Lesbian and Bisexual Health Fact Sheet

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What does it mean to be a lesbian?

A  lesbian is a woman who is  sexually attracted to another woman or who has sex with another woman,  even if it is only sometimes. A lesbian is  currently only having sex with a woman, even if she has had sex with men in the  past.

What does it mean to be bisexual?

A bisexual person is sexually attracted to, or sexually active with, both men and women.

What are important health issues that lesbians and bisexual women should discuss with their health care professionals?

All women have  specific health risks, and can take steps to improve their health through  regular medical care and healthy living. Research tells us that lesbian and  bisexual women are at a higher risk for certain problems than other women are,  though. It is important for lesbian and bisexual women to talk to their doctors  about their health concerns, which include:

Heart  disease. Heart  disease is the No. 1 killer of all women. The more risk factors you have, the greater  the chance that you will develop heart disease. There are some risk factors  that you cannot control, such as age, family health history, and race. But you  can protect yourself from heart disease by not smoking, controlling your blood  pressure and cholesterol, exercising, and eating well. These things also help  prevent type 2 diabetes, a leading cause of heart disease.

Lesbians and bisexual women have a higher rate of obesity, smoking, and stress. All of these are risk factors for heart disease. As such, lesbians and bisexual women should talk with their doctors about how to prevent heart disease.

Cancer. The most common cancers for all women  are breast, lung, colon, uterine, and ovarian. Several factors put lesbian and  bisexual women at higher risk for developing some cancers. Remember:

  • Lesbians are less likely than heterosexual women to have had a full-term pregnancy.        Hormones released during pregnancy and breastfeeding are thought to protect women against breast, endometrial, and ovarian cancers.
  • Lesbians and bisexual women are less likely to get routine screenings, such as a Pap test, which can prevent or detect cervical cancer. The viruses that cause most cervical cancer can be sexually transmitted between women. Bisexual women, who may be less likely than lesbians to have health insurance, are even more likely to skip these tests.
  • Lesbians and bisexual women are less likely than other women to get routine mammograms and clinical breast exams. This may be due to lesbians' and bisexuals' lack of health insurance, fear of discrimination, or bad experiences with health care professionals. Failure to get these tests lowers women's chances of catching cancer early enough for treatments to work.
  • Lesbians are more likely to smoke than heterosexual women are, and bisexual women are the most likely to smoke. This increases the risk for lung cancer in all women who have sex with women.

Depression and anxiety. Many factors cause depression and anxiety among all women. However, lesbian and bisexual women report higher rates of depression and anxiety than other women do. Bisexual women are even more likely than lesbians to have had a mood or anxiety disorder. Depression and anxiety in lesbian and bisexual women may be due to:

  • Social  stigma
  • Rejection  by family members
  • Abuse  and violence
  • Unfair  treatment in the legal system
  • Stress  from hiding some or all parts of one's life
  • Lack of health insurance

Lesbians and  bisexuals often feel they have to hide their sexual orientation from family,  friends, and employers. Bisexual women may feel even more alone because they don't  feel included in either the heterosexual community or the gay and lesbian  community. Lesbians and bisexuals can also be victims of hate crimes and  violence. Discrimination against these groups does exist, and can lead to depression and anxiety. Women can reach out to their doctors, mental health professionals, and area  support groups for help dealing with depression or anxiety. These conditions  are treatable, and with help, women can overcome them.

Polycystic Ovary Syndrome (PCOS). PCOS is the most common hormonal problem of the reproductive system in women of childbearing age. PCOS is a health problem that can affect a woman's:

  • Menstrual cycle (monthly bleeding)
  • Fertility (ability to get pregnant)
  • Hormones
  • Insulin production
  • Heart
  • Blood vessels
  • Appearance

Five  to 10 percent of women of childbearing age have PCOS. Lesbians may have a  higher rate of PCOS than heterosexual women.

What factors put lesbians' and bisexual women's health at risk?

There are a lot of things that  can cause health problems for lesbians and bisexual women. Some of these may be  outside of your control. Other things you can work to improve upon. These  include:

Lack  of fitness. Being obese and not exercising can raise your risk of heart disease, some  cancers, and early death. Many studies show that lesbians and bisexual women  have a higher body mass index (BMI)  than other women. Studies suggest that lesbians may store more of their fat in  the abdomen (stomach area). Belly fat increases the risk for heart disease and  type 2 diabetes. Some studies also suggest that lesbians think less about  weight issues than heterosexual women do. Research shows that lesbian and bisexual women are more likely to have a higher  BMI if they:

  • Are African American or Latina
  • Are older
  • Have poor health
  • Have a lower level of education
  • Don't exercise often
  • Live with a female partner

Smoking. Smoking can lead to heart disease and  cancers of the lung, throat, stomach, colon, and cervix. The group of women  most likely to smoke is bisexual women. Lesbians are also more likely to smoke  than heterosexual women are. Researchers think that higher rates of smoking among  lesbians and bisexual women are due to:

  • Tobacco ads aimed at gays and lesbians
  • Differences in community norms
  • Low self-esteem
  • Stress from bias
  • Anxiety from hiding one's sexual orientation

Alcohol  and drug abuse. Substance abuse is a serious health problem for all people in the U.S. Recent data  suggests that substance use among lesbians — mostly alcohol use — has gone down  over the past two decades. Reasons for this may include:

  • More general knowledge and concern about health
  • More moderate drinking among women in general
  • Some decrease in the social stigma and oppression of lesbians
  • Changing norms around drinking in some lesbian groups

But, heavy  drinking and drug abuse appear to be more common among lesbians (especially  young women) than heterosexual women. Lesbian and bisexual women are also more  likely to drink alcohol and smoke marijuana in moderation than other women are.  Bisexual women are the most likely to have injected drugs, putting them at a  higher risk for sexually transmitted infections (STIs).

Domestic  violence. Also  called intimate partner violence, this is when someone purposely causes either  physical or mental harm to someone else. Domestic violence can occur in lesbian  relationships (as it does in heterosexual ones). But, lesbian victims are more  likely to stay silent about the violence. Some reasons include:

  • Fewer services available to help lesbians and bisexual women
  • Fear of discrimination
  • Threats from the batterer to "out" the victim
  • Fear of losing custody of children

There are many resources available to women who are  victims of domestic violence. All women should  seek help and safety from domestic violence.

Are lesbian and bisexual women at risk of getting sexually transmitted infections (STIs)?

Women who  have sex with women are at risk for STIs. Lesbian and bisexual women can  transmit STIs to each other through:

  • Skin-to-skin contact
  • Mucosa contact (e.g., mouth to vagina)
  • Vaginal fluids
  • Menstrual blood
  • Sharing sex toys

Some STIs are  more common among lesbians and bisexual women and may be passed easily from  woman to woman (such as bacterial vaginosis). Other STIs are much less likely  to be passed from woman to woman through sex (such as HIV). When lesbians get  these less common STIs, it may be because they also have had sex with men,  especially when they were younger. It is also important to remember that some  of the less common STIs may not be passed between women during sex, but through  sharing needles used to inject drugs.Bisexual women may be more  likely to get infected with STIs that are less common for lesbians, since  bisexuals have typically had  sex with men in the past or are presently having sex with a man.

Common STIs that can be passed between  women include:

Bacterial vaginosis (vaj-uh-NOH-suhs)  (BV). BV is more  common in lesbian and bisexual women than in other women. The reason for this  is unknown. BV often occurs in both members of lesbian couples.

The vagina normally has a balance of  mostly "good" bacteria and fewer "harmful" bacteria. BV develops when the  balance changes. With BV, there is an increase in harmful bacteria and a  decrease in good bacteria.

Sometimes BV causes no symptoms. But  over one-half of women with BV have vaginal itching or discharge with a fishy  odor. BV can be treated with antibiotics.

Chlamydia (kluh-MI-dee-uh). Chlamydia is caused by bacteria. It's  spread through vaginal, oral, or anal sex. It can damage the reproductive  organs, such as the uterus, ovaries, and fallopian (fuh-LOH-pee-uhn) tubes. The  symptoms of chlamydia are often mild — in fact, it's known as a "silent  infection." Because the symptoms are mild, you can pass it to someone else  without even knowing you have it.

Chlamydia  can be treated with antibiotics. Infections that are not treated, even if there  are no symptoms, can lead to:

  • Lower abdominal pain
  • Lower back pain
  • Nausea
  • Fever
  • Pain during sex
  • Bleeding between periods

Genital  herpes. Genital herpes is an STI  caused by the herpes simplex  viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is  caused by HSV-2. HSV-1 can cause genital herpes. But it more commonly causes  infections of the mouth and lips, called "fever blisters or "cold sores." You  can spread oral herpes to the genitals through oral sex.

Most people have few or no symptoms from a genital  herpes infection. When symptoms do occur, they usually appear as one or more  blisters on or around the genitals or rectum. The blisters break, leaving  tender sores that may take up to four weeks to heal. Another outbreak can  appear weeks or months later. But it almost always is less severe and shorter  than the first outbreak.

Although the infection can stay in the body  forever, the outbreaks tend to become less severe and occur less often over  time. You can pass genital herpes to someone else even when you have no  symptoms.

There is no cure for herpes. Drugs can  be used to shorten and prevent outbreaks or reduce the spread of the virus to  others.

Human papillomavirus (pap-uh-LOH-muh-vahy-ruhs) (HPV). HPV  can cause genital warts. If left untreated, HPV can cause abnormal changes on  the cervix that can lead to cancer. Most people don't know they're infected  with HPV because they don't have symptoms. Usually the virus goes away on its  own without causing harm. But not always. The Pap test checks for abnormal cell  growths caused by HPV that can lead to cancer in women. If you are age 30 or  older, your doctor may also do an HPV test with your Pap test. This is a DNA  test that detects most of the high-risk types of HPV. It helps with cervical  cancer screening. If you’re younger than 30 years old and have had an abnormal  Pap test result, your doctor may give you an HPV test. This test will show if  HPV caused the abnormal cells on your cervix.

Both men and women can spread the virus to others whether or not they have  any symptoms. Lesbians and bisexual women can transmit HPV through direct  genital skin-to-skin contact, touching, or sex toys used with other women.  Lesbians who have had sex with men are also at risk of HPV infection. This is  why regular Pap tests are just as important for lesbian and bisexual women as  they are for heterosexual women.

There is no treatment for HPV, but a healthy immune (body defense) system  can usually fight off HPV infection. Two vaccines (Cervarix and Gardasil) can  protect girls and young women against the types of HPV that cause most cervical  cancers. The vaccines work best when given before a person's first sexual  contact, when she could be exposed to HPV. Both vaccines are recommended for 11  and 12-year-old-girls. But the vaccines also can be used in girls as young as 9  and in women through age 26 who did not get any or all of the shots when they  were younger. These vaccines are given in a series of 3 shots. It is best  to use the same vaccine brand for all 3 doses. Ask your doctor which brand  vaccine is best for you. Gardasil also has benefits for men in preventing  genital warts and anal cancer caused by HPV. It is approved for use in boys as  young as 9 and for young men through age 26. The vaccine does not replace the  need to wear condoms to lower your risk of getting other types of HPV and other sexually transmitted infections. If you do  get HPV, there are treatments for diseases caused by it. Genital warts can be  removed with medicine you apply yourself or treatments performed by your  doctor. Cervical and other cancers caused by HPV are most treatable when found  early. There are many options for cancer treatment.

Pubic lice. Also known as crabs, pubic lice are  small parasites that live in the genital areas and other areas with coarse  hair. Pubic lice are spread through direct contact with the genital area. They  can also be spread through sheets, towels, or clothes. Pubic lice can be treated  with creams or shampoos you can buy at the drug store.

Trichomoniasis  (TRIK-uh-muh-NEYE-uh-suhss) or "Trich." Trichomoniasis is caused by a parasite  that can be spread during sex. You can also get trichomoniasis from contact  with damp, moist objects, such as towels or wet clothes. Symptoms include:

  • Yellow, green, or gray vaginal discharge (often foamy) with a strong odor
  • Discomfort during sex and when urinating
  • Irritation and itching of the genital area
  • Lower abdominal pain (in rare cases)

Trichomoniasis  can be treated with antibiotics.

Less  common STIs that may affect lesbians and bisexual women include:

Gonorrhea (gon-uh-REE-uh). Gonorrhea is a common STI but is not commonly passed during woman to  woman sex. However, it could be since  it does live in vaginal fluid. It is caused by a type of bacteria that can grow  in warm, moist areas of the reproductive tract, like the cervix, uterus,  and fallopian  tubes in women. It can grow in the urethra in men and women. It can also grow in the mouth, throat, eyes, and anus. Even  when women have symptoms, they are often mild and are sometimes thought to be  from a bladder or other vaginal infection.

Symptoms  include:

  • Pain or burning when urinating
  • Yellowish and sometimes bloody vaginal discharge
  • Bleeding between menstrual periods

Gonorrhea can  be treated with antibiotics.

Hepatitis (hep-uh-TYT-uhs) B.Hepatitis B is a liver disease caused by a virus. It is spread through bodily  fluids, including blood, semen, and vaginal fluid. People can get hepatitis B through  sexual contact, by sharing needles with an infected person, or through  mother-to-child transmission at birth. Some women have no symptoms if they get  infected with the virus.

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
  • Yellow skin and whites of eyes

There is a  vaccine that can protect you from hepatitis B.

HIV/AIDS. The human immunodeficiency virus (HIV) is spread through body  fluids, such as blood, vaginal fluid, semen, and breast milk. It is primarily  spread through sex with men or by sharing needles. Women who have sex with  women can spread HIV, but this is rare. Some women with HIV may have no  symptoms for 10 years or more.

Women  with HIV symptoms may have:

  • Extreme fatigue (tiredness)
  • Rapid weight loss
  • Frequent low-grade fevers and night sweats
  • Frequent yeast infections (in the mouth)
  • Vaginal yeast infections
  • Other STIs
  • Pelvic inflammatory disease (an infection of the uterus, ovaries, or fallopian tubes)
  • Menstrual cycle changes
  • Red, brown, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids

AIDS, or acquired immunodeficiency syndrome, is the final  stage of HIV infection. HIV infection turns to AIDS when you have one or more  opportunistic infections, certain cancers, or a very low CD4 cell count.

Syphilis. Syphilis is an STI caused by bacteria. It's passed through direct  contact with a syphilis sore during vaginal, anal, or oral sex. Untreated  syphilis can infect other parts of the body. It is easily treated with  antibiotics. Syphilis is very rare among lesbians. But, you should talk to your  doctor if you have any sores that don't heal.

What challenges do lesbian and bisexual women face in the health care system?

Lesbians and bisexual women face unique problems  within the health care system that can hurt their health. Many health care  professionals have not had enough training to know the specific health issues that  lesbians and bisexuals face. They may not ask about sexual orientation when  taking personal health histories. Health care professionals may not think that a  lesbian or bisexual woman, like any woman, can be a healthy, normal female.

  Things that can stop lesbians and bisexual  women from getting good health care include:

  • Being scared to tell your doctor about your sexuality or your sexual history
  • Having a doctor who does not know your disease risks or the issues that affect lesbians and bisexual women
  • Not having health insurance. Many lesbians and bisexuals don't have domestic partner benefits. This means that one person does not qualify to get health insurance through the plan that the partner       has (a benefit usually available to married couples).
  • Not knowing that lesbians are at risk for STIs and       cancer

For these  reasons, lesbian and bisexual women often avoid routine health exams. They sometimes  even delay seeking health care when feeling sick. It is important to be proactive about your health, even  if you have to try different doctors before you find the right one.  Early detection — such as finding cancer early before it spreads — gives you the best  chance to do something about it. That’s one example of why it’s important to find a doctor who will work  with you to identify your health concerns and make a plan to address them.

What can lesbian and bisexual women do to protect their health?

Find a doctor who is sensitive to your  needs and will help you get regular check-ups. The Gay and Lesbian Medical  Association provides online health care referrals.

Get a Pap test. The Pap test finds changes in your  cervix early, so you can be treated before a problem becomes serious. Begin  getting Pap tests at age 21. In your 20s, get a Pap test every two years. Women  30 and older should get a Pap test every three years. If you are HIV-positive,  your doctor may recommend more frequent testing.

Get an HPV test. Combined with a Pap test, an HPV test  helps prevent cervical cancer. It can detect the types of HPV that cause  cervical cancer. Talk to your doctor about an HPV test if you've had an  abnormal Pap or if you're 30 or older.

Talk to your doctor or nurse about  other screening tests you may need. You need regular preventive screenings to stay healthy.  Lesbian and bisexual women need all the same tests that heterosexual women do. 

Practice safer sex. Get tested for STIs before starting a sexual  relationship. If you are unsure about a partner's status, practice methods to  reduce the chances of sharing vaginal fluid, semen, or blood. If you have sex  with men, use a condom every time. You should also use condoms on sex toys. Oral  sex with men or with women can also spread STIs, including, rarely, HIV. HIV  can potentially be passed through a mucous membrane (such as the mouth) by  vaginal fluids or blood, especially if the membrane is torn or cut.

Eat a balanced, healthy diet. Your diet should include a  variety of whole grains, fruits, and vegetables. These foods give you energy,  plus vitamins, minerals, and fiber. Reduce the amount of sodium you eat to  less than 2,300 mg per day.

Drink moderately. If you drink alcohol, don't have more  than one drink per day. Too much alcohol raises blood pressure and can increase  your risk for stroke, heart disease, osteoporosis, many cancers, and other  problems.

Get  moving. An active lifestyle can help any woman. You will benefit most from about 2 hours and 30 minutes of moderate-intensity aerobic physical activity each week. More physical activity means additional health and fitness benefits. On two or more days every week, adults should engage in muscle-strengthening activities, such as lifting weights or doing squats or push-ups.

Don't smoke. If you do smoke, try to quit. Avoid secondhand smoke as much as you can.

Try different things to deal with your  stress. Stress  from discrimination and from loneliness is hard for every lesbian and bisexual  woman. Relax using deep breathing, yoga, meditation, and massage therapy. You  can also take a few minutes to sit and listen to soft music or read a book.  Talk to your friends or get help from a mental health professional if you need  it.

Get help for domestic violence. Call the police or leave if you or  your children are in danger.

Build strong bones. Take the following steps to help  build strong bones and prevent osteoporosis:

  • Exercise
  • Get  a bone density test
  • Get  enough calcium and vitamin D each day
  • Reduce  your chances of falling by making your home safer. For example, use a rubber  bathmat in the shower or tub and keep your floors free from clutter.
  • Talk  to your doctor about medicines to prevent or treat bone loss

Know the signs of a heart attack. Women are less likely than men to know  when they are having a heart attack. So, they are more likely to delay in  seeking treatment. For women, chest pain may not be the first sign your heart  is in trouble. Before a heart attack, women have said that they have unusual tiredness, trouble sleeping, problems breathing,  indigestion, and anxiety. These symptoms can happen a month or  so before the heart attack. During a heart attack, women often have:

  • Pain or discomfort in the center of the chest
  • Pain or discomfort in the arms, back, neck, jaw, or stomach
  • Shortness of breath
  • A cold sweat
  • Nausea
  • Light-headedness

Know  the signs of a stroke.  The signs of a stroke appear suddenly and are different from those of a heart  attack. Signs you should look for include:

  • Weakness or numbness on one side of your body
  • Dizziness
  • Loss of balance
  • Confusion
  • Trouble talking or understanding speech
  • Headache
  • Nausea
  • Trouble walking or seeing

Remember: Even if you have a "mini-stroke," you  may have some of these signs.

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