What are lesbians' unique health risks?

Because women who partner with women are rarely an identified population in women's health research, more remains unknown about lesbians' health risks than is known. We do know that:

• Lesbians likely weigh more and smoke more than heterosexual women, which could put them at a higher risk for heart disease, stroke, and cervical and (possibly) colon cancers.
  
  
• Lesbians have fewer pregnancies and live births, thus allowing for uninterrupted estrogen over longer periods of time and putting them at greater risk for cancers such as breast, uterine and ovarian cancers.
  
  
• Lesbians can get sexually transmitted diseases (STDs) from other women. While more research is needed to learn how STDs are transmitted, and which STDs are most common among women who partner with women, some STDs have been identified as common. Bacterial vaginosis (BV), a common vaginal infection, occurs frequently; also, if one woman in a couple has it, it's likely her partner does too. Lesbians are at risk for human papillomavirus (HPV, the virus that causes cervical cancer) as well.

As a woman who has sex with women (WSW), what should I know when I go in to see my provider?

You'll receive the highest quality, most appropriate care from your health care provider if you plan ahead for your visit, keeping these issues in mind:

• Ask other sexual minority women to suggest a provider, or check the Greater Seattle Business Association's (GSBA) directory.
  
  
• Come out; this is the single most significant disclosure you can make during your visit because it focuses the care and health education you receive, and ensures these are right for you.
  
  
• Be prepared to answer some questions about your needs as a sexual minority woman. While it is true that your providers should educate themselves on WSW, there are two important considerations: 1) you are the expert on you and, 2) some providers may want to check out that what they know about WSW is true about you as well.
  
  
• Be honest about your past sexual history. Your provider needs to know if you have had sex with men to evaluate your risk for a variety of sexually transmitted infections, and for cervical cancer.
  
  
• Take someone with you to your visit. It's often easier for a partner or friend to raise questions or concerns than it is to do it yourself. You'll also feel safer.

What sort of routine screening exams do I need?

You should have the same screenings as any other woman. The problem is we don't have the research to tell us whether you need more or less than other women. Until we can document that lesbians are at greater or lesser risk for various diseases, you should follow the same screening schedules as are indicated for heterosexual women. Your provider may require some reminding on this point; a recent study showed that unless women complained of relevant symptoms, WPW were not screened for common infections such as bacterial vaginosis and chlamydia.

• STD screen: whenever you have a new partner, and before you and your partner discuss safe sex practices.
  
  
• Pap Smears: begin screening at age 18 or when you become sexually active. Have yearly Paps until you've had three consecutive negatives; after discussing your risk factors with your provider, you may then be able to have Paps every 2-3 years. Keep in mind that more recent research is indicating that women may acquire new strains of HPV from new partners, so a new partner may be a reason to revert to yearly Paps.
  
  
• Mammograms: every two years starting at age 40 and yearly at age 50 and older. Get an annual breast exam by a health care provider starting at age 30. Consult your provider if you have a family history of breast cancer (mother or sisters with it), and especially if they developed the disease prior to age 50. Keep watch on the published lesbian research. We may find lesbians require more frequent screening.
  
  
• Follow published frequencies for other exams. Remember that if you smoke or are overweight, you may need more checkups for some conditions.

Online Resources

The Advocate
The national gay & lesbian newsmagazine Internet site
http://www.advocate.com

City of Seattle Commission for Sexual Minorities
Policy and advocacy body for sexual minorities within City government.
http://www.ci.seattle.wa.us/scsm

Domestic Partnership Benefits at the University of Washington
http://www.washington.edu/admin/benefits/domestic.partners.html

Femme
A web zine from stonefemm.com.
http://www.stonefemme.com/femme

Gay Health
http://www.gayhealth.com

GLMA
Gay and Lesbian Medical Association. See their excellent white paper, commissioned by HRSA, on sexual minority health issues. (Note: this Web site opens in a new browser window since it is designed to disable the back button.)
http://www.glma.org

Healthy People 2010 and companion document on Sexual Minority Health
http://www.health.gov/healthypeople

Human Rights Campaign
Working for sexual minorities' equal rights.
http://www.hrc.org

The Mautner Project for Lesbians with Cancer
The only national organization dedicated to lesbians with cancer, their partners and caregivers.
http://www.mautnerproject.org

National Gay and Lesbian Task Force and Policy Institute
Working for sexual minorities' equal rights.
http://www.ngltf.org

Public Health-Seattle & King County's LGBT Web Site
Created with funds from a National Library of Medicine grant, this excellent web site has received national attention.
http://www.metrokc.gov/health/glbt

Seattle Lesbian Cancer Project
A grassroots organization dedicated to providing advocacy, education, information and referrals for women who partner with women.
http://www.slcp.org

Seattle Lesbian STD Research Project
Information about the NIH-funded, University of Washington-sponsored research project investigating sexually transmitted infections among women who partner with women.
http://www.lesbianstd.com