Gay and Lesbian people have many equality issues, many are shared, but some are gender specific. In the case of Lesbians, there is a great health care disparity between them and heterosexual women. At first this was dismissed, owing largely to biases within the mostly male medical community. But research shows that the problem runs deeper, leading to some avoidable health issues for the lesbian community.

The Big C

Studies by the National Cancer Institute (NCI) have demonstrated that while being a lesbian does not appear to increase the chance of contracting any particular form of cancer, there are lifestyle circumstances affecting occurance, diagnosis and treatment.

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The risk of cancer for all women is the same, according to the NCI. One in every three women will get cancer in her lifetime. Lung cancer is the leading cause of cancer deaths among women. 1 in every 9 women will get breast cancer.

According to the Mautner project, a non-profit organization for support and eduction of lesbians with cancer, socioeconomic conditions and homophobia contribute to delayed diagnosis, and therefore increased risk and mortality from cancer in the lesbian community.

Lesbians, according to the project, are less likely to seek health care. Dr. Katherine O'Hanlan, author of a 1995 Stanford University report, feels that "Lesbians have been alienated from the medical practice, either by accidental offense by a well meaning doctor, or by prejudice." The biggest factor, Dr. O'Hanlan feels, is internalized homophobia, which sabotages self-esteem, and results in poor health habits and low compliance with health care plans. Because they tend to visit the doctor less often, the report found that lesbians are at increased risk for breast, ovarian and endometrial carcinoma, as well as heart disease.

This discomfort of coming out to health care providers is confirmed by studies as recent as 1995. 84% of lesbians surveyed in one study reported they were uncomfortable seeking Healthcare. Non-empathetic (insensitive) responses for health care providers were given as the main reason for this discomfort.

With fewer visits to the doctor, normal gynecological services such as birth control and pre-natal care are performed less often. Therefore, cancers are less likely to be detected at earlier, more tangible stages. Early detection is critical for effective cancer treatment.

Even with regular OB-GYN care, lesbians are at higher risk for breast, cervical and ovarian cancers because they are less likely to have children by age 30, if at all. Pregnancy later in life seems to increase the risk for these forms of cancer.

Economics also influences the average lesbians risk for cancer. Lesbians are more directly influenced by women's lower earning power. Most do not have the benefit of spousal health insurance coverage. Again, due to economics, lesbians may be seen less often by medical professionals, so routine screening is not performed. Many forms of cancer are treatable, but only if the diagnosis is made early.

Oncologists recommend that ALL women do the following to reduce the risk of cancer:

• Stop Smoking - this will improve your health generally, and reduce your risk for lung cancer, the leading cause of cancer deaths among women.
• Have an annual PAP smear, breast and pelvic exam - These tests can quickly pinpoint problems early: Early detection means better treatment and higher probability of survival.
• Have an annual mammogram after age 35.
• Perform a monthly breast self-exam. If you are not sure how, call a women's health care office, or visit www.mautnerproject.org.
• Avoid excessive exposure to the sun.
• Establish a healthy and balanced diet. Low fat, high fiber diets decrease the risk of several forms of cancer.

Establish an open relationship with your health care provider. Visit them on a regular basis. The check-up you skip may be the one that catches the lump. One of the studies mentioned above found that 12% of lesbians found that coming out to their physician had a negative effect on their health care. Change doctors if this seems to be the case.

More than Cancer

While lesbians in general are at lower risk for most STDs, studies indicate that nearly 70% of lesbians have had sex with a man at least once, which means they are still at risk for STDs common to heterosexual women. Pap smears and other STD tests are therefore recommended for all women, regardless of sexual orientation.

This is another topic, highlighted by the Stanford study, where uninformed doctors neglected their lesbian patients. Most were not aware of the need for pap smears and STD testing for lesbians.

In Montreal, Canada, a study of the lesbian community found that nearly 90% had been diagnosed with chlamydia, and 50% with bacterial vaginosis. Some diseases, like chlamydia and gonorrhoea, remain asymptomatic until diagnosed by a gynecological exam: complete gynecological exams and pap smears are a must for all sexually active women.

HIV

What about HIV in the lesbian community? Since the mid-1980's, it has been documented that HIV can be passed between women. Besides sex, HIV can be transmitted by: donor insemination, needles, piercing and tattooing.

Body and Soul

A 1994 study by the American Psychological Association (APA) indicates that lesbians are active in seeking mental and spiritual health, and that those in the closet are more likely to seek professional counseling that those who are "out."

Surveying the professionals who work in the mental health field, the APA found that providers tend to overestimate the kinds of psychological problems faced by lesbians, but are well informed on the effects of social discrimination. They rated physical and sexual abuse and suicide as severe problems, well outside the real ranges, according to the study authors.

Nearly three quarters of lesbians surveyed had, at one time, sought mental health care. More than a third, at the time of the study, were currently seeing a counselor or therapist. The subjects lacked confidence in mental health care professionals, but still found the services beneficial.

Overall, it appears that the disparity between heterosexual and lesbian health care can be overcome. Honesty with one's physician, insistence on regular, detailed OB-GYN exams and tests can overcome the tendency for the medical profession to ignore circumstances specific to Lesbians.

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