Sexually transmitted diseases
Research has demonstrated that women who have sex with women (WSW) report having had most kinds of vaginitis, but gonorrhea, herpes or syphilis were reported only by lesbians who had sex with men (Carroll et al., 1997; Johnson et al., 1981, 1987; Robertson & Schacter, 1981; Roberts et al., 2000.) A careful sexual history is necessary to determine risk because lesbians often report a history of past male partners, sometimes within the last year (Diamant, Schuster, McGuigan, & Lever, 1999; Marrazzo & Stine, 2004). Lesbians who reported six or more male sexual partners were more likely to have had a sexually transmitted disease in one study (Diamant et al., 1999). Bacterial vaginosis (BV) is very commonly found in lesbians and their female partners (Berger et al., 1995) and can be spread between female partners (Marrazzo et al., 2002). Rates of HIV infection rates are generally low, but high in lesbians who have sex with high-risk men, use intravenous (IV) drugs, or other drugs and are sex workers (Cochran et al., 1996; Lemp et al., 1995; Mays, Cochran, Pies, Chu, & Ehrhardt, 1996). Researchers emphasize the need for history taking for sexual partners and drug use among WSW to assess risk and discuss prevention of HIV and other sexually transmitted diseases.
Mental health care
Research on utilization of mental health services has documented that lesbians use mental health services at high rates (Bernhard & Applegate, 1999; Bradford, Ryan, & Rothblum, 1994; Cochran & Mays, 2000; Hughes, Haas, & Avery, 1997; Hughes, Haas, Razzano, Cassidy, & Matthews, 2000; Matthews, Hughes, Johnson, Razzano, & Cassidy, 2002; Roberts, Grindel, Patsdaughter, Reardon, & Tarmina, in press; Sorensen & Roberts, 1997; Trippet & Bain, 1993) and have a more positive response to therapy (Jones & Gabriel, 1999; Morgan, 1997). Almost 70% to 80% of lesbian samples report use of mental health services (Bradford et al., 1994; Hughes et al., 1997; Roberts et al., in press; Sorensen & Roberts). Cochran and Mays found that both men and women reporting any same gender sex partners were more likely than others to have used mental health services in the previous year. Therapy rates in lesbians are significantly higher than in heterosexual women (Hughes et al., 1997, 2000; Matthews et al., 2002). Depression and relationship problems are the most commonly cited reasons for counseling (Bradford et al.; Roberts et al.; Sorensen & Roberts).
Depression has consistently been found to be the major mental health problem found in surveys of lesbians (Bradford et al., 1994; Cochran & Mays, 1994; Roberts et al., in press; Sorensen & Roberts, 1997). Several large studies found significantly higher levels of depression in lesbians in the sample compared with the heterosexual women (Case et al., 2004; Valanis et al., 2000). Another study also found higher rates of treatment for depression and of suicide attempts than the heterosexual women in their sample (Matthews et al., 2002). At least one suicide attempt was reported by 18% to 20% of lesbian samples in several surveys (Bradford et al.; Hughes et al., 1997; Roberts et al.; Sorensen & Roberts). Suicide attempt rates are highest among bisexual and lesbian adolescents (Garofalo, Wolf, Wissow, Woods, & Goodman, 1999; Ramafedi, French, Story, Resnick, & Blum, 1998).
There is little data on reasons for the increased mental health needs in this population, but it has been suggested that that "secrecy" about being a lesbian, dealing with their sexual identity, and being a member of a stigmatized group lead to anxiety and depression (Bernhard & Applegate, 1999; Case et al., 2004; Cochran, 2001). This reason is particularly true for adolescents (Paroski, 1987).
Alcohol use and abuse
Several groups of investigators, in early studies, identified a higher use of alcohol and alcohol abuse in lesbian populations, in some almost five times that of heterosexual women (Diamond & Wilsnack, 1978; Hall, 1992; Lewis, Saghir, & Robins, 1982; Milman & Su, 1973), but these studies were criticized for selecting their samples from bars and clinical populations in which alcohol abuse may be more frequent (Mosbacher, 1988). A study with improved methodology found a higher percentage of alcohol and drug use but not of heavy drug use when compared to the general public (McKirnan & Peterson, 1989a, 1989b). Subsequent community-based surveys have, however, consistently reported higher rates of drinking and heavy drinking when compared to national data on women in general (Aaron et al., 2001; Bradford et al., 1994; Roberts, Grindel, Patsdaughter, DeMarco, & Tarmina, 2004; Roberts & Sorensen, 1999a).
Data from the 1996 National Household Survey of Drug Abuse found that women who had same-sex sexual partners used alcohol more frequently, in greater amounts, and had greater alcohol-related morbidity than women with opposite sex partners (Cochran, Keenan, Schober, & Mays, 2000). They were also more likely to be classified with alcohol or drug dependency syndromes (Cochran & Mays, 2000). Hughes et al. (1997) found lower rates of alcohol use among lesbians than a heterosexual comparison group, but of the lesbians who reported abstinence from alcohol in the last year, 40% (as compared to 7% of heterosexual women) had been in alcohol treatment or in a 12-step recovery program. Two reviews concluded that lesbians have similar rates of heavy drinking, but that drinking rates do not decline with age as they do with heterosexual women, and that lesbians report more alcohol-related problems (Abbott, 1998; Hughes & Wilsnack, 1997).
The reason for heavy alcohol use and increased alcohol abuse in lesbians is not clear. A large study of women in a California Health Maintenance Organization (HMO) found that the lesbian and bisexual women were more likely than the heterosexual women in their sample to drink and to drink heavily, and this difference was independent of the effects of stress, depression, and socioeconomic variables (Gruskin et al., 2001). Another study also found higher rates of heavy drinking in lesbian than in a heterosexual comparison group, and 18% of the lesbians reported being in alcohol recovery compared with 2% of the heterosexual women (Hughes, Johnson, & Wilsnack, 2001). Alcohol abuse in this sample was related to a history of childhood sexual abuse. Several other studies have noted a relationship between heavy alcohol use and sexual abuse in lesbian samples (Roberts, Grindel, DeMarco, & Patsdaughter, 2004; Roberts & Sorensen, 1999b). Early studies had suggested that lesbians may report higher rates of childhood sexual abuse (Gundlach, 1977; Loulan, 1987) and subsequent surveys have reinforced this finding (Bradford et al., 1994; Roberts & Sorensen). Several reviews have suggested that heavy alcohol use and abuse is not related, per se, to homosexuality, but rather to the stress of discrimination and marginalization, and the presence of known risk factors, such as a history of sexual abuse (Hughes, 2006; Hughes & Wilsnack, 1997). Alcohol abuse may be related to the stress of discrimination and marginalization and the presence of known risk factors.