Lesbian women

Knowledge of the patient's sexual orientation is important for prevention and health promotion strategies, medical treatment and by enhancing the understanding of a patient's health in relation to her family and society.

What is a lesbian?

Usually refers the term 'lesbian' to women whose primary sexual and emotional partner, women, and 'bisexual' or 'bisexual' refers to women whose primary sexual and emotional partner, women or men. The preferred terminology varies - lesbians, homosexuals, gays, bisexuals, bisexual. It's about sexual orientation, which has nothing to do with disease.

The sexual orientation is not always uniform, and can change over time. It is estimated that 1-4% of women consider themselves as lesbians or bisexuals.
The meeting with the health service
Doctor's role

Knowledge of the patient's sexual orientation is important for prevention and health promotion strategies, medical treatment and by enhancing the understanding of a patient's health in relation to her family and society. Your doctor can be a useful resource for lesbians and bisexual women in connection with health issues, including related to life events such as births, death, marriage or partnership.
Barriers in the face of health care

Physicians often are reluctant to ask patients about sexual orientation - in one study had fewer than 10% of lesbians / bisexual women ever been asked about their sexual orientation. Lesbians and bisexual women are reluctant to talk about their sexual orientation - in the same study entered more than a third said they thought disclosure of their sexual orientation would impair their medical services. Among women who had told her about his sexual orientation, experienced 30% negative response from their physician.

There is a lack of knowledge, familiarity with the issues and research on health issues specific to lesbians and bisexual women.
Establishment of trust

Establishing trust is essential to overcome the above barriers to quality health care for lesbians and bisexual patients. Doctors can create an atmosphere conducive to open and confidential communications. An inclusive language both for physicians and other health professionals, where heterosexuality is not taken for granted creates a more relaxed tone.

In the consultation it is important to open conversation about all aspects of sexuality. Besides asking about sexual behavior, your doctor may ask about who they live with, who should be informed about issues relating to disease. Asking these questions in a way that demonstrates openness to a wide range of responses, provides for the establishment of a trusting relationship.

Posters and brochures on gays and lesbians in the waiting room and the bathroom may signal an accepting tone.
Health issues
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Social stress and mental strain

Most lesbians and bisexual women are emotionally healthy and well-adjusted and scored in population studies on quality of life and satisfaction with life as much as heterosexual people. Dog is lesbians, bisexuals and gays vulnerable to minority stress as prejudice, stigma and violence that can trigger mental stress, mental problems, suicidal thoughts and self harm. Lesbians with good social support, those who live in good relationships and those who are more open about their sexual orientation, have lower rates of depression. Available social support may be lower in this group of friends and family gives more with less support compared with heterosexuals. Doctors should be open to discuss these issues and social discrimination.
Sexual practices and sexually transmitted diseases

Open-minded questioning about specific sexual practices allow the physician to detect potential health risks and the need for tests. It means to ask partners, practices, behaviors that increase risk for sexually transmitted diseases, if you have a history of sexually transmitted diseases and concerns about pregnancy.

Relevant questions your doctor may ask are:

• Is your girlfriend a man or woman?
• Have you or have you ever had sex with men or women?
• Have you changed your partner last year?
• Does your partner having sex with someone other than yourself?
• What kind of sexual contact do you have? Oral, including mouth to vagina, anus (rectum) or penis?
• The penetration of the vagina, including the hands, sex toys or penis?
• Penetration in the rectum, including the hands, sex toys or penis?
• Do you have any questions or concerns about sex?
• Do you use barrier protection such as condoms or gloves during sexual contact? What type?
• Have you had sexual contact with someone who uses drugs intravenously or a man who has sex with other men?
• Need to protect yourself against unwanted pregnancy (if you are sexually active with men)
• Do you have any questions about sexually transmitted infections?

Sexually transmitted infections

Lesbians and bisexual women can participate in a variety of sexual endeavors with women and men, including oral-genital contact, genital manipulation and penetration of the vagina with fingers or sex toys.

Transfer of any sexual infections can occur between women: Herpes simplex , genital warts , trichomonas . Theoretically, the following can also be transferred, but the probability is very low: Chlamydia , gonorrhea , syphilis , hepatitis B and HIV .

Most lesbians have had sexual intercourse with men. It is wrong to believe that lesbians lack heterosexual experience. In a larger survey entered 77% of lesbians that they had had one or more male sex partners and 6% said they had had a male sexual partner in the past year. Lesbians with former male partner seems to have slightly increased risk of sexually transmitted disease.

Bacterial vaginosis is not considered a sexually transmitted disease, but is quite common among lesbians and bisexual women.
Cervical Cancer

Lesbians seem to have the same risk of abnormal cells on the cervix as heterosexuals. Nevertheless, several studies suggest that lesbians frequently have smear tests than heterosexual women. Lesbians and bisexual women, regardless of their sexual history with men, recommended the same sampling intervals as women in general.
Pregnancy and children

Increasingly choose lesbians having children. Under Norwegian law, they have no access to public offers of donor insemination, but many find other solutions on their own. Donor insemination involves calculating the time of ovulation and insemination with sperm from a known donor or from a commercial sperm bank. Women who are considering donor insemination should also get legal advice because the method can affect the legal relationship to the child, eg. can be known donors have parental rights and responsibilities.

Many children grow up with one or two gays or lesbians parents. These children do not differ from children of heterosexual parents neither emotionally, cognitively, socially or sexually.

The 01 February 2007 said yes Biotechnology Appeals Board by 10 votes to six for the Biotechnology Act be amended to also lesbians couples access to assisted reproduction. A change in the Biotechnology Act at the earliest be presented to Parliament in the summer of 2007.
Violence

Many lesbians and bisexual women experience fear of social violence and may fear for their safety. Violence also occurs within a relationship between two women, but is higher in heterosexual relationships. To clarify the risk of violence in your relationships, your doctor may ask about the following:

• How does your partner you?
• Have you ever or now been abused physically, emotionally or sexually?
• Have you been hit, kicked or otherwise hurt by someone in the past year?
• Do you feel safe in your current relationship?
• Do you have a partner from a previous relationship that makes you uncomfortable now?

Breast and ovarian cancer

The risk of breast cancer among lesbians are discussed. Reports of incidence are conflicting, but foreign results from mammography screening is the same for lesbians / bisexuals as heterosexual women. Lesbians women should follow the protocol for mammography screening, but there is no basis for extended supervision or control, or earlier initiation of mammographic screening. Risk factors for ovarian cancer that few births, less use of hormonal contraceptives (eg contraceptive pill), smoking, more frequent incidence of obesity is more common among lesbians than in the general population, but there is no scientific evidence that the incidence of ovarian cancer is higher.
Smoking, alcohol, drugs

Several other studies indicate higher tobacco consumption among lesbians than in the general female population. If alcohol use is higher, is uncertain. Data regarding drug use is limited and ambiguous.
Obesity and heart disease

Foreign studies show that lesbians women compared with heterosexual women may have higher body mass index, waist circumference and waist-hip measurement, while they exercise more often. There is no evidence of increased risk of heart disease among lesbians and bisexuals.