0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Lesbians' Sexual History With Men:  Implications for Taking a Sexual History FREE

Allison L. Diamant, MD, MSHS; Mark A. Schuster, MD, PhD; Kimberly McGuigan, PhD; Janet Lever, PhD
[+] Author Affiliations

From the Departments of Medicine (Dr Diamant) and Pediatrics (Dr Schuster), School of Medicine, and the Department of Health Services (Dr Schuster), University of California, Los Angeles; RAND, Santa Monica, Calif (Drs Schuster, McGuigan, and Lever); and California State University, Los Angeles (Dr Lever).


Arch Intern Med. 1999;159(22):2730-2736. doi:10.1001/archinte.159.22.2730.
Text Size: A A A
Published online

Background  Health care providers may not solicit a comprehensive sexual history from lesbian patients because of provider assumptions that lesbians have not been sexually active with men. We performed this study to assess whether women who identify themselves as lesbians have a history of sexual activities with men that have implications for receipt of preventive health screening.

Objective  To convey the importance for health care providers to know their patients' sexual history when making appropriate recommendations for preventive health care.

Methods  A survey was printed in a national news magazine aimed at homosexual men, lesbians, and bisexual men and women. The sample included 6935 self-identified lesbians from all 50 US states. The outcomes we measured were respondents' number of lifetime male sexual partners and partners during the past year, their lifetime history of specific sexual activities (eg, vaginal intercourse, anal intercourse), their lifetime condom use, and their lifetime history of sexually transmitted diseases.

Results  Of respondents, 77.3% had 1 or more lifetime male sexual partners, 70.5% had a lifetime history of vaginal intercourse, 17.2% had a lifetime history of anal intercourse, and 17.2% had a lifetime history of a sexually transmitted disease. Exactly 5.7% reported having had a male sexual partner during the past year.

Conclusion  These findings reinforce the need for providers to know their patients' sexual history regardless of their reported sexual orientation, especially with regard to recommendations for Papanicolaou smears and screening for sexually transmitted diseases.

ALTHOUGH THERE is strong consensus among primary care provider organizations that clinicians should obtain a sexual history from their patients, this aspect of a patient's medical history may not receive adequate attention because of reluctance on the part of the health care provider (ie, physician, nurse practitioner, physician assistant) or the patient.18 Provider knowledge of their patients' sexual history is important for (1) determining when to screen for sexually transmitted diseases (STDs) and pregnancy, (2) recommending appropriate preventive health care services, (3) developing a differential diagnosis, (4) providing relevant risk-reduction counseling, and (5) determining whether a patient has medically treatable sexual problems that could be inhibiting a fulfilling sexual life.

Women who have a history of vaginal intercourse are at greater risk for gynecologic infection and malignant neoplasms than women who have never had vaginal intercourse, and this risk increases for women who have a history of vaginal intercourse without a condom.9,10 Unless health care providers specifically ask a patient about her sexual history and the activities she has engaged in, they may make incorrect assumptions regarding her sexual history and sexual orientation, and these assumptions may affect the quality of health care services provided.

A lesbian is, by definition, a woman who is primarily physically and emotionally attracted to other women1115; however, the woman's past or current sexual partners may not be limited to women. Because of ambiguity of public perceptions and the fluidity of sexual activity, clinicians may assume, with good intentions, that they do not need to ask patients they know or assume to be lesbians about a history of male sexual partners. Results of previous studies indicate that many lesbians have had at least 1 male sexual partner at some time during their lives.1626 However, information has not been available on pertinent aspects of lesbians' sexual history with men, including age at onset of sexual activity with men, specific sexual activities, recency of sexual activity, number of lifetime male partners, and use of condoms.

In this article, we use national data from a magazine-based survey to determine whether women who identify themselves as lesbians have a history of engaging in vaginal intercourse and other sexual activities with men and, if so, the nature and duration of their sexual history with men, as well as their history of STDs and abnormal Papanicolaou (Pap) smears.

INSTRUMENT

A 186-item questionnaire was developed by 3 health services researchers (including M.A.S. and J.L.) and was printed in The Advocate, a monthly national news magazine for homosexual men, lesbians, and bisexual men and women. The questionnaire appeared as a several-page insert in the center of the March 1995 issue and included a postage-paid, return-addressed mailer. The questionnaire included demographics, sexual orientation, sexual history with men, and gynecologic history, as well as other items not covered in this article.

STUDY SAMPLE

Marketing and subscription information at the time of the survey indicated that 88 000 copies of each issue of The Advocate were distributed and that the female readership was about 24 000. There were 7929 respondents. The analysis sample for this article consisted of 6935 women from the 50 United States who identified themselves as lesbians on the basis of their response to the first item of the survey, "How do you describe your sexuality," with the following response options: (1) homosexual, gay, or lesbian; (2) bisexual; (3) heterosexual or straight; and (4) not sure. We only included lesbians because we were interested in assessing sexual activity with men among a population of women whose health care providers might make inaccurate assumptions about their sexual history on the basis of their orientation. Women who listed their orientation as bisexual or unsure (n = 862) and 132 women from 18 foreign countries were omitted from this analysis.

The study protocol was submitted to the university Human Subjects Protection Committee for the University of California, Los Angeles, and was granted institutional review board approval.

OUTCOME VARIABLES

Respondents reported their lifetime sexual activities with men, including kissing, mutual masturbation, fellatio, cunnilingus, vaginal intercourse with and without a condom, anal intercourse with and without a condom, and number of male sexual partners ever and during the past year. In the survey, vaginal intercourse was defined as occurring with men. The survey also included age at first and most recent vaginal intercourse and history of gonorrhea, Chlamydia infection, trichomoniasis, pelvic inflammatory disease, syphilis, genital or anal herpes, genital or anal warts, and human immunodeficiency virus (HIV) infection. We classified respondents as having a history of at least 1 STD if they reported 1 or more of these conditions. The survey also included items regarding history of an abnormal Pap smear and history of HIV testing.

STATISTICAL ANALYSES

We performed bivariate analyses by means of χ2 tests. We performed logistic regression for the following outcome variables: a history of vaginal intercourse, having a male sexual partner within the past year, and vaginal intercourse without a condom. We included in the regression models all independent variables that were significant at P<.05 in bivariate analyses.

DEMOGRAPHICS AND OTHER CHARACTERISTICS

In response to our survey, 84.8% of lesbian respondents were between 25 and 49 years of age (mean, 35 years), and 87.5% of respondents described themselves as white (Table 1). College graduates comprised 22.2% of the respondents, and an additional 40.6% had some graduate or professional school experience. An annual income between $20 001 and $50 000 was reported by 54.5%, and 35.3% lived in cities with greater than 1 million people.

Table Graphic Jump LocationTable 1. Demographic and Other Characteristics for a Sample of 6935 Self-identified Lesbians
SEXUAL HISTORY WITH MEN

Of the respondents, 77.3% reported ever having had a male sexual partner, 70.5% had engaged in vaginal intercourse at least once, and 17.2% had engaged in anal intercourse at least once (Table 2). Among women who had engaged in vaginal intercourse, the mean age at first intercourse was 18 years, and the mean age at last intercourse was 25 years. Our data showed that 5.7% of respondents reported having had 1 or more male sexual contacts within the preceding year. Respondents in this study also reported a history of ever having participated in the following sexual activities with men: kissing (94.5%), mutual masturbation (64.0%), fellatio (62.0%), and cunnilingus (62.3%).

Table Graphic Jump LocationTable 2. Lesbians' Lifetime Sexual History With Men by Demographic Characteristics*

Results of the multivariate logistic regression model are found in Table 3. Lesbians were significantly more likely to have a history of vaginal intercourse if they had not graduated from college and were less likely if they were younger than 50 years, or if they lived in small or medium-sized cities or rural areas.

Table Graphic Jump LocationTable 3. Multivariate Logistic Regression Models for a Lifetime History of Vaginal Intercourse, Lifetime History of Vaginal Intercourse Without a Condom, and History of a Male Sexual Partner Within the Past Year

The multivariate regression model that we used to assess the independent effects of the explanatory variables on whether lesbians had had a male sexual partner during the preceding year showed that women who were not white, who were younger than 50 years, who had not graduated from college, and who had an annual income of $20 000 or less (vs those with an annual income greater than $50 000) were more likely to have had 1 or more male sexual partners during the past year (Table 3).

CONDOM USE

Our results showed that 63.9% of all respondents and 88.2% of lesbians who had had vaginal intercourse reported that they had participated in vaginal intercourse without a condom, and these findings varied significantly in the bivariate analyses by race or ethnicity, age, education, and income (Table 2); also, 69.1% reported that they had ever used a condom during vaginal intercourse. For all respondents, 15.8% reported a lifetime history of anal intercourse without a condom, and there were significant differences by age, income, education, and place of residence. Our data showed that 4.8% reported ever using a condom during anal intercourse, with significant variation by race or ethnicity and income.

In the regression model, lesbians were significantly more likely to have engaged in vaginal intercourse without a condom if they were older than 50 years (compared with women younger than 25 years and women 25 to 29 years old), or if they reported more than 1 lifetime male sex partner (Table 3).

MEDICAL AND GYNECOLOGIC HISTORY

In response to our survey, 17.2% of respondents reported a lifetime diagnosis of an STD, and 17.3% reported a lifetime history of an abnormal Pap smear (Table 4). The most commonly reported STDs were trichomoniasis (6.0%), genital or anal warts (4.8%), Chlamydia infection (4.6%), genital or anal herpes (3.3%), pelvic inflammatory disease (2.0%), and gonorrhea (1.62%), with fewer than 1% of respondents reporting a history of syphilis (0.3%) or HIV infection (0.1%). Lesbians who reported 6 or more male sexual partners were most likely to have had an STD at some point during their lives. Lesbians who had participated in vaginal intercourse were more likely to have reported a history of an STD than lesbians who did not have a history of vaginal intercourse (21.4% vs 7.3%; P<.001). Lesbians who had engaged in vaginal intercourse and those who had engaged in anal intercourse reported higher rates of STDs and abnormal Pap smears than those who had not engaged in these activities (Table 4).

Table Graphic Jump LocationTable 4. History of Any STD, HIV Testing, and History of Abnormal Papanicolaou Smear for a Sample of Self-identified Lesbians by Lifetime History of Vaginal Intercourse or Anal Intercourse*
TESTING FOR HIV

Of all respondents, 53.2% had had an HIV test at some point during their lifetime, and 66.1% of individuals who had a lifetime history of an STD had undergone testing for HIV (P<.001). Among women who had engaged in vaginal intercourse or anal intercourse without a condom, 42.3% and 37.1%, respectively, had never been tested for HIV. Overall, 5.9% of respondents had ever participated in anal intercourse without a condom and had never been tested for HIV, and 26.9% of respondents had ever engaged in vaginal intercourse without a condom and had never been tested for HIV.

In this study, a majority of lesbians had engaged in penile vaginal intercourse, with a significant proportion participating in vaginal intercourse without a condom. Younger women were more likely to have had a male sexual partner during the preceding year. By contrast, older women were more likely than younger women to have engaged in vaginal intercourse, perhaps because the former have had a longer time during which to engage in such activity. Older women were also less likely to have used a condom, which may indicate that public health messages about safer sex are not influencing them or that such messages were not yet available when they were having intercourse.

If clinicians assume that a woman who identifies herself as a lesbian has not had any sexual contact with men, or that such contact was only in the distant past, they may not make appropriate diagnostic and treatment recommendations. Of particular importance with regard to recommendations by providers for cervical cancer screening is lesbians' prior sexual history with men, including age at first vaginal intercourse, use of condoms, and number of lifetime male sexual partners. The clinical importance of these findings relates to clinicians' advice to their lesbian patients regarding receipt of appropriate health care services, including cervical cancer screening, testing for STDs, advice regarding safe sexual behaviors, and information about contraception and fertility.

The findings from our study are consistent with previous studies that show a history of sexual contact with men for many lesbians1626; however, our study also provides information on specific sexual activities that lesbians have engaged in with men and on their use of condoms. This information is important for clinicians in the provision of appropriate health care services to lesbians. In a more recent study, Lemp et al16 reported on the prevalence of risk behaviors for HIV, such as "unsafe sex with men," among a sample of 498 lesbians and bisexual women in San Francisco and Berkeley, Calif. Forty percent of these lesbians had engaged in unprotected vaginal (39%) or anal (11%) sex within the preceding 3 years, some with homosexual or bisexual men or male injecting drug users.16

According to guidelines from the US Preventive Services Task Force, regular Pap smears are recommended for all women who are currently, or have been previously, sexually active with men and who have a cervix, beginning at age 18 years or when the woman first engages in sexual intercourse.1 After at least 3 consecutive annual tests have been normal, Pap smears may be done every 3 years for women at low risk for cervical dysplasia. These recommendations vary among specialty organizations.27,28 In general, women who have engaged in sexual intercourse with 5 or fewer lifetime male partners and who have not participated in unprotected vaginal intercourse are characterized as being at lower risk for cervical dysplasia.1 Women who become sexually active with a new male partner within a year of their last Pap smear are advised to undergo annual screening.

The Centers for Disease Control and Prevention established that unprotected anal intercourse is the highest-risk sexual activity for the transmission of HIV, and unprotected vaginal intercourse is also a high-risk sexual activity.29,30 In our study, 5.9% of respondents had ever participated in anal intercourse without a condom and had never been tested for HIV, and 26.9% of respondents had ever engaged in vaginal intercourse without a condom and had never been tested for HIV.

Other clinical implications of a history of vaginal intercourse with STDs include decreased fertility, chronic infection (eg, herpes simplex virus), and risk of transmission of disease to sexual partners of either sex. If women are or were sexually active with men, the potential for infection may be greater than if they have only been sexually active with women31; however, there is evidence that infection with herpes simplex virus, Trichomonas vaginalis, Gardnerella vaginalis, and perhaps human papillomavirus, may be transmitted between female sexual partners.26,32,33 The transmission of HIV between female sexual partners is less clear. There are several published case reports of women with HIV whose only known potential route of transmission was female-to-female sexual contact.3440 However, one short-term prospective study found no female-to-female transmission after 6 months among 18 couples discordant for HIV infection who participated in orogenital sex.41

This study has a number of important strengths. First, in contrast to previous studies, this study is based on a much larger number of respondents who resided in all 50 states, allowing subgroup analyses. Second, the questionnaire included detailed questions about types of sexual behaviors, which, combined with the large sample size and demographic information, permits analysis of relationships that have not previously been examined. Third, the sample includes a large number of women whose sexual behavior puts them in important health risk categories. Fourth, a broad-based media solicitation yields broader geographic diversity of representation that surpasses the convenience samples of lesbians studied to date.

Although this article presents results from the largest sample of lesbians studied to date, there are some limitations. This study did not use probability sampling, so generalization to all lesbians must be done with caution. The difficulty in identifying a probability sample partly results from the hesitancy of some women to disclose their sexual orientation because of fear of negative reactions from employers, family, and others.21,4244 Those women who read The Advocate magazine may not be representative of lesbians in general, and the lesbians who responded may not be representative of the full female readership of the magazine. How these sampling biases relate to either sexual history or health-seeking behavior is unknown in this population. Data suggest that individuals who answer surveys about sexual issues tend to hold more liberal sexual attitudes and be more sexually active than nonrespondents.45 Magazine readership also tends to be skewed toward people with higher-than-average education and income, which was also true of our sample. Another limitation is the reliance on self-report for disease conditions, a limitation common to survey-based studies.

If health care providers are to make appropriate recommendations to their lesbian patients regarding preventive health care screening, preventive behaviors, and treatment options, they must obtain an accurate social history that includes a woman's sexual history as well as, but not limited to, any history of substance use, physical or emotional abuse, social support systems, and employment. In previous studies, lesbians have reported negative experiences with health care providers that included insensitive comments, inadequate or inappropriate health care, and refusal to provide treatment.18,20,21,23,24,46 When introducing the topic of the sexual history to the patient, the clinician can preface the questions with an explanation of why an accurate and complete sexual history is important, and then ask the questions without specifying a presumed sex of the woman's partners. For example, the clinician can explain that women who have had vaginal intercourse have an increased risk for cervical dysplasia, that cervical cancer screening is recommended even in women who are no longer sexually active with men, and that STDs may have long-term effects on fertility.

In summary, many lesbians have a history of sexual contact with men that includes unprotected vaginal intercourse, and some have engaged in unprotected anal intercourse. Therefore, clinicians should not assume that women who describe themselves as lesbians have never engaged in sexual activity with men or are not currently doing so. It is important for the clinician to know a patient's complete medical and social history, including current and past sexual activity, to make appropriate decisions regarding the provision of appropriate health care. This care includes, but is not limited to, performing Pap smears, screening for STDs, assessing HIV risk factors, and advising on sexual risk reduction.

Accepted for publication March 15, 1999.

This study was supported by grants from the Centers for Disease Control and Prevention, Atlanta, Ga, and the Lesbian Health Fund, San Francisco, Calif, and by the UCLA Robert Wood Johnson Clinical Scholars Program, Los Angeles, Calif, and the University of California, Los Angeles, National Research Service Award Primary Care Fellowship.

This work does not necessarily represent the opinions of the funding organizations or of the institutions with which the authors are affiliated.

We thank Carol Edwards for programming and Katherine Kahn, MD, and Lillian Gelberg, MD, MSPH, for their comments on drafts of the manuscript.

Reprints: Allison L. Diamant, MD, MSHS, Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, 911 Broxton Plaza, Los Angeles, CA 90095 (e-mail: adiamant@ucla.edu).

US Preventive Services Task Force, Screening for cervical cancer. Guide to Clinical Preventive Services Report of the U.S. Preventive Services Task Force 2nd ed. Baltimore, Md Williams & Wilkins1996;105- 112
American Medical Association, HIV blood test counseling. Physician Guidelines. 2nd ed. Chicago, Ill American Medical Association1993;
American College of Obstetricians and Gynecologists, Human Immunodeficiency Virus Infection.  Washington, DC American College of Obstetricians and Gynecologists1992;Technical Bulletin No. 169.
American Academy of Family Physicians, Age Charts for Periodic Health Examination.  Kansas City, Mo American Academy of Family Physicians1994;Reprint No. 510.
American College of Physicians and Infectious Disease Society of America, Human immunodeficiency virus (HIV) infection. Ann Intern Med. 1994;120310- 319
Link to Article
American Academy of Pediatrics, Committee on Adolescence, Sexually transmitted diseases. Pediatrics. 1994;94568- 572
Leonardo  CChrisler  JC Women and sexually transmitted diseases. Women Health. 1992;181- 15
Link to Article
White  JC HIV risk assessment and prevention in lesbians and women who have sex with women: practical information for clinicians. Health Care Women Int. 1997;18127- 138
Link to Article
Kost  KForrest  JD American women's sexual behavior and exposure to risk of sexually transmitted diseases. Fam Plann Perspect. 1992;24244- 254
Link to Article
Stone  KM Avoiding sexually transmitted diseases. Obstet Gynecol Clin North Am. 1990;17789- 799
Harrison  AE Primary care of lesbian and gay patients: educating ourselves and our students. Fam Med. 1996;2810- 23
Rankow  EJ Lesbian health issues for the primary care provider. J Fam Pract. 1995;40486- 493
White  JLevinson  W Primary care of lesbian patients. J Gen Intern Med. 1993;841- 47
Link to Article
White  JCLevinson  W Lesbian health care: what a primary care physician needs to know. West J Med. 1995;162463- 466
Simkin  RJ Lesbians face unique health problems. CMAJ. 1991;1451620- 1623
Lemp  GFJones  MKellogg  TANieri  GNAnderson  LWithum  D HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, California. Am J Public Health. 1995;851549- 1552
Link to Article
Einhorn  LPolgar  M HIV-risk behavior among lesbians and bisexual women. AIDS Educ Prev. 1994;6514- 523
Bybee  D The Michigan Lesbian Health Survey.  Detroit Michigan Dept of Public Health1991;
Cochran  SDMays  VM Disclosure of sexual preference to physicians by black lesbian and bisexual women. West J Med. 1988;149616- 619
Johnson  SSmith  EGuenther  S Comparison of gynecologic health care problems between lesbians and bisexual women. J Reprod Med. 1987;32805- 811
Bradford  JRyan  C The National Lesbian Health Care Survey.  Washington, DC National Lesbian and Gay Health Foundation1987;
Bradford  JRyan  CRothblum  ED National Lesbian Health Care Survey: implications for mental health care. J Consult Clin Psychol. 1994;62228- 242
Link to Article
Smith  EJohnson  SGuenther  SM Health care attitudes and experiences during gynecologic care among lesbians and bisexuals. Am J Public Health. 1985;751085- 1087
Link to Article
Johnson  SGuenther  SMLaube  DWKeetel  WC Factors influencing lesbian gynecologic care: a preliminary study. Am J Obstet Gynecol. 1981;14020- 28
Mills  SGarcia  DMartinez  T  et al.  Health Behaviors Among Lesbian and Bisexual Women: A Community-Based Women's Health Survey.  San Francisco, Calif San Francisco Dept of Public Health, AIDS Office, Prevention Services Branch1993;
Carroll  NGoldstein  RSLo  WMayer  KH Gynecological infections and sexual practices of Massachusetts lesbian and bisexual women. J Gay Lesbian Med Assoc. 1997;115- 23
Link to Article
American College of Obstetricians and Gynecologists, Recommendations on Frequency of Pap Test Screening.  Washington, DC American College of Obstetricians and Gynecologists1995;Committee Opinion No. 152.
American Cancer Society, Guidelines for the Cancer-Related Checkup: An Update.  Atlanta, Ga American Cancer Society1993;
Centers for Disease Control and Prevention, Update: barrier protections against HIV infections and other sexually transmitted disease. MMWR Morb Mortal Wkly Rep. 1993;42589- 591, 597
Ostrow  DGDiFranceisco  WJChmiel  JSWagstaff  DAWesch  J A case-control study of human immunodeficiency virus type 1 seroconversion and risk-related behaviors in the Chicago MACS/CCS Cohort, 1984-1992. Am J Epidemiol. 1995;142875- 883
Robertson  PSchachter  J Failure to identify venereal disease in a lesbian population. Sex Transm Dis. 1981;875- 76
Link to Article
Berger  BJKolton  SZenilman  JMCummings  MCFeldman  JMcCormack  WM Bacterial vaginosis in lesbians: a sexually transmitted disease. Clin Infect Dis. 1995;211402- 1405
Link to Article
Bevier  PChaisson  MHeffernan  RTCastro  KG Women at a sexually transmitted disease clinic who reported same-sex contact: their HIV seroprevalence and risk behaviors. Am J Public Health. 1995;851366- 1371
Link to Article
Rich  JDBuck  AToumala  REKazanjian  PH Transmission of human immunodeficiency virus infection presumed to have occurred during female homosexual contact. Clin Infect Dis. 1993;171003- 1005
Link to Article
Chu  SYConti  LSchable  BADiaz  T Female-to-female sexual contact and HIV transmission [letter]. JAMA. 1994;272433
Link to Article
Chu  SYHammett  TABuehler  JW Update: epidemiology of reported cases of AIDS in women who report sex only with other women, United States, 1980-1991. AIDS. 1992;6518- 519
Link to Article
Monzon  OTCapellan  JMB Female-to-female transmission of HIV. Lancet. 1987;240- 41
Link to Article
Marmor  MWeiss  LRLyden  M  et al.  Possible female-to-female transmission of human immunodeficiency virus [letter]. Ann Intern Med. 1986;105969
Link to Article
Perry  SJacobsberg  LFogel  K Orogenital transmission of human immunodeficiency virus. Ann Intern Med. 1989;111951- 952
Link to Article
Kennedy  MDScarlett  MIDuerr  ACChu  SY Assessing HIV risk among women who have sex with women: scientific and communication issues. J Am Med Womens Assoc. 1995;50103- 107
Raiteri  RFora  RGioannini  P  et al.  Seroprevalence, risk factors and attitude to HIV-1 in a representative sample of lesbians in Turin. Genitourin Med. 1994;70200- 205
Stevens  PE Structural and interpersonal impact of heterosexual assumptions on lesbian health care clients. Nurs Res. 1995;4425- 30
Link to Article
Mathews  WCBooth  MWTurner  JDKessler  L Physicians' attitudes toward homosexuality: survey of a California county medical society. West J Med. 1986;144106- 110
Dardick  LGrady  KE Openness between gay persons and health professionals. Ann Intern Med. 1980;93115- 119
Link to Article
Dunne  MPMartin  NGBailey  JM  et al.  Participation bias in a sexuality survey: psychological and behavioral characteristics of responders and non-responders. Int J Epidemiol. 1997;26844- 854
Link to Article
Warshafsky  L Lesbian Health Needs Assessment.  Los Angeles, Calif Los Angeles Gay and Lesbian Community Center1992;

Figures

Tables

Table Graphic Jump LocationTable 1. Demographic and Other Characteristics for a Sample of 6935 Self-identified Lesbians
Table Graphic Jump LocationTable 2. Lesbians' Lifetime Sexual History With Men by Demographic Characteristics*
Table Graphic Jump LocationTable 3. Multivariate Logistic Regression Models for a Lifetime History of Vaginal Intercourse, Lifetime History of Vaginal Intercourse Without a Condom, and History of a Male Sexual Partner Within the Past Year
Table Graphic Jump LocationTable 4. History of Any STD, HIV Testing, and History of Abnormal Papanicolaou Smear for a Sample of Self-identified Lesbians by Lifetime History of Vaginal Intercourse or Anal Intercourse*

References

US Preventive Services Task Force, Screening for cervical cancer. Guide to Clinical Preventive Services Report of the U.S. Preventive Services Task Force 2nd ed. Baltimore, Md Williams & Wilkins1996;105- 112
American Medical Association, HIV blood test counseling. Physician Guidelines. 2nd ed. Chicago, Ill American Medical Association1993;
American College of Obstetricians and Gynecologists, Human Immunodeficiency Virus Infection.  Washington, DC American College of Obstetricians and Gynecologists1992;Technical Bulletin No. 169.
American Academy of Family Physicians, Age Charts for Periodic Health Examination.  Kansas City, Mo American Academy of Family Physicians1994;Reprint No. 510.
American College of Physicians and Infectious Disease Society of America, Human immunodeficiency virus (HIV) infection. Ann Intern Med. 1994;120310- 319
Link to Article
American Academy of Pediatrics, Committee on Adolescence, Sexually transmitted diseases. Pediatrics. 1994;94568- 572
Leonardo  CChrisler  JC Women and sexually transmitted diseases. Women Health. 1992;181- 15
Link to Article
White  JC HIV risk assessment and prevention in lesbians and women who have sex with women: practical information for clinicians. Health Care Women Int. 1997;18127- 138
Link to Article
Kost  KForrest  JD American women's sexual behavior and exposure to risk of sexually transmitted diseases. Fam Plann Perspect. 1992;24244- 254
Link to Article
Stone  KM Avoiding sexually transmitted diseases. Obstet Gynecol Clin North Am. 1990;17789- 799
Harrison  AE Primary care of lesbian and gay patients: educating ourselves and our students. Fam Med. 1996;2810- 23
Rankow  EJ Lesbian health issues for the primary care provider. J Fam Pract. 1995;40486- 493
White  JLevinson  W Primary care of lesbian patients. J Gen Intern Med. 1993;841- 47
Link to Article
White  JCLevinson  W Lesbian health care: what a primary care physician needs to know. West J Med. 1995;162463- 466
Simkin  RJ Lesbians face unique health problems. CMAJ. 1991;1451620- 1623
Lemp  GFJones  MKellogg  TANieri  GNAnderson  LWithum  D HIV seroprevalence and risk behaviors among lesbians and bisexual women in San Francisco and Berkeley, California. Am J Public Health. 1995;851549- 1552
Link to Article
Einhorn  LPolgar  M HIV-risk behavior among lesbians and bisexual women. AIDS Educ Prev. 1994;6514- 523
Bybee  D The Michigan Lesbian Health Survey.  Detroit Michigan Dept of Public Health1991;
Cochran  SDMays  VM Disclosure of sexual preference to physicians by black lesbian and bisexual women. West J Med. 1988;149616- 619
Johnson  SSmith  EGuenther  S Comparison of gynecologic health care problems between lesbians and bisexual women. J Reprod Med. 1987;32805- 811
Bradford  JRyan  C The National Lesbian Health Care Survey.  Washington, DC National Lesbian and Gay Health Foundation1987;
Bradford  JRyan  CRothblum  ED National Lesbian Health Care Survey: implications for mental health care. J Consult Clin Psychol. 1994;62228- 242
Link to Article
Smith  EJohnson  SGuenther  SM Health care attitudes and experiences during gynecologic care among lesbians and bisexuals. Am J Public Health. 1985;751085- 1087
Link to Article
Johnson  SGuenther  SMLaube  DWKeetel  WC Factors influencing lesbian gynecologic care: a preliminary study. Am J Obstet Gynecol. 1981;14020- 28
Mills  SGarcia  DMartinez  T  et al.  Health Behaviors Among Lesbian and Bisexual Women: A Community-Based Women's Health Survey.  San Francisco, Calif San Francisco Dept of Public Health, AIDS Office, Prevention Services Branch1993;
Carroll  NGoldstein  RSLo  WMayer  KH Gynecological infections and sexual practices of Massachusetts lesbian and bisexual women. J Gay Lesbian Med Assoc. 1997;115- 23
Link to Article
American College of Obstetricians and Gynecologists, Recommendations on Frequency of Pap Test Screening.  Washington, DC American College of Obstetricians and Gynecologists1995;Committee Opinion No. 152.
American Cancer Society, Guidelines for the Cancer-Related Checkup: An Update.  Atlanta, Ga American Cancer Society1993;
Centers for Disease Control and Prevention, Update: barrier protections against HIV infections and other sexually transmitted disease. MMWR Morb Mortal Wkly Rep. 1993;42589- 591, 597
Ostrow  DGDiFranceisco  WJChmiel  JSWagstaff  DAWesch  J A case-control study of human immunodeficiency virus type 1 seroconversion and risk-related behaviors in the Chicago MACS/CCS Cohort, 1984-1992. Am J Epidemiol. 1995;142875- 883
Robertson  PSchachter  J Failure to identify venereal disease in a lesbian population. Sex Transm Dis. 1981;875- 76
Link to Article
Berger  BJKolton  SZenilman  JMCummings  MCFeldman  JMcCormack  WM Bacterial vaginosis in lesbians: a sexually transmitted disease. Clin Infect Dis. 1995;211402- 1405
Link to Article
Bevier  PChaisson  MHeffernan  RTCastro  KG Women at a sexually transmitted disease clinic who reported same-sex contact: their HIV seroprevalence and risk behaviors. Am J Public Health. 1995;851366- 1371
Link to Article
Rich  JDBuck  AToumala  REKazanjian  PH Transmission of human immunodeficiency virus infection presumed to have occurred during female homosexual contact. Clin Infect Dis. 1993;171003- 1005
Link to Article
Chu  SYConti  LSchable  BADiaz  T Female-to-female sexual contact and HIV transmission [letter]. JAMA. 1994;272433
Link to Article
Chu  SYHammett  TABuehler  JW Update: epidemiology of reported cases of AIDS in women who report sex only with other women, United States, 1980-1991. AIDS. 1992;6518- 519
Link to Article
Monzon  OTCapellan  JMB Female-to-female transmission of HIV. Lancet. 1987;240- 41
Link to Article
Marmor  MWeiss  LRLyden  M  et al.  Possible female-to-female transmission of human immunodeficiency virus [letter]. Ann Intern Med. 1986;105969
Link to Article
Perry  SJacobsberg  LFogel  K Orogenital transmission of human immunodeficiency virus. Ann Intern Med. 1989;111951- 952
Link to Article
Kennedy  MDScarlett  MIDuerr  ACChu  SY Assessing HIV risk among women who have sex with women: scientific and communication issues. J Am Med Womens Assoc. 1995;50103- 107
Raiteri  RFora  RGioannini  P  et al.  Seroprevalence, risk factors and attitude to HIV-1 in a representative sample of lesbians in Turin. Genitourin Med. 1994;70200- 205
Stevens  PE Structural and interpersonal impact of heterosexual assumptions on lesbian health care clients. Nurs Res. 1995;4425- 30
Link to Article
Mathews  WCBooth  MWTurner  JDKessler  L Physicians' attitudes toward homosexuality: survey of a California county medical society. West J Med. 1986;144106- 110
Dardick  LGrady  KE Openness between gay persons and health professionals. Ann Intern Med. 1980;93115- 119
Link to Article
Dunne  MPMartin  NGBailey  JM  et al.  Participation bias in a sexuality survey: psychological and behavioral characteristics of responders and non-responders. Int J Epidemiol. 1997;26844- 854
Link to Article
Warshafsky  L Lesbian Health Needs Assessment.  Los Angeles, Calif Los Angeles Gay and Lesbian Community Center1992;

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 55

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles