Many lesbian women go to the OB/GYN for their annual exam and, unless previously established otherwise, their health care provider assumes they are straight.
That leaves us lesbian women with a choice: to disclose or not to disclose our sexuality.
I've told the story before of my experience with health care as a lesbian woman, but for those of you who don't know: I was diagnosed with "ego dystonic homosexuality" in 2009, I have been spoken to with medical ignorance during a follow-up visit for a borderline pap test, and have been met with assumptions of heterosexuality by my health care provider.
One very common situation among lesbian women is along the lines of what I experienced at one of my annual check ups.
Nurse: "What birth control are you on?"
Nurse: "Are you sexually active?"
Nurse: "Are you trying to get pregnant?"
Nurse: "You are sexually active, not trying to get pregnant, and are not on any BIRTH CONTROL!?!!"
Me: "Well, actually, I'm in a same sex relationship."
Nurse, obviously uncomfortable: "Oh".
This happens time and time again to those of us who are in same sex relationships or are sexually active with same sex gendered people. Oftentimes, it's much worse.
Health care providers are getting better and better about coming into visits with the possibility that you might be something other than heterosexual; however, as I'm sure a lot of you can attest to, there is much room for improvement.
In the meantime, I want to share with you a few recommendations for those of you who are sexually active with women.
1. You need pap smears just as often as your straight friends.
That's right. Studies show most lesbian women have had at least one male sexual partner, and other studies have shown that Human Papilloma Virus (HPV), the virus that is responsible for most cervical cancers, has been found in women who have only had sex with women. So, as a woman who has sex with women, you should follow the same schedule as other women. If your provider doesn't seem to be aware of this, I urge you to find another one who is up to date on health care recommendations for lesbian women.
2. You need mammograms just as often as your straight friends.
Some studies have shown that lesbian women get screening mammograms less often than heterosexual women. There are various theories for why this is, one of which is that the health care system has turned away many lesbian women because of poor treatment. However, it's important to find an LGBT-friendly clinic, or one where you feel comfortable, and to get those screening mammograms starting at age 40, or earlier, depending on your unique risk factors. In fact, some studies suggest that lesbian women may in fact have higher rates (or risk factors) for developing breast cancer than the general population.
3. Safe sex: it's not just about a penis and a vagina
Lesbian women may think they are not at risk for developing sexually transmitted infections or diseases (STIs and STDs) if they are only having sex with other women. This is not true. As I mentioned earlier, most lesbian women have had at least one male sex partner, and if she hasn't, then her partner most likely has. Regular STI/STD screening tests are recommended, based on sexual activity and sexual history. In addition, lesbian women have been found to have a higher rate of bacterial vaginosis when compared to the general population.
Of course, the only true "safe" sex is to not have sex at all. However, there are some measures you can take to protect yourself as a lesbian woman if you choose to be sexually active. First of all, when women are menstruating, the risk of transmission of some STI/STDs is increased, so take extra precautions when you or your sexual partner are menstruating.
Using a dental dam or a condom that is cut open to use as a barrier for oral sex is recommended. Using latex gloves, using condoms on any sex toys (and changing condoms/washing in between partner uses), and avoiding sexual contact with any visible lesions are also recommended.
I typically tell my patients that if you are in a new, monogamous relationship with someone, to use protection/barrier methods for at least 3 months. That way, if there has been an exposure from a previous partner, it allows time for symptoms or infections to present themselves.
Despite what may be mainstream belief, or even belief by your health care provider, it is possible for women to transmit STI/STDs between them, so take precautions as necessary. Report any symptoms to your health care provider immediately.
Several of these points have links to previous articles that expand upon the discussion of lesbian health. I'd love to hear from you if you have any questions or have some good resources to share. Please also check out the Resource Page for more information.