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6 Things Every Lesbian Should Know About Her Health, From A Gynecologist

Author:

Sheryl Ross, M.D., OB-GYN

August 21, 2020

Obstetrician & Gynecologist

By Sheryl Ross, M.D., OB-GYN

Obstetrician & Gynecologist

Sheryl Ross, M.D., OB-GYN, has been in private practice in Santa Monica, California for the past 20 years. She received her OB-GYN training at the University of Southern California School of Medicine and is the author of she-ology and the follow up she-ology the she-quel.

August 21, 2020

A lesbian patient recently asked if she needed to see me less often than straight women since she was at a lower risk for sexually transmitted infections. She figured she needed fewer Pap smears.

Actually, no.

Lesbians and bisexual women need to see their doctor with the same frequency as heterosexual women. The Pap smear, breast and pelvic exams, and mammogram screenings are done at the same interval regardless of your sexual orientation.

Here are a few things every lesbian should know about their health:

You should have a doctor who makes you feel safe.

In speaking with many lesbian and bisexual women in my 22 years as an ob-gyn, I've learned that some have felt apprehensive about getting health care because of discriminatory attitudes, concerns about confidentiality, and uncertainty about their specific health care needs.

The medical community should take the lead by learning sensitive ways of asking necessary medical questions and building trust with all patients. It's essential for everyone to find a health care provider with whom you feel completely comfortable. Not just the health care provider, but the entire office staff should be welcoming and receptive.

You should tell your doctor about your sexual identity.

Unfortunately, it’s rare for a doctor to ask if someone is straight or gay. While doctors do ask patients if they're sexually active, a lesbian may say yes without disclosing the gender of her partner. Ideally, if a patient discloses that she is sexually active, the doctor's next question is: “Is it with men, women, both, or others?” Hopefully, everyone will feel comfortable disclosing their sexual preferences even if they're not 100% sure of what that is.

From a medical standpoint, if a doctor knows whether a patient is gay, straight, or another sexual orientation, the doctor can be more sensitive and thorough with follow-up questions. For example, if the doctor knows you're a lesbian, she won't ask if your boyfriend wore a condom during sexual intercourse. In that case, the conversation might shift to questions like “Do you share sex toys? Do you use dental dams for protection against STIs?”

If you don't feel comfortable disclosing your sexual identity with your current doctor, it's worth researching a LGBTQ+ friendly and specifically lesbian-friendly gyno or doctor in your area to make sure you're able to get the care you need and deserve.

You may face barriers to health care and fertility treatments.

Same-sex marriage is legal across the U.S., and employment rights and benefits have never been so inclusive of gay couples. That said, there may still be some legal loopholes that allow some employers to refuse extending health care benefits to gay partners or spouses. Also, some health care providers will not offer fertility service to women who identify themselves as lesbian. Sadly, this could reflect personal prejudices that adversely affect their responsibilities as a physician.

The issues of having fertility treatments covered by insurance companies vary between countries, states, and different health plans. Some insurance companies, for example, will only define "infertility" as "unprotected sex for at least a year," which often references penis-in-vagina sex only and excludes lesbians. Others will cover insemination but not the sperm.

Regardless of sexual orientation, the first step in the lengthy, confusing and costly process of fertility treatments is finding the right doctor who will deliver equitable and complete health care.

Lesbians do have some higher risks than heterosexual women.

There are no known physiological differences between lesbian women and straight women, according to the American Congress of Obstetricians and Gynecologists 1. That said, research shows that lesbians are more likely to engage in some behaviors 2 with negative health consequences, including:

Tobacco use
Alcohol and drug use
Less use of oral contraception

Lesbians are also more likely to be at risk for certain diseases, according to ACOG:

Type 2 adult onset diabetes
Lung cancer
Cardiac disease and heart attacks
Obesity

Unfortunately, this means that lesbians have a greater risk of having a heart attack, breast cancer, and ovarian cancer compared to a heterosexual women. Depression, substance abuse, and intimate partner violence are also more common in lesbian and bisexual women 3 and should be screened and treated appropriately.

Given these increased health risks, lesbian patients need to feel comfortable disclosing their sexual orientation.

Lesbians still need to practice safer sex.

Woman-to-woman sexual activity still puts lesbians at risk for sexually transmitted infections (STIs) because you're touching each other's genitalia and exchanging body fluids.

Regardless of your sexual orientation, safer sex practices should always be discussed and encouraged to reduce the risk of getting or receiving STIs and HIV. For lesbian and bisexual women, safer sex includes condoms for sex toys, gloves for fisting, and dental dams for oral sex. It is not recommended to share sex toys and dildos.

Lesbians need Pap smears and gyno checkups just as regularly as straight women.

Since lesbians aren’t having sex with men, they don’t need Pap smears, right? Wrong!

Having sex with other women still puts you at risk for STIs, including bacterial vaginosis, candidiasis, herpes and the human papillomavirus infections (HPV), which increase the risk for abnormal Pap smears.

The Pap smear tests for a variety of sexually transmitted infections, and it's also used to detect cervical pre-cancer or cancer cells. We know cervical cancer is directly related to the number of sexually transmitted diseases you may have, which typically puts lesbians at a lower risk. However, many lesbians have been sexually active with men in their past. One study involving 6,000 lesbians found that 77% have had sex with men in their past and 70% report a lifetime history of vaginal intercourse.

Another thing to consider: Having a history of one normal Pap smear doesn’t mean you'll never have to get a pap again. A case in point is the human papilloma virus (HPV), for which lesbians are at risk. It can show up on future Pap smears as causing pre-cancer cells.

Below are the current guidelines for Pap testing 4.

Current guidelines for pap testing.

Women should begin pap testing at age 21 year of age.
Women 21-28 years should have a Pap test every 3 years.
Women 30-65 years should have a Pap test and HPV test every 5 years. It is also acceptable to have a Pap test alone very 3 years.
65 years and older: No screening recommended if adequate prior screening has been negative and high risk is not present

The bottom line.

Lesbian and bisexual women need to follow the exact same gynecological guidelines as straight women. Plain and simple.

That said, there may be more barriers to receiving comprehensive care, so it's important to do your research and find team of doctors who can help and support you care for your health long-term.