Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medical care of sexual minority women

Nina M Carroll, MD
Section Editors
Robert L Barbieri, MD
Joann G Elmore, MD, MPH
Deputy Editor
Kristen Eckler, MD, FACOG


In providing clinical care, clinicians are encouraged never to make assumptions about a patient's sexual identity, orientation, and behavior because they can differ from each other as well as change over time. Knowing and understanding a patient's sexual identity, orientation, and behavior improves health care providers' abilities to provide quality care and recognize areas of disproportionate risk. While there is no stereotypical profile that identifies sexual minority women (SMW) (eg, lesbian, gay, bisexual, and transgender women or LGBT), recognizing SMW is important because these women are at increased risk for adverse health outcomes, including mental health issues, tobacco and substance use, and sexually transmitted infections.

This topic will address issues related to the medical care of SMW. Detailed reviews of related topics are presented separately.

(See "Sexual minority youth: Primary care".)

(See "Sexual minority youth: Epidemiology and health concerns".)


Gender – Gender refers to the "cultural meanings of patterns of behavior, experience, and personality that are labeled masculine or feminine" and thus provides a social construct that determines roles and relationships [1,2]. The concept of gender can vary by society and can change over time [2].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Mar 03, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. National Academies Press; Washington, DC 2011.
  2. World Health Organization. Gender. Fact sheet No 403, August 2015. http://www.who.int/mediacentre/factsheets/fs403/en/ (Accessed on September 14, 2016).
  3. National Center for Transgender Equality. Transgender terminology, 2014. http://www.transequality.org/issues/resources/transgender-terminology (Accessed on July 26, 2016).
  4. Bailey JV, Farquhar C, Owen C, Whittaker D. Sexual behaviour of lesbians and bisexual women. Sex Transm Infect 2003; 79:147.
  5. National Health Statistics Reports. Sexual orientation and health among US adults: National health interview survey, 2013. http://www.cdc.gov/nchs/data/nhsr/nhsr077.pdf (Accessed on September 14, 2016).
  6. Copen CE, Chandra A, Febo-Vazquez I. Sexual Behavior, Sexual Attraction, and Sexual Orientation Among Adults Aged 18-44 in the United States: Data From the 2011-2013 National Survey of Family Growth. Natl Health Stat Report 2016; :1.
  7. Office of Disease Prevention and Health Promotion. HealthyPeople 2020. Lesbian, gay, bisexual, and transgender health. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health (Accessed on September 20, 2016).
  8. McLaughlin KA, Hatzenbuehler ML, Keyes KM. Responses to discrimination and psychiatric disorders among Black, Hispanic, female, and lesbian, gay, and bisexual individuals. Am J Public Health 2010; 100:1477.
  9. Ibañez GE, Purcell DW, Stall R, et al. Sexual risk, substance use, and psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS 2005; 19 Suppl 1:S49.
  10. Herek GM, Garnets LD. Sexual orientation and mental health. Annu Rev Clin Psychol 2007; 3:353.
  11. Remafedi G, French S, Story M, et al. The relationship between suicide risk and sexual orientation: results of a population-based study. Am J Public Health 1998; 88:57.
  12. Buchmueller T, Carpenter CS. Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000-2007. Am J Public Health 2010; 100:489.
  13. Kerker BD, Mostashari F, Thorpe L. Health care access and utilization among women who have sex with women: sexual behavior and identity. J Urban Health 2006; 83:970.
  14. Arbeit MR, Fisher CB, Macapagal K, Mustanski B. Bisexual Invisibility and the Sexual Health Needs of Adolescent Girls. LGBT Health 2016; 3:342.
  15. Austin EL. Sexual orientation disclosure to health care providers among urban and non-urban southern lesbians. Women Health 2013; 53:41.
  16. Johnson S. Gynecologic issues for lesbians. The Global Library of Women's Medicine, 2008. https://www.glowm.com/section_view/heading/Gynecologic%20Issues%20for%20Lesbians/item/430 (Accessed on November 02, 2016).
  17. Denenberg R. Report on lesbian health. Womens Health Issues 1995; 5:81.
  18. O'Hanlan KA. Lesbian health and homophobia: Perspectives for the treating obstetrician/gynecologist. Curr Probl Obstet Gynecol Fertil 1995; 18:99.
  19. Case P, Austin SB, Hunter DJ, et al. Sexual orientation, health risk factors, and physical functioning in the Nurses' Health Study II. J Womens Health (Larchmt) 2004; 13:1033.
  20. Gruskin EP, Greenwood GL, Matevia M, et al. Disparities in smoking between the lesbian, gay, and bisexual population and the general population in California. Am J Public Health 2007; 97:1496.
  21. Cherpitel CJ. A brief screening instrument for problem drinking in the emergency room: the RAPS4. Rapid Alcohol Problems Screen. J Stud Alcohol 2000; 61:447.
  22. Hall TM, Reback CJ, Shoptaw S. Clinical management of substance use and substance disorders among LGBT individuals. In: The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, 2nd ed, Makadon HJ, Mayer KH, Potter J, Goldhammer H (Eds), American College of Physicians, Philadelphia 2015. p.227-268.
  23. Mravcak SA. Primary care for lesbians and bisexual women. Am Fam Physician 2006; 74:279.
  24. Roberts SJ, Sorensen L. Lesbian health care: a review and recommendations for health promotion in primary care settings. Nurse Pract 1995; 20:42.
  25. Harrison AE. Primary care of lesbian and gay patients: educating ourselves and our students. Fam Med 1996; 28:10.
  26. Kreiss JL, Patterson DL. Psychosocial issues in primary care of lesbian, gay, bisexual, and transgender youth. J Pediatr Health Care 1997; 11:266.
  27. Cahill SR, Baker K, Deutsch MB, et al. Inclusion of Sexual Orientation and Gender Identity in Stage 3 Meaningful Use Guidelines: A Huge Step Forward for LGBT Health. LGBT Health 2016; 3:100.
  28. White JC, Levinson W. Lesbian health care. What a primary care physician needs to know. West J Med 1995; 162:463.
  29. Gelman M, Van Wagenen A, Potter J. Principles for taking an LGBTQ-inclusive health history and conducting a culturally competent physical exam. In: The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, 2nd ed, Makadon HJ, Mayer KH, Potter J, Goldhammer H (Eds), American College of Physicians, Philadelphia 2015. p.159-192.
  30. Daskalakis DC, Radix A, Mayer G. Sexual health of LGBTQ people. In: The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, 2nd ed, Makadon HJ, Mayer KH, Potter J, Goldhammer H (Eds), American College of Physicians, Philadelphia 2015. p.289-324.
  31. Centers for Disease Control and Prevention. A guide to taking a sexual history. http://www.cdc.gov/std/treatment/sexualhistory.pdf (Accessed on October 26, 2016).
  32. National Health Service. NHS Choices. Gay health: Access to healthcare, July 2014. http://www.nhs.uk/Livewell/LGBhealth/Pages/Access.aspx (Accessed on September 20, 2016).
  33. Lick DJ, Durso LE, Johnson KL. Minority Stress and Physical Health Among Sexual Minorities. Perspect Psychol Sci 2013; 8:521.
  34. Koh AS, Ross LK. Mental health issues: a comparison of lesbian, bisexual and heterosexual women. J Homosex 2006; 51:33.
  35. Riggle ED, Rostosky SS, Reedy CS. Online surveys for BGLT research: issues and techniques. J Homosex 2005; 49:1.
  36. King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry 2008; 8:70.
  37. Jackson CL, Agénor M, Johnson DA, et al. Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the United States: a cross-sectional study. BMC Public Health 2016; 16:807.
  38. Valanis BG, Bowen DJ, Bassford T, et al. Sexual orientation and health: comparisons in the women's health initiative sample. Arch Fam Med 2000; 9:843.
  39. Boehmer U, Bowen DJ, Bauer GR. Overweight and obesity in sexual-minority women: evidence from population-based data. Am J Public Health 2007; 97:1134.
  40. Ward BW, Dahlhamer JM, Galinsky AM, Joestl SS. Sexual orientation and health among U.S. adults: national health interview survey, 2013. Natl Health Stat Report 2014; :1.
  41. Mason TB, Lewis RJ. Minority Stress, Depression, Relationship Quality, and Alcohol Use: Associations with Overweight and Obesity Among Partnered Young Adult Lesbians. LGBT Health 2015; 2:333.
  42. Eliason MJ, Fogel SC. An ecological framework for sexual minority women's health: factors associated with greater body mass. J Homosex 2015; 62:845.
  43. Boehmer U, Miao X, Maxwell NI, Ozonoff A. Sexual minority population density and incidence of lung, colorectal and female breast cancer in California. BMJ Open 2014; 4:e004461.
  44. Clavelle K, King D, Bazzi AR, et al. Breast Cancer Risk in Sexual Minority Women during Routine Screening at an Urban LGBT Health Center. Womens Health Issues 2015; 25:341.
  45. Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health 2001; 91:1869.
  46. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
  47. Marrazzo JM. Genital human papillomavirus infection in women who have sex with women: a concern for patients and providers. AIDS Patient Care STDS 2000; 14:447.
  48. Marrazzo JM, Koutsky LA, Kiviat NB, et al. Papanicolaou test screening and prevalence of genital human papillomavirus among women who have sex with women. Am J Public Health 2001; 91:947.
  49. Dibble SL, Roberts SA, Robertson PA, Paul SM. Risk factors for ovarian cancer: lesbian and heterosexual women. Oncol Nurs Forum 2002; 29:E1.
  50. Vessey M, Painter R. Oral contraceptive use and cancer. Findings in a large cohort study, 1968-2004. Br J Cancer 2006; 95:385.
  51. Collaborative Group on Epidemiological Studies of Ovarian Cancer, Beral V, Doll R, et al. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet 2008; 371:303.
  52. Koh AS, Gómez CA, Shade S, Rowley E. Sexual risk factors among self-identified lesbians, bisexual women, and heterosexual women accessing primary care settings. Sex Transm Dis 2005; 32:563.
  53. Muzny CA, Sunesara IR, Martin DH, Mena LA. Sexually transmitted infections and risk behaviors among African American women who have sex with women: does sex with men make a difference? Sex Transm Dis 2011; 38:1118.
  54. Eisenberg M. Differences in sexual risk behaviors between college students with same-sex and opposite-sex experience: results from a national survey. Arch Sex Behav 2001; 30:575.
  55. Goodenow C, Szalacha LA, Robin LE, Westheimer K. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Public Health 2008; 98:1051.
  56. Marrazzo JM, Thomas KK, Ringwood K. A behavioural intervention to reduce persistence of bacterial vaginosis among women who report sex with women: results of a randomised trial. Sex Transm Infect 2011; 87:399.
  57. Marrazzo JM, Stine K. Reproductive health history of lesbians: implications for care. Am J Obstet Gynecol 2004; 190:1298.
  58. Lemp GF, Jones M, Kellogg TA, et al. HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, California. Am J Public Health 1995; 85:1549.
  59. National Health Service. NHS Choices. Seuxal health for lesbian and bisexual women, July 2014. http://www.nhs.uk/Livewell/LGBhealth/Pages/lesbianhealth.aspx (Accessed on September 20, 2016).
  60. Carroll N, Goldstein RS, Lo W, Mayer KH. Gynecological infections and sexual practices of Massachusetts lesbian and bisexual women. J Gay Lesbian Med Assoc 1997; 1:15.
  61. Fethers K, Marks C, Mindel A, Estcourt CS. Sexually transmitted infections and risk behaviours in women who have sex with women. Sex Transm Infect 2000; 76:345.
  62. Berger BJ, Kolton S, Zenilman JM, et al. Bacterial vaginosis in lesbians: a sexually transmitted disease. Clin Infect Dis 1995; 21:1402.
  63. Kellock D, O'Mahony CP. Sexually acquired metronidazole-resistant trichomoniasis in a lesbian couple. Genitourin Med 1996; 72:60.
  64. Rich JD, Buck A, Tuomala RE, Kazanjian PH. Transmission of human immunodeficiency virus infection presumed to have occurred via female homosexual contact. Clin Infect Dis 1993; 17:1003.
  65. Troncoso AR, Romani A, Carranza CM, et al. [Probable HIV transmission by female homosexual contact]. Medicina (B Aires) 1995; 55:334.
  66. O'Hanlan KA, Crum CP. Human papillomavirus-associated cervical intraepithelial neoplasia following lesbian sex. Obstet Gynecol 1996; 88:702.
  67. Marrazzo JM, Koutsky LA, Eschenbach DA, et al. Characterization of vaginal flora and bacterial vaginosis in women who have sex with women. J Infect Dis 2002; 185:1307.
  68. Forcey DS, Vodstrcil LA, Hocking JS, et al. Factors Associated with Bacterial Vaginosis among Women Who Have Sex with Women: A Systematic Review. PLoS One 2015; 10:e0141905.
  69. Bradshaw CS, Walker SM, Vodstrcil LA, et al. The influence of behaviors and relationships on the vaginal microbiota of women and their female partners: the WOW Health Study. J Infect Dis 2014; 209:1562.
  70. Diamant AL, Schuster MA, McGuigan K, Lever J. Lesbians' sexual history with men: implications for taking a sexual history. Arch Intern Med 1999; 159:2730.
  71. Power J, McNair R, Carr S. Absent sexual scripts: lesbian and bisexual women's knowledge, attitudes and action regarding safer sex and sexual health information. Cult Health Sex 2009; 11:67.
  72. Ben-Natan M, Maor S. Factors related to Israeli lesbian women's intention to be vaccinated against human papillomavirus. Int J STD AIDS 2014; 25:800.
  73. Agénor M, Peitzmeier S, Gordon AR, et al. Sexual Orientation Identity Disparities in Awareness and Initiation of the Human Papillomavirus Vaccine Among U.S. Women and Girls: A National Survey. Ann Intern Med 2015; 163:99.
  74. Anderson PL, Glidden DV, Liu A, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med 2012; 4:151ra125.
  75. Cochran SD, Bandiera FC, Mays VM. Sexual orientation-related differences in tobacco use and secondhand smoke exposure among US adults aged 20 to 59 years: 2003-2010 National Health and Nutrition Examination Surveys. Am J Public Health 2013; 103:1837.
  76. Breiding MJ, Smith SG, Basile KC, et al. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization--national intimate partner and sexual violence survey, United States, 2011. MMWR Surveill Summ 2014; 63:1.
  77. Gold MA, Perrin EC, Futterman D, Friedman SB. Children of gay or lesbian parents. Pediatr Rev 1994; 15:354.
  78. Brewaeys A, van Hall EV. Lesbian motherhood: the impact on child development and family functioning. J Psychosom Obstet Gynaecol 1997; 18:1.
  79. Hunfeld JA, Fauser BC, de Beaufort ID, Passchier JP. Child development and quality of parenting in lesbian families: no psychosocial indications for a-priori withholding of infertility treatment. A systematic review. Hum Reprod Update 2002; 8:579.
  80. Ross LE, Steele LS, Epstein R. Lesbian and bisexual women's recommendations for improving the provision of assisted reproductive technology services. Fertil Steril 2006; 86:735.
  81. Parks CA. Lesbian parenthood: a review of the literature. Am J Orthopsychiatry 1998; 68:376.
  82. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 428: Legal status: health impact for lesbian couples. Obstet Gynecol 2009; 113:469.
  83. Supreme Court of the United States Blog. Obergefell v. Hodges. http://www.scotusblog.com/case-files/cases/obergefell-v-hodges/ (Accessed on March 03, 2017).
  84. Blanchfield BV, Patterson CJ. Racial and sexual minority women's receipt of medical assistance to become pregnant. Health Psychol 2015; 34:571.
  85. Ethics Committee of American Society for Reproductive Medicine. Access to fertility treatment by gays, lesbians, and unmarried persons: a committee opinion. Fertil Steril 2013; 100:1524.
  86. ACOG Committee on Health Care for Underserved Women. ACOG Committee Opinion No. 525: Health care for lesbians and bisexual women. Obstet Gynecol 2012; 119:1077.
  87. Marina S, Marina D, Marina F, et al. Sharing motherhood: biological lesbian co-mothers, a new IVF indication. Hum Reprod 2010; 25:938.
  88. Carpinello OJ, Jacob MC, Nulsen J, Benadiva C. Utilization of fertility treatment and reproductive choices by lesbian couples. Fertil Steril 2016; 106:1709.
  89. Cahill S, South K, Spade J. Outing Age: Public Policy Issues Affecting Gay, Lesbian, Bisexual, and Transgender Elders, Cahill S, Cordova S, Riggs J, Vaid U (Eds), The Policy Institute of the National Gay and Lesbian Task Force Foundation, Washington, DC 2009.
  90. Fredriksen-Goldsen KI, Kim HJ, Barkan SE, et al. Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. Am J Public Health 2013; 103:1802.
  91. Simone MJ, Meyer H, Eskildsen MA, Appelbaum JS. Caring for LGBT older adults. In: Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, 2nd ed, Makadon HJ, Mayer KH, Potter J, Goldhammer H (Eds), American College of Physicians, Philadelphia 2015. p.133-158.
  92. Still out, still aging: The MetLife study of lesbian, gay, and bisexual and transgender baby boomers. MetLife Mature Market Institute, 2010. https://www.metlife.com/assets/cao/mmi/publications/studies/2010/mmi-still-out-still-aging.pdf (Accessed on November 04, 2016).
  93. Croghan CF, Moone RP, Olson AM. Friends, family, and caregiving among midlife and older lesbian, gay, bisexual, and transgender adults. J Homosex 2014; 61:79.
  94. ActionAid. Hate crimes: The rise of"corrective" rape in South Africa. https://www.actionaid.org.uk/sites/default/files/publications/hate_crimes_the_rise_of_corrective_rape_in_south_africa_september_2009.pdf (Accessed on November 02, 2016).
  95. Beck AJ, Berzofsky M, Caspar R, Krebs C. Sexual victimization in prisons and jails reported by inmates, 2011 to 2012. United States Department of Justice Bureau of Justice Statistics. https://www.bjs.gov/content/pub/pdf/svpjri1112.pdf (Accessed on November 02, 2016).
  96. World Health Organization. Depression. http://www.who.int/topics/depression/en/ (Accessed on July 26, 2016).