Addressing the Lifetime Healthcare Needs of Lesbian Patients

Lesbian Identity

The term “lesbian” refers to a sexual identity, a label used to recognize that a woman has physical, emotional, or sexual attractions toward other women.

Lesbian women have the same healthcare needs as all women; however, unlike their heterosexual counterparts, they are at higher risk for obesity, certain cancers, substance use or abuse, and depression. Also, issues relevant to all women (e.g., intimate partner violence [IPV], sexually transmitted infections [STIs]) may affect lesbian women differently. These health disparities are perpetuated by social stigma and discrimination, which inhibit access to healthcare.

Behavioral Health Considerations

Compared with heterosexual women, lesbian women are more likely to live in poverty, delay seeking healthcare, and be at higher risk for obesity, alcohol use, and tobacco use. These factors, in conjunction with nulliparity, place lesbian women at higher risk for breast cancer. Given that lesbian women are less likely to undergo cervical cancer screening, they are also at higher risk for this form of cancer. Lesbian women are more likely to report experiencing depression, in part due to stigma and discrimination. 

Healthcare screening recommendations for lesbian women are the same as for all women. Age, lifestyle behaviors, and health-related practices should guide screening rather than sexual identity. However, given the health disparities unique to lesbian women, it is important to pay special attention to weight and use of alcohol and tobacco, and to conduct regular screening for depression and IPV.

Sexual Health Considerations

Lesbian women are at risk for STIs. As many as 70% of women who identify as lesbian have engaged in penile-vaginal penetration in their lifetimes. Additionally, >86% of women who have sex with women use, or have used, a sexual device. Sharing sexual devices can increase risk for bacterial vaginosis and transmission of human papillomavirus (HPV). Like all women, lesbian women should be counseled about using a barrier (condom or dental dam) during sexual activity, not sharing sexual devices between partners or orifices, and washing sexual devices with soap and water after use.

Gay Freedom Parade, San Francisco, California, June 1979.

Providing Inclusive Care

Healthcare providers are in a unique position to reduce the stigma and discrimination experienced by lesbian patients by promoting an inclusive healthcare environment. This includes creating a visually welcoming space, a healthcare environment with nonjudgmental patient–provider interactions and intake questionnaires that do not assume heterosexuality.