The delivery of routine primary healthcare to lesbian, gay, bisexual, and transgender women (LGBT) can be complicated by the patient’s inability to disclose their sexual identity and the healthcare provider’s lack of cultural competence when approaching these patients . LGBT women often underutilize clinical care services and present later for healthcare than heterosexual women . The reluctance to obtain healthcare is facilitated by providers who lack awareness of their health issues, discriminate against them, and create negative experiences . In addition, these women are often of lower socioeconomic status than men who have sex with men (MSM) and they often do not have spousal or family benefits, such as health insurance. Because they are less likely to use services that focus on contraception and reproduction than young heterosexual women, they are less exposed to women’s traditional points of entry into the healthcare system.
Understanding a patient's sexual orientation, behavior, and identity has a bearing on the ability to provide quality care. Issues related to sexual desire, sexual behavior, and sexual identity are important because they may increase a woman’s risk of some health problems, such as sexually transmitted diseases (STDs) and certain cancers.
Some terms women may use to describe themselves include lesbian, gay, queer, partnered with a woman, homosexual, and others. The term lesbian is generally used to describe sexual orientation, while women who have sex with women (WSW) describes a behavior. Some women who are just beginning to “come out,” or differentiate from heterosexual identity/behavior, may experience a desire to be intimate with other women, but may not yet have been sexually active with women or even identify as being lesbian.
Sexual orientation and behavior — Sexual orientation relates to erotic attraction and defines whether an individual is attracted is individuals of the same or the opposite biological sex. While there are three main categories of sexual orientation (heterosexual, homosexual [lesbian or gay], and bisexual), sexual behavior may not be so clearly categorized.
Women who have sex with women (WSW) embraces a complex spectrum of attraction, or experiences of romantic or sexual feelings towards other women, behavior or patterns of romantic or sexual activity, and identity, which is a personal self-concept that establishes oneself within a social or collective group. Studies surveying self-identified lesbians show a wide range of sexual behaviors (eg, celibacy, heterosexuality, bisexuality, homosexuality). Many dichotomies exist regarding sexual behaviors: past versus present, volitional versus nonvolitional, and admitted versus practiced. Furthermore, behavior is not always concordant with self-identification and can be fluid over time. For example, a self-identified lesbian may also be attracted to, and engage in, sex with individuals who identify as transgender.