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F R E Q U E N T LY A S K E D Q U E S T I O N S

Lesbian Health The more risk factors (or things that


increase risk) a woman has, the
greater the chance that she will
develop heart disease. There are
some factors that you can’t control
WomensHealth.gov Q: What challenges do lesbian such as getting older, family health
1-800-994-9662 women face in the health care history, and race. But you can do
TDD: 1-888-220-5446 system? something about some of the
A: Lesbians face unique challenges within
biggest risk factors for heart and
the health care system that can cause
cardiovascular disease—smoking,
poorer mental and physical health.
high blood pressure, lack of exercise,
Many doctors, nurses, and other health
diabetes, and high blood cholesterol.
care providers have not had sufficient
● Exercise. Studies have shown
training to understand the specific
that physical inactivity adds to a
health experiences of lesbians, or that
person’s risk for getting heart and
women who are lesbians, like
cardiovascular disease, as well as
heterosexual women, can be healthy
some cancers. People who are not
normal females. There can be barriers
active are twice as likely to develop
to optimal health for lesbians, such as:
heart and cardiovascular disease
● Fear of negative reactions from their compared to those who are more
doctors if they disclose their sexual active. The more overweight you
orientation. are, the higher your risk for heart
● Doctors’ lack of understanding of disease. More research with lesbians
lesbians’ disease risks, and issues that in this area is needed.
may be important to lesbians. ● Obesity. Being obese can make you
● Lack of health insurance because of more likely to get heart disease, and
no domestic partner benefits. cancers of the uterus, ovary, breast,
and colon. Many studies have found
● Low perceived risk of getting
that lesbians have a higher body
sexually transmitted diseases and
mass than heterosexual women.
some types of cancer.
Studies suggest that lesbians may
For the above reasons, lesbians often store fat more in the abdomen and
avoid routine health exams and even have a greater waist circumference,
delay seeking medical care when health which places them at higher risk for
problems occur. heart disease and other obesity-
related issues such as premature
Q: What are important health death. Additionally, some suggest
that lesbians are less concerned
issues for lesbians to discuss
about weight issues than
with their doctors or nurses?
heterosexual women.
A: ● Heart disease. Heart disease is the

#1 killer of all women. Factors that


At this time, more research is
raise women’s risk for heart
needed in these areas: physical
disease—such as obesity, smoking,
activity in lesbians; possible dietary
page 1 and stress—are high among lesbians. differences between lesbians and

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F R E Q U E N T LY A S K E D Q U E S T I O N S

heterosexual women; if a higher


compared to the general population.
BMI is a ref lection of lean tissue and
Smoking as a teen increases the risk
not excess fat; and if there’s a
of becoming an adult smoker. We
different cultural norm among
know that about 90 percent of adult
lesbians about thinness. In addition,
smokers started smoking as teens.
WomensHealth.gov
other important factors for ● Depression and Anxiety. Many
1-800-994-9662 researchers to consider are factors cause depression and anxiety
TDD: 1-888-220-5446 race/ethnic background, age, health
among all women. Studies show that
status, education, cohabitation with
lesbian and bisexual women report
a female relationship partner, and
higher rates of depression and
having a disability. Studies have
anxiety than heterosexual women
reported that among lesbian and do. This may result from the fact
bisexual women, African American that lesbian women may also face:
or Latina ethnicity, older age, poorer

health status, lower educational > Social stigma

attainment, lower exercise > Rejection by family members


frequency, and cohabiting with a
female relationship partner increases > Abuse and violence
a lesbian woman’s likelihood of > Being treated unfairly in the legal
having a higher BMI. system
● Nutrition. Research supports that > Hiding some or all aspects of
lesbian and bisexual women are less one’s life
likely to eat fruits and vegetables
> Lacking health insurance
every day. More research on food
consumption and dietary differences Lesbians often feel they have to conceal
in relation to health and lesbians and their lesbian status to family, friends,
bisexuals is needed. and employers. Lesbians can also be
recipients of hate crimes and violence.
● Smoking. Smoking can lead to
Despite strides in our larger society,
heart disease and multiple cancers,
discrimination against lesbians does
including cancers of the lung,
exist, and discrimination for any reason
throat, stomach, colon, and cervix.

may lead to depression and anxiety.


Lesbians are more likely to smoke,

compared to heterosexual women.


● Alcohol and drug abuse.
Researchers think that high rates of
Substance abuse is as serious a public
smoking in this population are a
health problem for the lesbians, gay
consequence several things, like
men, bisexuals, and transgendered
social factors, such as low self-
people (LGBT) as it is for the
esteem, stress resulting from
general U.S. population. Overall,
discrimination, concealing one’s
recent data suggest that substance
sexual orientation, and tobacco
use among lesbians—particularly
advertising targeted towards gays
alcohol use—has declined over the
and lesbians. Studies have also found
past two decades. Reasons for this
that smoking rates are higher among
decline may include greater
gay and lesbian adolescents
awareness and concern about health;
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U.S. Department of Health and Human Services, Office on Women’s Health
F R E Q U E N T LY A S K E D Q U E S T I O N S

more moderate drinking among ● Domestic Violence. Also called


women in the general population; intimate partner violence, this is
some lessening of the social stigma when one person purposely causes
and oppression of lesbians; and either physical or mental harm to
changing norms associated with another. Domestic violence can
WomensHealth.gov
drinking in some lesbian occur in lesbian relationships as it
1-800-994-9662 communities. However, both heavy does in heterosexual relationships,
TDD: 1-888-220-5446 drinking and use of drugs other than though there is some evidence that
alcohol appear to be prevalent it occurs less often. But for many
among young lesbians and among reasons, lesbian victims are more
some older groups of lesbians. likely to stay silent about the
● Cancers. Lesbian women may be at violence. Some reasons include
a higher risk for uterine, breast, fewer services available to help
cervical, endometrial, and ovarian them; fear of discrimination; threats
cancers because of the health from the batterer to “out” the
profiles listed above. However, more victim; or fear of losing custody of
research is needed. In addition, these children.
reasons may contribute to this risk: ● Polycystic Ovarian Syndrome.
> Lesbians have traditionally been PCOS is the most common
less likely to bear children. hormonal reproductive problem in
Hormones released during women of childbearing age. PCOS
pregnancy and breastfeeding are is a health problem that can affect a
believed to protect women woman’s menstrual cycle, fertility,
against breast, endometrial, and hormones, insulin production,
ovarian cancers. heart, blood vessels, and appearance.
Women with PCOS have these
> Lesbians have higher rates of characteristics:
alcohol use, poor nutrition, and
obesity. These factors may > high levels of male hormones,
increase the risk of breast, also called androgens
endometrial, and ovarian cancers, > an irregular or no menstrual cycle
and other cancers. > may or may not have many small
> Lesbians are less likely to visit a cysts in their ovaries. Cysts are
doctor or nurse for routine f luid-filled sacs.
screenings, such as a Pap, which An estimated five to 10 percent of
can prevent or detect cervical women of childbearing age have
cancer. The viruses that cause PCOS (ages 20-40). There is
most cervical cancer can be evidence that lesbians may have a
sexually transmitted between higher rate of PCOS than
women. Lesbians have similar heterosexual women.
rates of mammography testing
(for breast cancer) as heterosexual ● Osteoporosis. Millions of women
women. already have or are at risk for

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U.S. Department of Health and Human Services, Office on Women’s Health
F R E Q U E N T LY A S K E D Q U E S T I O N S

osteoporosis. Osteoporosis means


the cervix that can lead to cancer,
that your bones get weak, and
if it is not treated. Most people
you’re more likely to break a bone.
with HPV or genital warts don’t
Osteoporosis in lesbian women has
know they are infected until they
not yet been well studied.
have had a Pap test because they
WomensHealth.gov
● Sexual Health. Lesbian women are may not have symptoms, but the
1-800-994-9662 virus can still be spread by
at risk for many of the same STDs as
TDD: 1-888-220-5446 heterosexual women. Lesbian
contact. Lesbians can transmit
women can transmit STDs to each
HPV through direct genital skin-
other through skin-to-skin contact,
to-skin contact or by the virus
mucosa contact, vaginal f luids, and
traveling on hands or sex toys.
menstrual blood. Sharing sex toys is
Some women and their doctors
another method of transmitting
wrongly assume that lesbian
STDs. These are common STDs women do not need a regular Pap
that can be passed between women: test. However, the virus can be
spread by lesbian sexual activity,
> Bacterial vaginosis (BV). and many lesbians have been
Although we don’t know for sure sexual with men so it is
that BV is caused by a sexually recommended that lesbian
transmitted agent, BV occurs women have a Pap test. This
more commonly among women simple test is an effective method
who have recently acquired other of detecting abnormal cells on
STD’s, or who have recently had the cervix that can lead to cancer.
unprotected sex. For reasons that Begin getting Pap tests no later
are unclear, BV is more common than age 21 or sooner if you’re
in lesbian and bisexual women sexually active. These
than heterosexual women, and recommendations apply equally
frequently occurs in both to lesbians who’ve never had sex
members of lesbian couples. BV with men, as cervical cancer
happens when the normal caused by HPV has been seen in
bacteria in the vagina get out of this group of women.
balance. Sometimes, BV causes
no symptoms, but over half of > Trichomoniasis “Trich”. It is
affected women have a vaginal caused by a parasite that can be
discharge with a fishy odor or passed from one person to
vaginal itching. If left untreated, another during sexual contact. It
BV can increase a woman’s can also be picked up from
chances of getting other STDs contact with damp, moist objects
such as HIV, chlamydia, such as towels or wet clothing.
gonorrhea, and pelvic Trich is spread through sexual
inf lammatory disease. contact with an infected person.
Signs include yellow, green, or
> Human papillomavirus gray vaginal discharge (often
(HPV). HPV can cause genital foamy) with a strong odor;
warts and abnormal changes on discomfort during sex and when
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N AT I O N A L W O M E N ’ S H E A LT H I N F O R M AT I O N C E N T E R
U.S. Department of Health and Human Services, Office on Women’s Health
F R E Q U E N T LY A S K E D Q U E S T I O N S

urinating; irritation and itching HSV-1 is another herpes virus


of the genital area; and lower that usually infects the mouth
abdominal pain in rare cases. To and causes oral cold sores, but
tell if you have trich, your doctor can also be transmitted to the
or nurse will do a pelvic exam genital area through oral sex.
WomensHealth.gov
and lab test. A pelvic exam can Lesbians can transmit this virus
1-800-994-9662 show small red sores, or to each other if they have
TDD: 1-888-220-5446 ulcerations, on the wall of the intimate contact with someone
vagina or on the cervix. Trich is with a lesion or touching infected
treated with antibiotics. skin even when an outbreak is
> Herpes. Herpes is a virus that not visible.
can produce sores (also called > Syphilis. Syphilis is an STD
lesions) in and around the vaginal caused by bacteria. Syphilis is
area, on the penis, around the passed through direct contact
anal opening, and on the with a syphilis sore during
buttocks or thighs. Occasionally, vaginal, anal, or oral sex. If
sores also appear on other parts of untreated, syphilis can infect
the body where the virus has other parts of the body. Syphilis
entered through broken skin. remains uncommon in the
Most people get genital herpes by general population, but has been
having sex with someone who is increasing in men who have sex
shedding the herpes virus during with men. It is extremely rare
periods when an outbreak is not among lesbians. However,
visible. The most common cause lesbians should talk to their
of recurrent genital herpes is doctor if they have any non-
HSV-2, which is transmitted healing ulcers.
through direct genital contact.

Q: What other STDs can lesbian women get?


STD Symptoms

Chlamydia Most women have no symptoms.Women with symptoms may have:


● abnormal vaginal discharge
● burning when urinating
● bleeding between menstrual periods

Infections that are not treated, even if there are no symptoms, can lead to:
● lower abdominal pain
● low back pain
● nausea
● fever
● pain during sex
● bleeding between periods
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U.S. Department of Health and Human Services, Office on Women’s Health
F R E Q U E N T LY A S K E D Q U E S T I O N S

STD Symptoms

Gonorrhea Symptoms are often mild, but most women have no symptoms. Even
when women have symptoms, they can sometimes be mistaken for a
WomensHealth.gov bladder or other vaginal infection. Symptoms are:
1-800-994-9662 ● pain or burning when urinating
● yellowish and sometimes bloody vaginal discharge
TDD: 1-888-220-5446
● bleeding between menstrual periods

Hepatitis B Some women have no symptoms.Women with symptoms may have:

● mild fever
● headache and muscle aches
● tiredness
● loss of appetite
● nausea or vomiting
● diarrhea
● dark-colored urine and pale bowel movements
● stomach pain
● skin and whites of eyes turning yellow

HIV/AIDS Some women may have no symptoms for 10 years or more.Women with
symptoms may have:
● extreme fatigue
● rapid weight loss
● frequent low-grade fevers and night sweats
● frequent yeast infections (in the mouth)
● vaginal yeast infections and other STDs
● pelvic inflammatory disease (PID)
● menstrual cycle changes
● red, brown, or purplish blotches on or under the skin or inside the
mouth, nose, or eyelids

Pubic Lice ● itching


● finding lice

Q: What can lesbian women do to You can access their database of


protect their health? members at www.glma.org/
A: ● Find a doctor who is sensitive to programs/prp/index.shtml or
your needs to help you get contact them at (415) 255-4547.
regular check ups. The Gay and ● Get a Pap test. The Pap test finds
Lesbian Medical Association changes in your cervix early, so you
provides online health care referrals. can be treated before the problem
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N A T I O N A L W O M E N ’ S H E A L T H I N F O R M AT I O N C E N T E R
U.S. Department of Health and Human Services, Office on Women’s Health
F R E Q U E N T LY A S K E D Q U E S T I O N S

becomes serious. Begin getting Pap


Read more about having a healthy
tests no later than age 21 or within
diet at http://www.4woman.gov/
three years of first having sexual
faq/diet.htm.
intercourse. After two to three
● Drink moderately. If you drink
yearly Pap tests have been normal,
alcohol, don’t have more than one
WomensHealth.gov
talk to your doctor or nurse about
drink per day. Too much alcohol
1-800-994-9662 getting a Pap test at least once every
raises blood pressure and can raise
TDD: 1-888-220-5446 three years. your risk for stroke, heart disease,
● Talk to your doctor or nurse osteoporosis, many cancers, and
about an HPV test if your Pap other problems.
test is abnormal. In combination ● Get moving. An active lifestyle can
with a Pap test, an HPV test helps
help every woman. Thirty minutes
prevent cervical cancer. It can detect
of moderate physical activity on
the types of HPV that cause cervical
most days of the week can greatly
cancer. The Food and Drug improve your health and decrease
Administration (FDA) has approved your risk of heart disease and some
an HPV DNA test for women for cancers!
the following uses:
● Don’t smoke. If you do smoke, try
> as a follow-up to a Pap test with to quit. Avoid second hand smoke as
results that are abnormal much as you can. Read more about
> in combination with a Pap test in
quitting at http://www.4woman.gov/
women aged 30 and older
QuitSmoking.
● Practice safer sex. Get tested for ● Try different strategies to deal
STD’s like chlamydia or herpes with your stress. Stress from
before beginning a relationship. If discrimination is a tough challenge
you’re unsure about a partner’s in the life of every lesbian. Relax
status, practice methods to reduce using deep breathing, yoga,
the likelihood of sharing vaginal meditation, and massage therapy.
f luid or blood, including condoms You can also take a few minutes to
on sex toys. sit and listen to soothing music, or
read a book. Talk to your friends or
● Have a balanced, healthy diet. Eat
get help from a professional if you
a variety of whole grains, fruits, and
need it.
vegetables. These foods give you

energy, plus vitamins, minerals, and


● Talk to your doctor or nurse
fiber. Besides, they taste good! Try
about screening tests you may
foods like brown rice or whole-wheat
need. Regular preventive screenings
bread. Bananas, strawberries, and
are critical to staying healthy. All the
melons are some great tasting fruits.
tests that heterosexual women need,
Try vegetables raw, on a sandwich, or
lesbian women need too. See these
in a salad. Be sure to pick a variety of
online charts for screening
colors and kinds of fruits and
guidelines for different age groups:
vegetables. You can vary the form—
www.4woman.gov/screeningcharts.
page 7 try fresh, frozen, canned, or dried.

N AT I O N A L W O M E N ’ S H E A LT H I N F O R M AT I O N C E N T E R
U.S. Department of Health and Human Services, Office on Women’s Health
F R E Q U E N T LY A S K E D Q U E S T I O N S

● Get help for domestic violence. doctor or nurse about taking


Call the police or leave if you or medicines to prevent or treat bone
your children are in danger! Call a loss.
crisis hotline or the National ● Know the Signs of a Heart
Domestic Violence Hotline at 800- Attack. Women are less likely than
WomensHealth.gov
799-SAFE or TDD 800-787-3224, men to believe they are having a
1-800-994-9662 which is available 24 hours a day, heart attack and more likely to delay
TDD: 1-888-220-5446 365 days a year, in English, Spanish,
in seeking treatment. For women,
and other languages. The Helpline
chest pain may not be the first sign
can give you the phone numbers of
your heart is in trouble. Before a
local hotlines and other resources. heart attack, women have said that
● Build strong bones. Exercise. Get a they have unusual tiredness,
bone density test. Learn more about trouble sleeping, problems
that at: http://www.4woman.gov/ breathing, indigestion, and
faq/osteopor.htm. Make sure you get anxiety. These symptoms can
enough calcium and vitamin D each happen a month or so before the
day. Reduce your chances of falling heart attack. During a heart attack,
by making your home safer. For women often have these symptoms:
example, use a rubber bathmat in the > Pain or discomfort in the center
shower or tub. Keep your f loors free of the chest.
from clutter. Lastly, talk to your

Signs of a Heart Attack

Dash line indicates


that organ is behind
other main organs. Brain
anxiety, dizziness, trouble sleeping

Chest
Arms, Back, Jaw, chest pain, chest pressure, fullness
Shoulders, Neck or squeezing (lasts more than a few
pain minutes or comes and goes)

Skin
cold sweat

Lungs
trouble breathing

Stomach
upset stomach, urge to throw up

Body
feel tired and weak

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U.S. Department of Health and Human Services, Office on Women’s Health
F R E Q U E N T LY A S K E D Q U E S T I O N S

> Pain or discomfort in other areas


and are different from the signs of a
of the upper body, including the
heart attack. Signs you should look
arms, back, neck, jaw, or
for are weakness or numbness on
stomach.
one side of your body, dizziness, loss
of balance, confusion, trouble
WomensHealth.gov > Other symptoms, such as
talking or understanding speech,
1-800-994-9662
shortness of breath, breaking out
headache, nausea, or trouble walking
in a cold sweat, nausea, or light-
TDD: 1-888-220-5446 or seeing. Remember: Even if you
headedness.
have a “mini-stroke,” you may have
● Know the Signs of a Stroke. The some of these signs. ■
signs of a stroke happen suddenly

Signs of a Stroke

Dash line indicates


that organ is behind
other main organs. Brain
confusion, trouble talking or
understanding speech, dizziness,
loss of balance, bad headache

Face, Arm, or Leg Eyes


numbness or trouble seeing in one or both eyes
weakness (mainly on
one side of the body)
Stomach
throwing up (or urge to)

Body
feel tired

Legs
trouble walking

page 9

N AT I O N A L W O M E N ’ S H E A LT H I N F O R M AT I O N C E N T E R
U.S. Department of Health and Human Services, Office on Women’s Health
F R E Q U E N T LY A S K E D Q U E S T I O N S

For more information


For more information on lesbian health issues, contact the National Women’s Health
WomensHealth.gov
Information Center at 1-800-994-9662 or the following organizations:

1-800-994-9662
Centers for Disease Control and Lesbian STD Web Site, University of
TDD: 1-888-220-5446 Prevention (CDC) Washington
Internet Address: www.cdc.gov Internet Address:
http://depts.washington.edu/wswstd/
Off ice on Violence Against Women,
OJP, DOJ National Center for Lesbian Rights
Phone: (800) 799-7233 Phone: (415) 392-6257
Internet Address: Internet Address: http://www.nclrights.org
http://www.ojp.usdoj.gov/vawo
The Mautner Project
Gay and Lesbian Medical Association Phone: (202) 332-5536
(GLMA) Internet Address:
Phone: (415) 255-4547 http://www.mautnerproject.org
Internet Address: http://www.glma.org

Lesbian Health Research Center,


Institute for Health and Aging, UCSF
Phone: (415) 502-5209
Internet Address:
http://www.lesbianhealthinfo.org

The lesbian health FAQ has been reviewed by the University of Washington, University of
California, Los Angeles, and Gynecological Health Associates.

January 2005

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U.S. Department of Health and Human Services, Office on Women’s Health