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By: Wulf Utian MD PhD DSc

About 5% of women will have their primary emotional
and sexual relationship with other women. Beyond that, lesbian (homosexual,
gay) women are identical in almost every other respect to the general
population in terms of age at menopause, ethnic origin, education, religious
persuasion, and all the other differences that make us all so interesting. Even
their sexual behavior may range from abstinence/celibacy to bisexuality, or
intermittent hetero- and homosexual relationships.

There is some evidence to suggest that lesbian
women experience higher rates for some chronic diseases after midlife including
CVD and some cancers. The attributable cause may be that this is related to
relevant lifestyle risks. The latter was confirmed in the data from the various
groups within the WHI demonstrating higher incidence of risk factors like
smoking, obesity, and alcohol consumption. Another reason might be less
frequent use of health care services, perhaps partly explained by fear of
insensitivity or lack of confidentiality when lesbian women avail themselves of
health care.

Inappropriate assumptions such as lesbians not
having had heterosexual encounters and therefore less exposed to sexually
transmitted diseases (STDs), or that they are less subject to physical sexual
abuse, and therefore less susceptible to psychological trauma, account for some
of the inappropriate medical management provided to these women. In fact,
lesbians do develop cervical cancer, and if they do not have a pregnancy they
may be at increased risk for breast cancer and ovarian cancer. Intimate partner
violence does occur, albeit less frequently than in heterosexual relationships.
Furthermore, antigay verbal abuse and discrimination may result in greater
levels of anxiety and mood disorders.

The important lessons I have taught clinical
practitioners over many years is that they must ask the correct questions at
the time of medical history taking on entrance into a practice, that all
appropriate screening tests must be considered and followed through, and
special care needs to be taken in acquiring information and ensuring confidence
when counseling lesbian menopausal women.

I also advise that their office staff must be well
trained and able to obtain a detailed sexual history with a nonjudgmental
attitude. The staff must be able to instill confidence and to assure
confidentiality of all information obtained. An office questionnaire should
include questions about sexual orientation and behavior such as “are you
sexually active,” “in a relationship,” “partner/s male female or both,” and “are
there multiple partners?” Useful information would also relate to bisexual
relationships. Finally sexual dysfunction is not limited to heterosexual
relationships, and appropriate sexual function questions should be addressed.

Recommended screening tests obviously should
include Pap smears and mammographic examinations. Screening for STDs is also
important. Trichomonas vaginitis, bacterial vaginitis, herpes virus infection,
and human papilloma virus (HPV) can be spread woman to woman. HIV transfer is
unlikely unless there is intravenous drug abuse or bisexual contact.

I will address some issues relating to sexually
transmitted disease and menopause in my next column.

Have a great week.

Utian MD PhD DSc

MENOPAUSE – Why one size does not fit


The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.

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