Initial considerations

The number of lesbians in a population is difficult to determine with precision due to the fact that many women prefer not to disclose this information.  Approximately has identified about 1-4% of women as gay, lesbian or bisexual.

Lesbians, like other marginalized groups of women, often underutilized health care services and delay significantly its health care compared with heterosexual women. One of the reasons that explains this difference lies in that female health providers lack an adequate knowledge about lesbian women's health problems, and may even express rejection or discrimination by creating experiences negative in the patient, of course, hardly will return. This is valid both for medical man or women.

Lesbians do not use health services that focus on contraception and reproduction, so that these points of entry into the health care system are lost to many of these women.

Identification and adequate medical behavior

Lesbian is a term that refers to sexual behavior as a form of identity. There is a stereotypical profile to easily identify the lesbian patients: found in all ethnic groups and class socioeconomic, single, married or divorced, housewives or practitioners, youth or seniors.  Many women decide to not identify as lesbians to avoid tensions and cultural, social or family rejection and are unwilling to reveal their identity to avoid negative encounters with physicians who potentially could discriminate against them and offer them a suboptimal care by ignorance or personal prejudices

Professionalism and confidentiality are key elements to allow lesbians to be identified, as well as to generate a proper interaction between the doctors and their lesbian patients. Sexual identification can be done directly and without prejudice, honesty never is overrated and the patient will thank you. There are many indirect questions to get to the sexual nature of the patient but I particularly prefer to be transparent and ask directly and openly. This approach is very similar to that you use with sex workers: honesty, transparency, and lack of prejudices!

Preventive health considerations

Contraception

Approximately 75 to 80 percent of lesbians report history of heterosexual activity (past, present or potential), often without using contraception or prevention methods against sexually transmitted diseases. Lesbians who may be thinking of engaging in heterosexual relations would benefit from a discussion about contraceptive options.

Cancers

According to surveys, lesbians are more prone to smoking and drinking alcohol, having a high body mass index (overweight & obesity), be nulliparous or low parity, and have fewer preventive health screenings than heterosexual women; also, lesbian women are less likely to have used oral contraceptives or have breastfed.

These characteristics are high risk factors that predispose to various types of cancer: colon, lung, endometrium, ovary and breast.

Cervical cancer – like all women, lesbians should undergo routine screening for early detection of cancer of the cervix, its precursor lesions (dysplasia) and HPV infection.

The risk of cervical neoplasia is higher in lesbian women than:

• Have history of onset of sexual intercourse at an early age with men and that in the future have had poor gynaecological control

• Have had sexual intercourse with more than one male sexual partner

• Have been infected with HPV, especially if they are smokers

Breast cancer – the theoretical risk of breast cancer in lesbians has been estimated at 1 in 3 lesbian women compared to 1 in 8 women in general. This alarming figure was determined by the analysis of demographic profiles and stories of health of lesbians in several polls. Contributing factors are: absence of pregnancy and lactation, pregnancy after age 30, lower frequency of breast clinical and radiological assessments. These factors reduce the likelihood of early detection of the disease.

Ovarian cancer – lesbians have increased theoretical risk of developing ovarian cancer due to risk factors such as a lower probability of being pregnant or have not used oral contraceptives for at least two years (the use of) oral contraceptives reduces the risk of ovarian cancer even in 70%).

Recommendations for the detection of cancers in lesbian women are controversial and are based on risk factors, not sexual orientation.

Sexually transmitted diseases

Sexually transmitted diseases can be infected to sexual partners, even with a missing of male sexual partners or remote history. The risk of infection by sexually transmitted diseases (gonorrhea, chlamydia, hepatitis B, HIV, syphilis, HPV, genital herpes, trichomoniasis) varies widely, depending on sexual orientation, the number of partners and sexual practices.

Bacterial vaginosis (BV) – not considered to be transmissible in heterosexual women, appears to occur more frequently among lesbians (up to twice as often) by which some researchers consider it as a form of sexually transmitted disease. It is possible that the sexual Dynamics has connection with the frequency of Vaginosis: vagino-vaginal, oral, oral-genital sex and sex toys, and his explanation is in the exchange of year-vaginal secretions, directly or indirectly, through fingers and sex toys contaminated.

Lesbians with gynecological infections must be encouraged to inform their partners about the need for detection, diagnosis and treatment.

HIV – The increasingly higher rate of HIV acquisition in heterosexual women challenged the original groups of risk concepts. Lesbian women who are or have been prostitutes or intravenous drug users may be at greater risk of HIV infection. The transmission of the HIV female­female has been documented, even though we know little about the incidence of transmission. It is clear that a greater number of sexual partners the greater the risk of acquiring this or other infectious diseases.