Lesbian and Bisexual Women Health Fact Sheet
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)
- Insulin production
- Blood vessels
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.
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.
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. Learn more about what tests you need, based on your age.
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. Learn more about how to stop smoking. 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. Call a crisis hotline that can give you the phone numbers of local hotlines and other resources.
Build strong bones. Take the following steps to help build strong bones and prevent osteoporosis:
- 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
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:
- Weakness or numbness on one side of your body
- Loss of balance
- Trouble talking or understanding speech
- Trouble walking or seeing
Remember: Even if you have a "mini-stroke," you may have some of these signs.