Funding for more research is urgently needed

Lesbian health has been understudied. Important issues need to be examined, such as access and barriers to care, whether appropriate services are being offered, and the health behaviors and health status of lesbians. Most research on lesbian health has relied on nonprobability samples, with limited information from studies that have included heterosexual women and that compared the 2 groups. Although this study is not probability-based, participants—lesbians and bisexual and heterosexual women—were sampled from groups of women in a variety of health care settings. The findings from this study are consistent with information from prior research. The study also highlights that lesbians may not be seeking the preventive care they need. Of note, the women in this study were lesbians who were already receiving medical care. They are not representative of lesbians (and heterosexual women) who have difficulty gaining access to the health care system.

This study shows the large gaps that exist in medical knowledge regarding lesbian health and the need for adequate support for the study of lesbian, gay, bisexual, and transgender health issues. Increased funding is vital. We need to perform probability-based studies, including population studies that will provide representative data identifying the health care issues of lesbians in this country. Population-based studies are also necessary to measure the differences between lesbians and heterosexual women in their access to health care, health status, and risk for poor health. Population-based samples indicate that significant differences exist in the access and receipt of care between these 2 groups and that lesbians are more likely not to receive medical care and to encounter barriers to care (ALD, C Wold, K Spritzer, L Gelberg, unpublished data, 2000).¹

Including items that assess sexual orientation and sexual behaviors in large studies such as the National Health Interview Survey would lead to a more accurate understanding of the types and extent of disparities in health care that exist for lesbians. The information obtained could be used to develop programs that focus on eradicating these disparities. A requirement to include lesbian, gay, bisexual, and transgender people in research studies, such as has been used to ensure that women and minority groups are represented, should also be strongly considered.

Standardization of the terms used in lesbian research is necessary to identify the health issues of concern to lesbians. Three dimensions are apparently used to define sexuality: sexual orientation, sexual behavior (sex of one's sexual partners), and sexual attraction or desire.^1(p31) To validly assess the effects on health of being “lesbian,” some measurement of these 3 dimensions is important. Women who identify themselves as lesbian and have male sexual partners may face different health issues than women who have female partners only. Research in this area is particularly important in setting the agenda to study lesbian health.

Factors that may put lesbians at risk for reduced access to and receipt of health care include a lack of health insurance and a history of adverse experiences within the health care system. Health care professionals not only should be trained in the mechanics of taking a sexual history but also should understand how to provide sensitive care that does not alienate lesbians from seeking the medical services they need. Health care professionals should be taught to ask all patients about their sexual history, including sexual orientation and the sex of their sexual partners (current and lifetime).