TEN THINGS LESBIANS SHOULD DISCUSS WITH THEIR DOCTORS

Most commonly of concern for lesbians. While not all of these items apply to everyone, it’s wise to be aware of these issues.
1. Breast Cancer
Lesbians have the richest concentration of risk factors for breast cancer than any subset of women in the world. Combine this with the fact that many lesbians over 40 do not get routine mammograms, do breast self-exams, or have a clinical breast exam, and this cancer may elude early diagnosis, when it is most curable.

2. Depression/Anxiety
Lesbians have been shown to experience chronic stress from homophobic discrimination. This stress is compounded by the need that some still have to hide their orientation from family and colleagues at work, and by the fact that many lesbians have lost the important emotional support most others get from their families due to alienation stemming from their sexual orientation.

3. Heart Health
Smoking and obesity are the most prevalent risk factors for heart disease among lesbians; but all lesbians need to also get an annual clinical exam because this is when blood pressure is checked, cholesterol is measured, diabetes is diagnosed, and exercise is discussed. Preventing heart disease, which kills 45 percent of women, should be paramount to every clinical visit.

4. Gynecological Cancer
Lesbians have higher risks for many of the gynecologic cancers. What they may not know is that having a yearly exam by a gynecologist can significantly facilitate early diagnosis and a better chance of cure.

5. Fitness
Research confirms that lesbians have higher body mass than heterosexual women. Obesity is associated with higher rates of heart disease, cancers, and premature death. What lesbians need is competent and supportive advice about healthy living and healthy eating, as well as healthy exercise.

6. Tobacco
Research also indicates that lesbians may use tobacco and smoking products more often than heterosexual women use them. Whether smoking is used as a tension reducer or for social interactions, addiction frequently follows and is associated with higher rates of cancers, heart disease, and emphysema — the three major causes of death among all women.

7. Alcohol
Alcohol use and abuse may be higher among lesbians. While one drink daily may be good for the heart, more than that can be a risk factor for cancer or osteoporosis.

8. Substance Use
Research indicates that lesbians may use illicit drugs more often than heterosexual women. This may be due to added stressors in lesbian lives from discrimination. Lesbians need support from each other and from health care providers to find healthy releases, quality recreation, stress reduction, and coping techniques.

9. Domestic Violence
Domestic violence is reported to occur in about 11 percent of lesbian homes, about half the rate of 20 percent reported by heterosexual women. But the question is where do lesbians go when they are battered? Shelters need to welcome and include battered lesbians, and offer counseling to the offending partners.

10. Osteoporosis
The rates and risks of osteoporosis among lesbians have not been well characterized yet. Calcium and weight-bearing exercise as well as the avoidance of tobacco and alcohol are the mainstays of prevention. It is also important to get bone density tests every few years to see if medication is needed to prevent fracture.

HOW TO HAVE SAFER GAY SEX

SAFE SEX & AIDS: AIDS is caused by the HIV virus. HIV can be spread by four body fluids: blood, semen, vaginal fluid and breast milk. You cannot get infected unless the virus in one of these fluids reaches your bloodstream. Saliva alone cannot spread HIV.

Safe sex, as it applies to HIV, is any type of sex which does not let one person's blood, semen, vaginal fluid, or breast milk get inside another person's body. Below is a useful set of guidelines produced by the San Francisco AIDS Foundation. These guidelines are useful in preventing transmission of other STDs as well.

Wet Kissing: is safe unless either of you has a cut or sore in your mouth, or bleeding gums. (After you brush or floss your teeth, wait at least 1/2 hour before kissing.) Blood, not saliva, contains the virus.

Touching your lover's breasts is safe. You can lick, suck, kiss and bite them too-as long as there's no blood or breast milk. Massage, dry kissing, masturbation (touching yourself), and body-to-body rubbing are all safe.

Putting your fingers inside her can be risky. To be safe, wear latex gloves. If you use a lubricant, be sure it is water-based. (Oil-based lubricants like Vaseline and hand lotion will damage the latex.)

Sores or cuts on your fingers, mouth or vagina, or on her's, increase the risk. Sores and cuts can provide a way for the virus to get inside you. If you touch her vagina and then touch your own (or vice-versa), you could spread the virus. Be sure to use gloves in between!

Contact with menstrual blood is very risky. If she is infected, her menstrual blood (like other blood) will have a lot of virus in it.

Oral sex on a woman is risky, especially when she has her period. To make it safe, cover her vulva (genital area) with a piece of plastic wrap. This will keep her fluids out of your mouth. Latex dams-also called "dental dams" - are safe to use for oral sex too.

Sex toys are safe by themselves, but it is risky to share them. If you share dildos or vibrators, cover them with a condom and put on a fresh one every time it is used by a different person.

Getting pregnant can be risky. If you have sex with a man or have a man donate sperm to you, make sure he tests HIV negative at least 6 months after his last possible risk. (All licensed sperm banks test their donors carefully.)

SM activities are safe if there is no blood involved. If you are piercing each other, clean the needle with bleach between users. Use different razors if you shave each other. Don't let urine or feces of another person get inside your body.

HOW TO HAVE SAFER GAY SEX

SAFE SEX & AIDS: AIDS is caused by the HIV virus. HIV can be spread by four body fluids: blood, semen, vaginal fluid and breast milk. You cannot get infected unless the virus in one of these fluids reaches your bloodstream. Saliva alone cannot spread HIV.

Safe sex, as it applies to HIV, is any type of sex which does not let one person's blood, semen, vaginal fluid, or breast milk get inside another person's body. Below is a useful set of guidelines produced by the San Francisco AIDS Foundation. These guidelines are useful in preventing transmission of other STDs as well.

Wet Kissing: is safe unless either of you has a cut or sore in your mouth, or bleeding gums. (After you brush or floss your teeth, wait at least 1/2 hour before kissing.) Blood, not saliva, contains the virus.

Touching your lover's breasts is safe. You can lick, suck, kiss and bite them too-as long as there's no blood or breast milk. Massage, dry kissing, masturbation (touching yourself), and body-to-body rubbing are all safe.

Putting your fingers inside her can be risky. To be safe, wear latex gloves. If you use a lubricant, be sure it is water-based. (Oil-based lubricants like Vaseline and hand lotion will damage the latex.)

Sores or cuts on your fingers, mouth or vagina, or on her's, increase the risk. Sores and cuts can provide a way for the virus to get inside you. If you touch her vagina and then touch your own (or vice-versa), you could spread the virus. Be sure to use gloves in between!

Contact with menstrual blood is very risky. If she is infected, her menstrual blood (like other blood) will have a lot of virus in it.

Oral sex on a woman is risky, especially when she has her period. To make it safe, cover her vulva (genital area) with a piece of plastic wrap. This will keep her fluids out of your mouth. Latex dams-also called "dental dams" - are safe to use for oral sex too.

Sex toys are safe by themselves, but it is risky to share them. If you share dildos or vibrators, cover them with a condom and put on a fresh one every time it is used by a different person.

Getting pregnant can be risky. If you have sex with a man or have a man donate sperm to you, make sure he tests HIV negative at least 6 months after his last possible risk. (All licensed sperm banks test their donors carefully.)

SM activities are safe if there is no blood involved. If you are piercing each other, clean the needle with bleach between users. Use different razors if you shave each other. Don't let urine or feces of another person get inside your body.

I have a recurring tiny white hard itchy pimple on my vulva. What is this?

A:
It's impossible to say without examining you, so I suggest you seek care from a knowledgeable provider with experience in women's health and genital complaints. Many conditions can do this, ranging from bacterial folliculitis to genital herpes to a blockage of a pore or gland.

Can women give other women STDs?

Yes!!

There is a misconception among health care providers and women themselves that lesbian and bisexual women have little or no risk for sexually transmitted diseases (STD). This myth is fueled by the lack of reliable studies of STD transmission in these communities.

In fact, the risk of STD transmission between women varies significantly depending on the STD. Herpes, HPV (genital wart virus), and bacterial vaginosis are transmitted fairly easily between women during sex. HIV, hepatitis B, gonorrhea, and chlamydia are much less likely to be transmitted--the risk is low but it is still possible.

The majority of lesbian and bisexual women have (or have had) sex with men, and all STDs are easily transmitted from men to women during intercourse. Often STD do not have symptoms, so it is possible for a woman to have become infected years ago and to still harbor the infection.

It is important that you share your particular sexual history with a GLBT-friendly health care provider who can advise you of the appropriate STD screening tests for you. All women, including lesbian and bisexual women, need to receive regular Pap tests.

HIV

Often people worry more about HIV (the virus that causes AIDS) than about any other STD. HIV is transmitted when infected sexual fluids or blood enter another person's bloodstream.

There are little research specifically concerning woman-to-woman transmission of HIV. It has been documented in several studies that women who have had sex only with other women, and have not used intravenous drugs, are at low risk for HIV. Although there are case reports of woman-to-woman transmission through oral sex or shared sex toys, this is an uncommon transmission route. The risk of exposure to HIV in menstrual blood is not known, but could provide another means of transmission between women.

Women who have had sexual contact with men, which includes the majority of women who identify as lesbian, have a higher risk for HIV. Women who have had unprotected sex with gay or bisexual men, or men who have injected drugs, are at an especially high risk.

Herpes and HPV

Genital herpes and the human papillomavirus (HPV) are more likely to be transmitted between women than HIV is because they can be transmitted by skin-to-skin, genital-to-genital, or mouth-to-genital contact.

In addition, because these viruses are not curable and stay in the body, a woman could acquire herpes or HPV from a male partner and later pass it on to a female partner. Case studies and recent research support this possibility. As HPV can lead to cervical cancer, lesbians and bisexual women need Pap tests on a regular basis, just as heterosexual women do.

Bacterial STDs

While chlamydia, gonorrhea and syphilis are less likely to be transmitted between women, it does happen rarely. One study found that four of 241 lesbians had one of these infections. An April 2000 article in the Journal of Obstetrics and Gynecology reports of two lesbians diagnosed with pelvic inflammatory disease (PID) which is usually caused by untreated chlamydia or gonorrhea. These studies show that lesbians are at a low, but not nonexistant risk for bacterial STDs, reinforcing the need for providers to obtain full and complete sexual histories.

Bacterial Vaginosis

Researchers are especially interested in bacterial vaginosis (BV) in women who have sex with women both because it occurs frequently among lesbians and because the cause and transmission of BV is not clearly understood. In one study over half of the lesbians had BV and BV was diagnosed even in the absence of sexual activity with a man in the previous year. Additionally, there was a high likelihood that if one partner in a monogamous couple had BV her partner would as well.

It is important for both providers and lesbian and bisexual women to remember that orientation and identity are not enough to assess risk of STDs. A woman's history--particularly her sexual activity with men--and her sexual behaviors are more reliable and comprehensive indicators of risk