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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: