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The barrier methods recommended include the use of dental dams for oral—genital or oral-anal contact; condoms on dildos and sex toys; and latex finger cots during vaginal or anal penetration. PARENTING Many lesbians raise children who are the product of previous heterosexual relationships, and an increasing number want to start families in a lesbian relationship. Adoption is a desirable option, but domestic adoptions of healthy newborns are difficult for lesbians to arrange. As a result, many lesbian families pursue international adoption, or children with special needs.
Women who inquire about this option should be advised to consult with persons knowledgeable about the adoption situation locally. Women wishing to be biologic mothers should be advised that donor insemination through a medical or other licensed facility is optimal. The essential procedure placing semen in the vagina does not require any special medical expertise or equipment and can be arranged without medical or legal consultation; however, this method is not advisable for a number of reasons. First, the donor may later desire involvement with the child beyond the original agreement, and although sometimes this works out well, it often may not.
Second, the donor may decide to stop donating semen without notice. Finally, and perhaps most importantly, the woman cannot be sure that the donor is infection-free, particularly from HIV. HIV transmission via artificial insemination one in the United States has been reported, with an estimated risk of less than 0. Half of the women received fresh semen from gay or bisexual men living in San Francisco before All women in the study were tested for HIV; none were positive. Ross et al surveyed a group of lesbians and bisexual women, and shared their suggestions with assisted reproductive services who were interested in being more lesbian-friendly.
The basis for this policy is sometimes stated as concern for the outcome of the children born into a lesbian household. A number of studies have specifically focused on role development and social relationships. To test this hypothesis, they performed their own analysis of 21 studies published throughand found a number of interesting differences, which they point out are essentially ignored by the authors of the studies. For example, young children being raised by lesbians are less likely to restrict their play to gender stereotypic activities; older girls are more likely to have interest in traditionally masculine occupations; and children of both genders are more likely to report homoerotic thoughts, although there is not a difference in reported sexual orientation.
In conclusion, the authors suggest that there might be much to gain in the understanding of families and parenting styles if these differences were examined instead of glossed over. A model for those who choose to provide lesbians with insemination services is described by Brewaeys and associates. Before being accepted as clients, lesbians must: Lesbians who become pregnant appear to be model patients. Harvey and colleagues 65 surveyed 35 women who became pregnant as a result of artificial insemination. The factors that have been identified so far include higher rates of tobacco and alcohol use, 1237666768 obesity; 69 lower rates of parity and thus less breastfeeding, and less use of oral contraceptives.
However, there are few data examining the relative rates of these diseases between heterosexual and homosexual women. Based on data collected at the time of enrollment, the lesbians and bisexual women were more likely to report the risk factors of obesity, smoking, and had a higher rate of alcohol use. Overall, there were no significant differences in the rates of any of the disease conditions assessed, and differences described here must be interpreted accordingly. Rates of 'any cancer' were highest for the bisexual women, while the rates were similar for the other groups. Breast cancer was reported by each of the nonheterosexual groups more often than the heterosexual women, although the trend was not significant.
Interestingly, the highest rates of cervical cancer were reported by the bisexual women, and unexpectedly, lifetime lesbians. Lifetime lesbians also reported the highest rate of colorectal cancer. There were no cases of endometrial cancer among the lifetime lesbians, also unexpected given their higher rate of nulliparity. In the category of cardiovascular disease, adult and lifetime lesbians reported more myocardial infarctions, but had the same rate of hypertension, and fewer strokes as compared to the bisexual and heterosexual women. Although the sample sizes for the nonheterosexual groups are the largest published to date in this age group, they are quite small from an epidemiologic perspective, and a finding of no difference must be interpreted with caution.
Mental Health Issues Alcohol and Substance Abuse The older literature suggested that lesbians have a high rate of alcohol abuse, and indeed, bars had an important place in lesbian culture.
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Most recent studies, conducted in general population samples, have found that more lesbians than heterosexual women use alcohol, but the rates of heavy descirbe are similar to those of the heterosexual controls. Data from the Trilogy Project, a longitudinal study of more than young adult gay men and lesbians, found higher rates of marijuana but not cocaine use compared to a general population survey. Population desccribe studies provide the best data. A national probability survey in the US showed Women describe lesbian higher rate of anxiety disorders among lesbians compared elsbian heterosexual women, 74 whereas a similarly designed study in the Netherlands showed higher rates of depression, but not anxiety, among lesbians compared to heterosexual women.
The methods required for identification and intervention may differ from those that are effective with heterosexual women. In a national probability sample, the prevalence of intimate partner violence was higher between gay men, and lower between lesbian partners compared to heterosexual couples. Koh 45 compared screening testing among lesbians, bisexual women, and heterosexual women recruited from a clinic setting and found that the rate of cholesterol testing was the same, the rate of HIV testing was higher among the lesbians and bisexuals, and mammography and Pap smear rates were the same.
Positive attitudes on the part of providers are detectable by lesbian patients, and have good consequences on health care. Based on a survey of almost lesbians, Diamant and colleagues reported that disclosure of lesbian status to the health care professional was associated with a higher likelihood of getting a Pap smear, supporting the notion that openness is associated with better health care. Stevens 1 points out that there are substantial personal costs to continually maintaining nondisclosure.
If disclosure to a new person is considered, a complex monitoring process must occur to determine if the disclosure is describr. Despite the risks, many lesbians do choose to disclose Wlmen health care providers. In two large surveys, half of the lesbian respondents had disclosed to at least one physician. Smith and colleagues 87 provide additional details. Yet, disclosure was usually unsolicited; only one fourth of the women who disclosed did so in response to a direct question from the physician. In summary, there is both theoretical and empirical evidence to suggest that disclosure to health care providers perhaps especially physicians is considered risky, yet it appears that a large number of lesbians do so despite the risk.
Johnson and Guenther 88 suggest three possible reasons: A need for appropriate health care might overcome fear of adverse interpersonal consequences. A lesbian with a vaginal infection will want to know if she can transmit it to her female partner, and if so, during what specific sexual activities. More urgently, she may want to discuss her risk of acquiring HIV infection and how to reduce this risk. Many lesbians now want to have children, and must successfully negotiate the process for insemination, and later, prenatal care and childbirth. The lesbian with a life-threatening illness needs to include her partner in discussions with the provider, and to make known the power-of-attorney to be used should she be unable to speak for herself.
The other two motivations for disclosure are less obvious but no less important. An honest, respectful, mutually satisfactory relationship between the provider and the patient leads to better health outcomes. When it is necessary to withhold these aspects of the self from the provider, trust cannot develop. Finally, individuals who are comfortable being 'out' may disclose purely for political purposes. This strategy may, in fact, be useful.
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Physicians who have lesbjan treated homosexual patients have been shown to be deacribe likely to be homophobic. Educate yourself about the medical aspects of problems relevant to lesbians. This chapter provides a starting point lesbkan that task. Questions about marriage, sexual descrobe, and birth control are often asked in a way that assumes the respondent is heterosexual. Some clinicians use a personal code in the medical record so that they remember from visit to visit. Practice different responses with colleagues, just as you practice other things that you want to learn. Figure out what you feel comfortable saying. Responses will vary by age and developmental stage of the student.
Your comfort in answering these questions will set a welcoming tone in your class and school community. An answer can be as simple as: Focus on love and relationships: You can just clarify that people love each other in different ways. Some women love and want to be partners with a man and some women love and want to be partners with a woman. What does that mean? Will your answer be about name-calling, defining what it means to be gay, different kinds of families or some combination of answers? Think about what messages you want to share: All people deserve respect.