II. Epidemiology

  1. Incidence: 1.3 to 1.9% in U.S. self-identified as lesbian (3.1 to 4.8% self-identified as bisexual)

III. Precautions

  1. Lesbian Women are more likely to avoid healthcare (and may have associated worse outcomes)
    1. Negative prior interactions related to discrimination
    2. Misconception that they cannot acquire Sexually Transmitted Infections
    3. Not tied to Contraception refills
  2. Women Who Have Sex With Women also commonly have or have had male partners (more than half)
    1. More than half of the women reporting a same-sex relationship, identify themselves as heterosexual
    2. May have delayed diagnosis of pregnancy or Sexually Transmitted Infection
  3. Lesbian Women may have less social support
    1. May have less close family and friends (may have been isolated, estranged from family)
    2. May have no grown children
      1. However women in same sex relationships have often had children from prior heterosexual relationships
      2. In 2014, lesbian couples reported children in their household >20% of the time

IV. History: Sexual

  1. How many sexual partners have you had in the last year?
  2. Have you had sex with women, men or both?
  3. Does your current partner(s) have sex with someone other than you?
  4. Do you have sex with strangers or acquaintances?
  5. Do you have sex after Alcohol or drugs?
  6. Do you have oral sex, vaginal sex, anal sex?
  7. Do you use protection with Condoms, gloves, dental dams?
  8. Are there times you do not use protection?
  9. Have you ever been pregnant? (if so, ask about G- P---- status)
  10. If you have sex with men, do you use another form of Contraception?
  11. Have you ever had a Sexually Transmitted Infection?

V. History: Social

  1. Intimate Partner Violence
    1. Does your partner insult or demean you, threaten to or physically harm you?
  2. Support systems
    1. Do you have close family or friends?

VI. Complications: Conditions with increased risk among Women Who Have Sex With Women

  1. Obesity
    1. Higher BMI than heterosexual women
    2. Increased Type II Diabetes Mellitus risk
  2. Cardiovascular risk
    1. Higher Tobacco use rates
  3. Cancer Risk (Cervical Cancer, Breast Cancer, Ovarian Cancer, Lung Cancer)
    1. Lower rates of Pap Smear, Mammogram
    2. Less routine preventive health
    3. Tobacco Abuse
  4. Mental Health Conditions
    1. Higher risk of Major Depression, Suicidality, Anxiety Disorders
    2. Higher risk of Eating Disorders (esp. adolescents)
    3. Alcohol Abuse
    4. Substance Abuse (esp. adolescents who may abuse Alcohol, Marijuana, Cocaine, MDMA)
    5. Tobacco Abuse (bisexual women 36% rate, lesbian 22% rate compared with heterosexual 14% rate)
  5. Sexually Transmitted Infections (STI)
    1. Higher risk sexual behavior, typically with men and women
      1. No protection
      2. Sex while intoxicated
      3. Sex with high risk partners
    2. Common STIs
      1. HPV or Genital Warts (esp. bisexual women)
      2. Chlamydia (at least as common, and may be more common in Women Who Have Sex With Women)
      3. Herpes Simplex Virus 2 (Genital Herpes or HSV2)
    3. Other STI that are less common in Women Who Have Sex With Women (but still occurs, and protection should be used)
      1. Gonorrhea
      2. Hepatitis B
      3. HIV Infection
      4. Syphilis
  6. Other genitourinary infections
    1. Bacterial Vaginosis infection (More common)

VII. Prevention

  1. Maintain cancer screening
    1. Cervical Cancer Screening (many women in same sex relationships have had prior intercourse and HPV is common)
    2. Breast Cancer Screening and Mammograms
    3. Colon Cancer screening
  2. Screen for Intimate Partner Violence
    1. See SAFE Screen for Intimate Partner Violence
    2. See HITS Screen for Intimate Partner Violence
    3. See Women Abuse Screening Tool (WAST)
  3. Screen for mental health disorders
    1. Major Depression and Suicidality
    2. Eating Disorders
    3. Substance Abuse (Tobacco Abuse, Alcohol Abuse, Drug Abuse)
  4. Prevent Sexually Transmitted Infections
    1. Use Condoms, latex sheets, dental dams, gloves
    2. Apply a new Condom before each use of a sex toy
    3. Avoid contact with menstrual blood and genital lesions
    4. Use gloves and lubricants for sex that could result in bleeding

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Related Studies

Ontology: Female Homosexuality (C0242659)

Definition (MSHCZE) Sexuální přitažlivost a vztah mezi ženami.
Definition (MSH) Sexual attraction or relationship between females.
Concepts Individual Behavior (T055)
MSH D018452
SnomedCT 89217008, 154904009, 268761000
English Lesbianism, Homosexuality, Female, Female homosexual state, female homosexuality, female homosexual, lesbianism, lesbians, lesbian, Lesbian, Female homosexual, Female homosexuality, Female homosexual (finding), Female Homosexuality
Dutch lesbisch zijn, Homoseksualiteit, vrouwelijke, Lesbische liefde
Swedish Homosexualitet, kvinnlig
Japanese ジョセイドウセイアイ, 女性同性愛, レスビアニズム, 女性の同性愛, 同性愛-女性
Czech homosexualita ženská, Lesbismus, sapfismus, lesbismus, lesbická láska
Finnish Naisten homoseksuaalisuus
Italian Lesbismo, Omosessualità femminile
Polish Miłość lesbijska, Homoseksualizm żeński
Hungarian Leszbikusság
Norwegian Homoseksualitet, kvinnelig
Spanish homosexualidad femenina (hallazgo), homosexualidad femenina, lesbianismo, Lesbianismo, Homosexualidad Femenina
French Homosexualité féminine, Lesbianisme
German Lesbianismus, Lesbische Liebe, Homosexualität, weibliche
Portuguese Homossexualidade Feminina, Lesbianismo

Ontology: Lesbian Health (C1456540)

Concepts Group Attribute (T102)
English Lesbian Health

Ontology: Lesbians (C1533642)

Concepts Population Group (T098)
MSH D018452
English Lesbian, lesbian, homosexual female, Homosexual female, Lesbians
Dutch homoseksuele vrouw
French Homosexuelle femelle, Lesbiennes
German homosexuelle Frau
Italian Omosessuale femmina, Lesbiche
Portuguese Mulher homossexual
Spanish Homosexual femenino
Japanese 女性同性愛者, ジョセイドウセイアイシャ
Czech Homosexualita u ženy, lesbičky, lesby
Hungarian Homoszexuális nő
Norwegian Lesbiske