did not welcome the news of a new grandchild of their lesbian daughter. Be sure to include your parents in your support system, as well as your close friends. Parenting is hard work as well as much fun, and you need as much support as possible!
Breastfeeding is very important for the baby’s health and your health. If you are partnered, your partner can sometimes induce breastmilk herself and share breastfeeding with you, although usually medication is needed for this, as well as frequent pumping of the breasts. When you choose your pediatric care provider for your baby, be sure you are comfortable with this provider (meet them before the birth if possible), and be sure that they are supportive of your alternative family.

Weight Management/Exercise

Research shows that lesbians have an increased body mass index (are heavier) than heterosexual women. What the actual health risks are, depend on how overweight you are. You can calculate your body mass index here: http://www.nhlbisupport.com/bmi/
Eating healthy is very important. A new food pyramid has been designated by the experts:

For the severely obese, there are possible surgeries available that are very effective, such as gastric banding (a newly developed technique), or the more traditional gastric bypass. However, for those in the in-between category of obesity or overweight, there are multiple approaches to try to achieve a healthier weight, including Weight Watchers, which has an on-line program. Be wary before you invest resources in any “quick-fix” approach, as often the weight loss is temporary in these programs . Check with your primary care practitioner to see what is available in your community, and which programs have an established long-term success rate.

Exercise is a very important part of maintaining your health. The target duration should be 30 minutes of exercise per day. This exercise can be broken up into 3 ten minute walks, or a 30 minute swim. Sometimes exercising with a friend can be a motivating factor. Have several back-up plans for each day.

Smoking

The rate of smoking is much higher in lesbians than in heterosexual women. The LGBT community has been targeted by the tobacco industry, which often has developed ties with advertising, as well as sponsoring community events.. The lung cancer rate already is high in women in general (the number one cancer killer of women). Not only does smoking affect lesbians who are doing the smoking, but smoking also affects the folks who are around them in terms of second hand smoke exposure, which also causes lung cancer (3,000 deaths in the United States per year of non-smokers from second-hand smoke). Chronic obstructive pulmonary disease (COPD) is also associated with a history of smoking, and can become a significant quality-of-life issue as lesbians age. There are many programs to help with smoking cessation: often the first try does not work but subsequent attempts often do work. If a woman smokes, it takes 14 years off her life span. Smoking also increases the risk of cardiovascular disease.
For suggestions on how to stop smoking, try www.lungusa.org

Alcohol

Research confirms that lesbians between the ages of 20 to 40 have more alcohol intake than heterosexual women. Alcohol is often seen as easing some of the awkwardness of social interactions for lesbians “coming out,” and lesbian bars often are community gathering places. Many lesbians over the age of 40, are “in recovery.” In large cities, there are often well known lesbian Alcoholic Anonymous group meetings (www.aa.org)
How do you know if you are an alcoholic? There are many definitions: if you are having black outs, if your friends have ever told you that they are concerned about your having a drinking problem, or if you are worrying that you are drinking too much are all signs. The absolute amount of alcohol consumed every day is not used in determining alcoholism, as binge drinking can have the same medical and social consequences as can daily drinking. One questionnaire that is helpful in diagnosing alcoholism is the CAGE:
1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
If you have answered any of the four questions with a yes, you should seek some help for your alcohol use.

Substance Use

Use of substances other than alcohol, such as cocaine, crack, and heroin are probably at the same level of prevalence as for heterosexual women. Treatment centers may vary in their acceptance of lesbian lifestyle, and should be checked for this prior to entry.

Depression and Other Mental Health Issues

Lesbians do “get the blues” more frequently than heterosexual women. Symptoms of a major depression may include: depressed mood most of the day, markedly decreased interest or pleasure in activities most of the day, a decrease or increase in appetite, a decrease or increase in sleep, restlessness or decreased activity, fatigue or loss of energy, feelings of worthlessness or excessive or inappropriate guilt, decreased concentration or indecisiveness, and /or recurrent thoughts of death or suicide.
There is effective treatment for depression: therapy and/or medication.
Lesbians utilize therapy for the treatment of depression more frequently than do depressed heterosexual women. Not only is traditional interpersonal therapy available, but cognitive behavioral therapy (CBT) has also been shown to be effective and is increasingly available. CBT is time-limited. Lesbians with depression use anti-depressants less often than heterosexual women with depression. Some of the newer medications such as SSRIs are very effective for the treatment of depression, usually with minimal side-effects. Many primary care physicians prescribe SSRIs. There are also additional therapies such as the use of a light box, etc.
Risk factors for lesbians for depression include living in a homophobic society, facing possible rejection from one’s family, not having equal legal recognition of relationships, being closeted in some (or all) aspects of one’s life, using substances abusively, and lacking equal insurance benefits.
The prevalence of other mental illness in lesbians is most likely at the same level as heterosexual women (such as bipolar disorder, schizophrenia) but this has not been specifically studied.
 Research has shown that there is a slight increased rate of childhood sexual abuse in lesbians, as well as physical parental abuse, especially when there is
expression of atypical gender activities. See the section on relationships for discussion on how to find a lesbian sensitive therapist.

Cancer

The only cancer that has been studied well in lesbians is breast cancer.
There is an increased risk of breast cancer in lesbians, although for all women the chance of breast cancer is 1 in 8. It is very important if you feel a breast mass, to see a medical provider within the next month or two. Regular mammograms starting at the age of 40 are also important (if you have a family history or other risk factors, the mammograms may need to start earlier). Breast cancer is more common in women who have not had children before the age of 30, and in women who are obese, both common in lesbians. Warning signs are a lump in your breast that does not go away with a menstrual cycle, dimpling of the breast skin or other changes in the skin of the breast, or spontaneous nipple discharge. Prevention includes regular exercise, weight control, healthy eating, and limiting alcohol intake. (www.breastcanceractionproject.org).
The chance of lung cancer for all women is 1 in17 women, and is probably higher in lesbians since there is an increased rate of smoking. Warning signs include a persistent cough, phlegm streaked with blood, chest pain, repeated bouts of pneumonia or bronchitis, hoarseness, weight or appetite loss, and shortness of breath or wheezing. Prevention is to stop smoking, and to stop being around second hand smoke. Stopping smoking will also decrease the risk of heart attack by 50% in the first year of smoking cessation.
The chance of colorectal cancer is 1 in 18 women. Screening allows for early detection, when colorectal cancer is highly curable. The preferred option for screening is colonoscopy every ten years once a woman reaches age 50, but alternatives include yearly stool tests for blood, or flexible sigmoidoscopy or double-barium contrast enema every five years. The American College of Gastroenterology recommends that African American women begin screening at the age of 45. Earlier screening should also start if there is a personal or family history of colon polyps or colorectal cancer, or a personal history of inflammatory bowel disease. Possible warning signs are a persistent change in bowel habits such as narrowing of the stool, bleeding from the rectum or blood in the stool, cramping pain in the abdomen, unexplained weight loss, or fatigue. Prevention includes weight control, regular exercise, stopping smoking, and limiting alcohol intake.
Uterine cancer occurs in 1 in 40 women, and if diagnosed early is usually curable. Endometrial is the more common form of uterine cancer, and occurs when the lining of the uterus builds up. Sarcoma is a tumor from the muscle of the uterus and is more aggressive than endometrial cancer. These cancers are probably slightly increased in lesbians, since most lesbians have never given birth, and have a higher rate of obesity. Warning signs are unusual vaginal bleeding, spotting or discharge, heavy menstrual bleeding, and postmenopausal bleeding. Prevention includes a yearly pelvic exam, weight control, and avoidance of prolonged exposure to estrogen hormone without the balancer hormone of progesterone.
Ovarian cancer occurs in 1 in 68 women, and is probably slighter higher in lesbians due to an increased proportion of lesbians not having borne children, as well as less use of oral contraceptive pills, which cuts the rate of future ovarian cancer significantly. The problem with ovarian cancer, is that there are no reliable screening tests, and that it is recognized usually at advanced stages when it is very hard to treat effectively. Warning signs include unexplained bloating, pelvic or abdominal pain, back pain, increasing abdominal size, difficulty eating (e.g. early filling), unexplained weight loss, urinary incontinence, frequent urination, constipation, fatigue and indigestion. 
Cervical cancer occurs in 1 in 135 women, and is likely prevalent at the same rate in lesbians. Prevention is effective: vaccination of girls with the Human Papilloma Vaccine, regular Pap smears, limiting the number of sexual partners, and not smoking. Warning signs include abnormal vaginal bleeding, spotting or discharge, bleeding after sex, and pelvic pain.

Gynecologic Issues

Lesbians may have an increased rate of polycystic ovarian syndrome, which is often more common in women who are overweight. The most common presenting symptom is an irregular pattern of periods (long cycles). It is important to have at least four menses per year, as this condition may pre-dispose to an increased risk of endometrial cancer. The rate of uterine fibroids (benign muscle tumors of the uterus) is most likely similar to heterosexual women. Urinary incontinence may be more common in lesbians, due to increased risk of being overweight. There are many new treatments for incontinence, not all of which involve surgery.

Aging Issues

Women in general are living longer, and it is not known if this is true for lesbians, since it has never been tracked. Aging issues for lesbians include partner loss, chronic illness such as diabetes, and Alzheimers, to name several. Nursing homes have been known to treat lesbians disrespectfully as well as deny use of “conjugal rooms” to same-sex couples.  Many lesbians try to stay at home as long as possible before going to a nursing home if there are chronic illness issues. Some cities are currently organizing housing units for the elderly LGBT, as well as
LGBT services for seniors. There are also some private retirement communities developing for the LGBT community (Santa Fe, New Mexico).

End-of-Life Issues

All lesbians need to have a power of attorney filled out, as well as a living will or advanced directive, to state what their wishes are for end-of-life care. For those lesbians who are partnered, it is important to always have a set of papers in a known place in the house which can be grabbed on the way to the hospital, as partners have been denied the right to be with their loved one in the emergency room or in the Intensive Care Unit, since they are not an “official spouse.” These forms can be found on the Web by searching for “advance directive.” One useful site is:
http://familydoctor.org/online/famdocen/home/pat-advocay/endoflife/003.html

Conclusion

Lesbian health is important, and you need to be pro-active in planning your health care. Find a medical care provider you are comfortable with, and whom you visit regularly for your check-ups. Eat healthily, exercise, stop smoking, and maximize your emotional health by having a good support system, including your lesbian community!

Helpful Web sites:


                          www.lesbianhealthinfo.org
                          www.mautnerproject.org
                          www.acog.org
                          www.glma.org
                          www.aglp.org
                          www.4woman.org/owh
                          www.nimh.nih.gov/publicat/depwomenknows.cfm
                          www.depression.org
                          www.ndmda.org
                          www.cancer.org
                          www.breastcanceraction.org
                          www.niaaa.nih.gov/


Support Resources: www.pflag.org
                                www.hrc.org
                                www.thetaskforce.org
                                www.biresource.org
                                www.lyric.org
                                www.nclr.org
                                www.familyequality.org
                                www.colage.org