HME

Preventive Health Care of Women Who Have Sex With Women

Preventive Health Care of Women Who Have Sex With Women, Health Maintenance for Lesbian Women, Preventive Health Care for Homosexual Women, Women Who Have Sex With Women, Female Homosexuality, Lesbian Women

See Also

Epidemiology

Incidence: 1.3 to 1.9% in U.S. self-identified as lesbian (3.1 to 4.8% self-identified as bisexual)

Precautions

Lesbian Women are more likely to avoid healthcare (and may have associated worse outcomes)
1. Negative prior interactions related to discrimination
2. Misconception that they cannot acquire Sexually Transmitted Infections
3. Not tied to Contraception refills
Women Who Have Sex With Women also commonly have or have had male partners (more than half)
1. More than half of the women reporting a same-sex relationship, identify themselves as heterosexual
2. May have delayed diagnosis of pregnancy or Sexually Transmitted Infection
Lesbian Women may have less social support
1. May have less close family and friends (may have been isolated, estranged from family)
2. May have no grown children
  1. However women in same sex relationships have often had children from prior heterosexual relationships
  2. In 2014, lesbian couples reported children in their household >20% of the time

History
Sexual

How many sexual partners have you had in the last year?
Have you had sex with women, men or both?
Does your current partner(s) have sex with someone other than you?
Do you have sex with strangers or acquaintances?
Do you have sex after Alcohol or drugs?
Do you have oral sex, vaginal sex, anal sex?
Do you use protection with Condoms, gloves, dental dams?
Are there times you do not use protection?
Have you ever been pregnant? (if so, ask about G- P---- status)
If you have sex with men, do you use another form of Contraception?
Have you ever had a Sexually Transmitted Infection?

History
Social

Intimate Partner Violence
1. Does your partner insult or demean you, threaten to or physically harm you?
Support systems
1. Do you have close family or friends?

Complications
Conditions with increased risk among Women Who Have Sex With Women

Obesity
1. Higher BMI than heterosexual women
2. Increased Type II Diabetes Mellitus risk
Cardiovascular Risk
1. Higher Tobacco use rates
Cancer Risk (Cervical Cancer, Breast Cancer, Ovarian Cancer, Lung Cancer)
1. Lower rates of Pap Smear, Mammogram
2. Less routine preventive health
3. Tobacco Abuse
Mental Health Conditions
1. Higher risk of Major Depression, Suicidality, Anxiety Disorders
2. Higher risk of Eating Disorders (esp. adolescents)
3. Alcohol Abuse
4. Substance Abuse (esp. adolescents who may abuse Alcohol, Marijuana, Cocaine, MDMA)
5. Tobacco Abuse (bisexual women 36% rate, lesbian 22% rate compared with heterosexual 14% rate)
Sexually Transmitted Infections (STI)
1. Higher risk sexual behavior, typically with men and women
  1. No protection
  2. Sex while intoxicated
  3. Sex with high risk partners
2. Common STIs
  1. HPV or Genital Warts (esp. bisexual women)
  2. Chlamydia (at least as common, and may be more common in Women Who Have Sex With Women)
  3. Herpes Simplex Virus 2 (Genital Herpes or HSV2)
3. Other STI that are less common in Women Who Have Sex With Women (but still occurs, and protection should be used)
Other genitourinary infections
1. Bacterial Vaginosis infection (More common)

Prevention

Maintain cancer screening
1. Cervical Cancer Screening (many women in same sex relationships have had prior intercourse and HPV is common)
2. Breast Cancer Screening and Mammograms
3. Colon Cancer screening
Screen for Intimate Partner Violence
1. See SAFE Screen for Intimate Partner Violence
2. See HITS Screen for Intimate Partner Violence
3. See Women Abuse Screening Tool (WAST)
Screen for mental health disorders
Prevent Sexually Transmitted Infections
1. Use Condoms, latex sheets, dental dams, gloves
2. Apply a new Condom before each use of a sex toy
3. Avoid contact with menstrual blood and genital lesions
4. Use gloves and lubricants for sex that could result in bleeding

References