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