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

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.

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.

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?”

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.

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 women3 and should be screened and treated appropriately.

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.

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.

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