Guide To Health For Lesbian and Bisexual Women

Everything you need to know about accessing healthcare and other health issues

Accessing Healthcare | Health Issues | Sex | Other Issues | Useful Contacts

Being a lesbian or bisexual woman means different things to each of us. We are of all ages, cultural backgrounds, belief systems and abilities, and we define our identities, communities, families and support systems in many ways. Each of us defines our health in different ways too, and what’s important can change over time. In this light, we recognise there is no single formula to being well and happy, but we hope this guide can contribute to you feeling good! You may find that some of the information is not relevant to you or that there’s information not included that you need. If this is the case, please use the contact list at the end to make contact with services you’re looking for.

Accessing Healthcare

Accessing Healthcare As lesbian and bisexual women, we have the right to quality health care that meets our needs – as we define them. There are lots of different ways we can and do look after ourselves – through what we’ve learned, through our support networks, by chatting with other people such as family, friends and partners, and by consulting health care providers. Taking an active role in looking after our health can help us make more informed choices that lead to better health outcomes.

Accessing health services can be difficult for lesbian and bisexual women, for a number of reasons, such as:

Feeling unsure about “coming out” to health care providers
Fear of discrimination and assumptions about our sexuality, behaviours and needs
Concerns about the level of knowledge and understanding of health issues specific to same sex attracted women
Concerns about lack of confidentiality
Feeling confused about sexuality
Geographical, social or cultural isolation

Past experiences of discrimination, homophobia or feeling invisible as a lesbian or bisexual woman can mean that we might not seek information, treatment or assistance when we need it, or it might be that we walk away with information that’s not quite what we were looking for.

Tips on accessing healthcare

Find out who or what is available
Get on that grapevine and talk to other people about who offers a good service. To find out what’s available, you could call a women’s or community health centre, or check out a community newspaper or magazine. There are lesbian (or sometimes gay and lesbian) social and support groups in lots of areas – contact these groups for ideas and suggestions. They are usually listed in gay and lesbian community press.

Some women want a health care provider who is a lesbian herself, while others find that this is not important. It might be useful to ask yourself how important and relevant this is for you. Lesbians and bisexual women can experience discrimination within their professional lives too – you can offer your support by being mindful to respect the privacy of health care providers in the same manner that you would like your privacy respected. Finding good health care providers is about professionalism, openness, sensitivity and knowledge.

Be mindful too that you may not find someone who fits all your desired qualities or characteristics, especially in areas where there are limited services. Don’t let this mean that you delay or avoid a visit to a health care provider. Rather, factor this in to your planning before the visit.

Coming out to healthcare providers
Sometimes it can be hard to be open about being a lesbian or bisexual woman for lots of reasons, and the choice to disclose information about your sexuality is yours. Some women feel safer not talking about their sexuality or may fear inferior treatment if they do. Others feel it is very important to talk openly about this part of themselves and their life. Being able to paint an accurate picture of what’s going on can often result in a more appropriate and beneficial health care experience.

Coming out is a personal journey. Think about how coming out or not coming out will impact on the overall management of your health. How relevant is it in each situation? There is no right or wrong answer - it’s about comfort and confidence. Talk to someone you trust about the pros and cons of coming out in certain situations. If there are times when you’re not comfortable seeing your usual health care provider (maybe they’ve been your family doctor for a long time, or they are well-known within your community and you would feel less nervous with someone else), look around for alternatives.

How open do you feel you can be about your partner/s, family, support networks and lifestyle? Maybe it’s not an issue. If you don’t feel comfortable talking openly, try to think up responses to questions that are as close to your current situation as possible. As you build up a good rapport with your health care provider, you may feel comfortable speaking more openly.

Some women find it useful to be direct with their health care provider about their sexuality, and take note of verbal and non-verbal responses. Some lesbians ask “Are you comfortable dealing with my health needs as a lesbian/bisexual woman? If not, do you know someone you can refer me to?” Some healthcare providers assume heterosexuality, and this can be uncomfortable. It may be useful to prepare some answers to common questions such as:

Q: Do you have a boyfriend?
A: No, I have a girlfriend.
A: No, I see women.
Lips A. I don’t have a partner at the moment.

Q: Do you use contraception/are you on the Pill?
A: No, I’m not sexually active with men at the moment.
A: No, it’s not necessary.
A: Yes, to regulate my cycle.

Q: You’re a lesbian! Are you sexually active?
A: Is that relevant at the moment?
A: What exactly do you need to know?

Q: Why would you need a Pap smear?
A: Because lesbians need Pap smears too.
A: Because all women who have ever had sex need a Pap smear.
A: Because it’s an important part of looking after my health.

Identify support people
Sometimes it can be really difficult thinking about what we need to do to take care of ourselves, and it’s good to have someone else around. Involving a supportive partner or friend in the health care process may be a good idea. Think about taking someone with you to appointments to bounce ideas around with, help think of questions, stay with you in consultations, or even take notes for you.

Know your rights
Health records are confidential documents, and information regarding your health and health care should not be disclosed without your knowledge and consent. You can always ask who has access to your files, and play an active role in deciding what information is recorded in your health records. If you’d like to know how your personal and health information is recorded, it’s probably a good idea to discuss this early on. Decide whether you would like your sexual orientation and partner/s details recorded. Sometimes it can be hard to make these decisions on the spot, so take some time to think it through.

Remember, when it comes to your health, you are entitled to seek a second opinion (or more) if you feel it is necessary. You can stop a consultation or interaction at any time if you are unhappy or uncomfortable and seek services elsewhere or make a complaint.

What to do if you have a bad health care experience
Health care providers are encouraged to have a sensitive approach when dealing with clients, particularly when it comes to sexual health issues, but occasionally people have a bad experience. It is also illegal to discriminate against someone because of their sexual orientation.

You can contact the Office of Health Review on 9323 0600 or the Equal Opportunity Commission on 9216 3900 if you have a complaint to make about a health care provider. Whether or not you decide to make a complaint, it can be useful to talk about your experience with someone who can offer you support, such as a friend or counsellor.

Health Issues

Pap smears
There is a common misconception that lesbians don’t need to have Pap smears because they don’t have sex with men. However, many lesbians and their partners have had sex with men in the past, meaning they may have been exposed to the Human Papilloma Virus (HPV) at some stage, which is one of the main causes of cervical cancer. HPV can also be passed on through female sexual activity.

Regular Pap smears help detect early warning signs of cancer and it is recommended that all women who have ever been sexually active have one every two years. Many lesbians don’t have regular Pap smears because of difficulties finding a suitable health care provider or negative experiences in the past, but regular Pap smears are the best way to protect against cervical cancer. A free cervical cancer vaccine is available for young women – talk to a doctor or FPWA clinician for more details

Some women can feel nervous or uncomfortable having a Pap smear, but it shouldn’t be painful. Talk this through with your health care provider - you may like to ask them to explain the process before it begins, or you can insert the speculum yourself if you wish. It is important to remember that a Pap smear only tests for changes to the cervix, and not for sexually transmissible infections (STIs). It is possible, however, to be tested for STIs at the same time as your Pap smear - talk to your health care provider for more details.

Breast awareness
There is no standard shape or size for breasts, and every set is different. It is normal for breasts to change in size and shape at various times in your life. It’s important for all women to be aware of their breasts and know their look and feel – by becoming familiar with your breasts, you are more likely to notice any abnormal changes and be able to get them checked promptly. Use a well-lit mirror to look for changes, and from time to time feel your breasts with your hands.

Things to look for include:

A lump or thickening in the breast, or any sudden change in breast size or shape
Changes to the skin of the breast, such as dimpling or a rash
Persistent or unusual pain
Discharge from the nipple

If you notice any of these changes, see a doctor immediately. Remember – breast pain or lumps in the breast rarely mean you have cancer. It is recommended that women have a mammogram every two years from the age of 50, as regular mammograms are the best way of detecting breast cancer in this age group. Women who are having regular screenings still need to be aware of the look and feel of their breasts and see a doctor if they notice any changes.

Genital health
Genital problems are common among women and include itching, irritation or soreness around the vaginal opening, a burning sensation when urinating or increased or unusual discharge. If you are experiencing any of these symptoms see a doctor, as they can indicate an infection. Thrush and bacterial vaginosis are common vaginal infections that can be easily treated. Remember that female genitals are very sensitive – avoid irritation by using plain water or a soap alternative to wash the area, rather than soap or antiseptics.

Sex

Lesbian sex can be exciting and varied, limited only by imagination. Some lesbian and bisexual women may choose not to be sexually active while some are very active - we all have very different ways we relate sexually. Remember both partners must always consent to sex (meaning you both want to do it). Forcing someone to have sex against their will is a crime, as is taking advantage of someone if they’ve been taking drugs or drinking.

Sexually transmissible infections and HIV
As with any sexually active women, lesbians and bisexual women are at risk of STIs such as herpes, genital warts and hepatitis, which can all be passed on through an exchange of body fluids or skin-to-skin contact. Infections such as gonorrhoea and chlamydia can also be transmitted if sharing sex toys.

Many women with an STI have no symptoms, so it’s possible to have one and not know it. Symptoms, when present, can include:

Unusual discharge or bleeding from the vagina
Itchiness around the genital area
A burning sensation when peeing
A rash, sores or small lumps on or around the vagina or anus

If you notice any of these symptoms, or if you’ve had unprotected sex in the past, get tested. Testing for STIs is quick and painless - it only takes a few minutes and usually involves a urine sample and a vaginal swab. Sometimes symptoms go away by themselves, but this doesn’t mean the infection has gone.

Lesbian and bisexual women also need to be aware of HIV, and whilst the risk of transmission during female sexual activity is relatively low, it is still possible. The risk increases when there is blood is involved, like during menstruation or adventurous sexual practices, or when there are small cuts/abrasions in the mouth, on the fingers or in the vagina. Some lesbians may also continue to have sex with men, or have partners who are sexually active with men, and some of these men may have been exposed to HIV. Always practise safe sex, regardless of who your partner is.

Safe sex – talk about it
Hand Latex dams (thin squares held over the vaginal or anal area during oral sex) and gloves (for fingering) reduce the risk of getting or passing on an STI by stopping blood and vaginal fluids from being exchanged. Always use water-based lube as oil-based lube increases the risk of the latex breaking. The best way to keep your toys safe and clean is to cover them with a condom every time you use them. Use a new condom each time, and replace it when you switch between the vagina, anus or mouth, and if you share a toy with a partner.

Starting a conversation with a partner (or potential partner) about safe sex isn't easy, but it’s a good idea to talk about it early on in any relationship. Lots of people plan on having safe sex, particularly with a new partner, but find it hard to bring up the topic in the heat of the moment.

The way you start the conversation will depend on the person and how well you know them. If you don’t want to be direct you may say something like ‘What do you think about dams?’, or mention a magazine article you read on safe sex. Introduce the topic at a low-key moment such as while on a walk, during dinner, or over the phone.

Communicate your feelings about safe sex in a clear and positive manner, to ensure there are no misunderstandings. It’s often difficult to be assertive when negotiating safe sex, and you may worry about your partner’s reaction. A lot of cultures don’t speak openly about sex, and this can make it even harder to communicate. It is important to remember that your health is worth whatever feelings of awkwardness a conversation about safe sex might bring up, so persevere, even if you are finding it difficult.

Hopefully your partner will agree with you about the importance of safe sex. If they don’t, try talking to them about the benefits of using protection and remind them that safe sex doesn’t mean it has to be less pleasurable. If they have a negative attitude about safe sex, think about whether they are someone you still want to have sex with.

Other Issues

Parenting
The decision to have a child is an important one. For some people it is difficult to decide when the right time is, and for many no time is ever going to be perfect. Lots of people feel apprehensive, even though they are confident in their decision to have a child. Some of the issues you could consider:

Are you ready? If you have a partner, are they ready?
Have you discussed how you will share the parenting of a child?
Have you considered the economic, emotional and lifestyle changes that will occur, and what support you will require?

If you are considering a pregnancy be sure to get tested and treated for STIs beforehand, and screen your sperm donor! Decisions regarding becoming a parent or co-parent may also raise particular questions or issues about access to assisted reproductive technology. For more information contact Concept Fertility Centre, Pivot Fertility Clinic, Hollywood Hospital or the Reproductive Technology Council.

Alcohol, smoking and other drugs
If you drink alcohol or take drugs make sure you know your own limits so you can make the same safe decisions you would if you were sober. If you inject drugs, always have plenty of clean (sterile, single use) equipment handy (fits, tourniquets, swabs, spoons, waters, filters) - regardless of how often you inject. Blood-borne viruses such as HIV and hepatitis (in particular hepatitis C) can be transmitted through sharing needles and syringes. Understanding and using safe injecting practices is vital. Smoking also increases the risk of cervical cancer, miscarriage and premature birth, so all women should seriously consider quitting before they get pregnant.

Relationships and emotional health
How we’re feeling about ourselves, our relationships and life in general is an important part of our overall health and wellbeing. For some lesbians “coming out” can place a huge strain on relationships with parents, siblings and friends. Things like coming to terms with sexuality and experiences of discrimination can also be an additional burden. If these issues start to become overwhelming and affect how you are functioning, it’s important to talk to someone.

Breaking up can be hard. It can be even harder when there are children involved. Sometimes you might need a bit of space to figure things out or time to just be by yourself. You might find putting some limits around phone, e-mail or face-to-face contact for a while gives you a little bit of space to think things through. Many people find counselling beneficial at some stage in their lives. See the ‘Useful Contacts’ for information on services available.

Violence
All lesbian and bisexual women have the right to live safely, free from violence and abuse in our relationships, communities, and within wider society. Violence against women can take the form of ongoing harassment, intimidation, verbal abuse and/or physical assault. Domestic violence also occurs within same-sex relationships. It is not always easy to acknowledge situations of violence and it can be difficult to deal with. Although you may feel isolated, there are people who can offer support. For more information contact the Same Sex Domestic Abuse Group (SSDAG) on 9226 2370.

Useful Contacts

FPWA Sexual Health Services
FPWA provides confidential sexual health services for men and women of all ages and sexualities, including clinic, library and education services.
70 Roe Street Northbridge 9227 6177 www.fpwa.org.au
Sexual Health Helpline 9227 6178/1800 198 205
Quarry Health Centre for under 25s 7 Quarry Street Fremantle 9430 4544

Freedom Centre
Freedom Centre provides a safe space, information, support and referral services for young gay, lesbian, bisexual, queer, transgender and questioning youth.
1/471 William Street Northbridge 9228 0354 www.freedom.org.au

Roe St Centre for Human Relationships
The Centre offers counselling around all areas of sexual health, including relationships and sexuality.
70 Roe Street Northbridge 9228 3693 www.fpwa.org.au/services/roestreetcentre

Gay and Lesbian Community Services
GLCS offers telephone counselling as well as courses, forums and events.
City West Lotteries House, Unit 1/2 Delhi Street West Perth 9486 9855 www.glcs.org.au

OUT in Perth (available at the Freedom Centre and various local outlets)
OUT in Perth is WA’s only publication exclusively for gay and lesbian people and their community and friends.

Pride WA
Pride fights for gay and lesbian rights and organises various events throughout the year.
9427 0828 www.pridewa.asn.au

Parts of this text adapted from ‘Opening the Window – A guide to lesbian health’
with kind permission from ACON

Page last updated Tue, 09 Oct 2007 14:45