Getting the Best Out of Healthcare: Information for Lesbian Teens and Women

Patient Information |
August 24, 2017

Getting the Best Out of Healthcare: Information for Lesbian Teens and Women

  1. Diane E. Judge, APN/CNP

Take charge of your health by getting the information you need and finding a clinician who will help.

  1. Diane E. Judge, APN/CNP

If you are a teen or woman who identifies as lesbian (physically, sexually, or emotionally attracted to women), you have the same healthcare needs as any other woman — with a few added challenges. One can be finding a clinician (physician, nurse practitioner, nurse midwife, physician assistant) with whom you feel comfortable. Lesbians have often felt unwelcome in healthcare settings. That is changing as clinicians learn more about helping you feel at ease.

The Issues in General

Compared with heterosexual women, lesbians have greater likelihood of some health conditions. They are more likely to live in poverty, delay seeking healthcare, be obese, and use tobacco and excessive amounts of alcohol. Some of these factors (plus the fact that lesbians may be less likely to bear children, which protects against breast cancer) mean breast cancer is more common. Delaying or avoiding healthcare increases the likelihood of cervical cancer, which is mostly preventable with regular Pap smears and the human papillomavirus (HPV) vaccine. Lesbian women are also more likely to report depression, in part because of the stigma and discrimination they face.

Maintaining a healthful diet, exercising regularly, quitting smoking (or not starting), seeking help if you experience symptoms of depression (problems sleeping, losing interest in pleasurable activities, feeling “down” most of or all the time), and avoiding drugs and excessive alcohol are good health practices. For some helpful strategies, see the Resources below. You should also get regular Pap tests — every 3 years from ages 21 to 30 and either a Pap test every 3 years or Pap plus HPV test every 5 years from ages 30 to 65. Screening for breast cancer should be based on your personal risk factors. For women at “average risk,” one recommendation is a mammogram every 2 years starting at age 50, but starting earlier and screening more often are open to discussion with your clinician.

If You're an Older Woman

Older lesbian women are especially likely to struggle with obesity and more likely than heterosexual women to have heart disease and physical disabilities. Concern about discrimination may delay seeking the housing help they need, such as assisted living or nursing homes. Because women's pay is historically lower than men's, older lesbian couples may be less financially prepared for retirement and healthcare costs than heterosexual couples. Advocacy & Services for LGBT Elders (SAGE) offers assistance in obtaining lesbian, gay, bisexual, and transgender (LGBT)–friendly housing and residential care through the National LGBT Housing Initiative (see Resources below).

If You're a Teen or a Friend or Relative of a Teen

If you identify as queer, no identity, sexually fluid, or lesbian, you face the discrimination that comes with being “different,” particularly at this time of life. Bullying and victimization by peers — and even family members — during the coming-out process is difficult and can lead to substance abuse, depression, and thoughts of suicide. The Trevor Project and the Trevor Lifeline (see Resources below) are dedicated to assisting young women in coping with these problems.

Preventing Sexually Transmitted Infections (STIs)

STIs don't discriminate. They can and do affect women who have sex with women. Many women and their partners who identify as lesbian have had sex with men and may continue doing so. STIs can spread from man to woman, then from woman to woman. Herpes can be spread between women, including by oral sex if one partner has cold sores (caused by herpes).

Sharing sex toys can spread HPV (the main cause of cervical cancer) between women. This can also transmit bacterial vaginosis — not an STI, but a common vaginal infection causing a fishy-smelling irritating discharge. You can decrease the likelihood of infections, including STIs, with the following measures:

  • Use a dental dam or a condom cut halfway through and unrolled to form a barrier between your vulva (the vaginal lips and area outside the vagina) and your partner's during oral sex.

  • Wash sex toys with soap and water after every use, and always before sharing them. You can also use latex condoms on sex toys. If a toy has touched your or your partner's anal area, wash it with soap and water before using it on your or her vulva or vagina.

  • Use condoms if you have sex with a male partner.

  • If you can, get the HPV vaccine to lower the likelihood of getting this infection. The series of 2 or 3 shots is recommended for females between the ages of 9 and 26, ideally starting at age 11 to 12. If you're older than 26, the vaccine may still help protect you; ask your clinician.

  • Get tested for chlamydia and gonorrhea every year before age 25, with additional testing at other times depending on your individual situation.

Finding a Clinician

One way to find a clinician is to ask your friends or local lesbian and LGBT social and support groups. You can also check the GLMA: Health Professionals Advancing LGBT Equality directory (see Resources below) for clinicians who welcome lesbian women. If your health insurance or lack of insurance restricts your choice of clinicians, you might want to take someone with you as an “advocate” on your first visit. At some point in your visit your clinician may ask your advocate to step out, for a good reason: partners of abused women often insist on staying in the room to be sure the abuse is not revealed. Your clinician needs a private conversation with you to make sure you are safe.

To assess your health risks, including STIs, your clinician may ask very specific, personal questions about what you do during sex. This is good medical practice for every person who has sexual contact, no matter what their gender identity or sexual preference. If you feel uncomfortable with these questions, it's okay to ask why the information is necessary; your clinician should explain.

In Summary

No matter who you are, your health is important. Take charge of it by getting the information you need and finding a clinician who will help.

Resources

General Information

https://www.womenshealth.gov/a-z-topics/lesbian-and-bisexual-health

Depression

https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml

Smoking Cessation

https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/help-quitting-fact-sheet

Obesity

https://medlineplus.gov/obesity.html

Drug and Alcohol Abuse

https://medlineplus.gov/drugabuse.html

Advocacy & Services for LGBT Elders

National LGBT Housing Initiative

http://www.sageusa.org

1-888-234-SAGE

The Trevor Project

http://www.thetrevorproject.org

The Trevor Lifeline 24/7 Suicide Prevention Hotline

866-488-7386

GLMA: Health Professionals Advancing LGBT Equality

http://www.glma.org

Editor Disclosures at Time of Publication

  • Disclosures for Diane E. Judge, APN/CNP at time of publication Equity Stryker Corporation

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