Women who have sex with women (WSW) are women who engage in sexual activities with other women, whether or not they identify themselves as lesbian, bisexual, pansexual, heterosexual, or dispense with sexual identification altogether. The term WSW is often used in medical literature to describe such women as a group for clinical study, without needing to consider sexual self-identity.
In terms of medical issues with regard to lesbian sexual practices, the sexual identification of women who consult a medical professional is usually not sought nor volunteered, due to the misconceptions and assumptions about sexuality and the hesitancy of some women in disclosing their accurate sexual histories even to a physician. Many women who do not participate in heterosexual activity do not go to see a physician because they do not require birth control, which is the initiating factor for most women to seek consultation with a gynecologist when they become sexually active. As a result, these women are not screened regularly with pap smears because they have a lower perceived risk of acquiring a sexually transmitted infection or types of cancer. A factor which leads to lesbians neglecting to seek medical screening in the United States is a lack of health insurance offered by employers for same-sex domestic partners.
When women do seek medical attention, medical professionals often fail to take a complete medical history. In a recent study of 2,345 lesbian and bisexual women, only 9.3% had claimed they had ever been asked their sexual orientation by a physician. A third of the respondents believed disclosing their sexual history would result in a negative reaction, and 30% had received a negative reaction from a medical professional after identifying themselves as lesbian or bisexual.
A patient's complete history helps medical professionals identify higher risk areas and corrects assumptions about the personal histories of women. In a similar survey of 6,935 lesbians, 77% had had sexual contact with one or more male partners, and 6% had that contact within the previous year.
Heart disease is listed by the U.S. Department of Health and Human Services as the number one cause of death for all women. Factors that add to risk of heart disease include obesity and smoking, both of which are more prevalent in lesbians. Studies show that lesbians have a higher body mass and are generally less concerned about weight issues than heterosexual women, although they are more likely to engage in exercise regularly.
Lack of differentiation between lesbians and heterosexual women in medical studies that concentrate on health issues for women skews results for lesbians and non-lesbian women. Reports are inconclusive about occurrence of breast cancer in lesbians. It has been determined, however, that the lower rate of lesbians tested by regular pap smears makes it more difficult to detect cervical cancer at early stages in lesbians. The risk factors for developing ovarian cancer rates are higher in lesbians than in heterosexual women, perhaps because many lesbians lack protective factors of pregnancy, abortion, contraceptives, breast feeding, and miscarriages.
Since medical literature began to describe homosexuality, it has often been approached from a view that sought to find an inherent psychopathology as the root cause. Much literature on mental health and lesbians centered on their depression, substance abuse, and suicide. Although these issues exist among lesbians, discussion about their causes shifted after homosexuality was removed from the Diagnostic and Statistical Manual in 1973. Instead, social ostracism, legal discrimination, internalization of negative stereotypes, and limited support structures indicate factors homosexuals face in Western societies that often adversely affect their mental health. Women who identify as lesbian report feeling significantly different and isolated during adolescence; these emotions have been cited as appearing on average at 15 years old in lesbians and 18 years old in women who identify as bisexual. On the whole, women tend to work through developing a self-concept internally, or with other women with whom they are intimate. Women (heterosexual or otherwise) also limit who they divulge their sexual identities to and more often see being lesbian as a choice, as opposed to gay men, who work more externally and see being gay as outside their control.
Anxiety disorders and depression are the most common mental health issues for women. Depression is reported among lesbians at a rate similar to heterosexual women. It is a more significant problem among women who feel they must hide their sexual orientation from friends and family, experience compounded ethnic or religious discrimination, or experience relationship difficulties with no support system. More than half the respondents to a 1994 survey of health issues in lesbians reported they had suicidal thoughts, and 18% had attempted suicide.
A population-based study completed by the National Alcohol Research Center found that women who identify as lesbian or bisexual are less likely to abstain from alcohol. Lesbians and bisexual women have a higher likelihood of reporting problems with alcohol, as well as not being satisfied with treatment for substance abuse programs. Many lesbian communities are centered in bars, and drinking is an activity that correlates to community participation for lesbians and bisexual women.
Sexually transmitted infections
Some STIs/STDs are communicable between women, including human papillomavirus (HPV), Trichomoniasis (trich), syphilis, human immunodeficiency virus (HIV), Bacterial vaginosis (BV), and herpes simplex virus (HSV). Transmission of specific sexually transmitted diseases among women who have sex with women depends on the sexual practices women engage in. Any object that comes in contact with cervical secretions, vaginal mucosa, or menstrual blood, including fingers or penetrative objects may transmit sexually transmitted diseases. Oral-genital contact may indicate a higher risk of acquiring HSV, even among women who have had no prior sex with men. Bacterial vaginosis (BV) occurs more often in lesbians, but it is unclear if BV is transmitted by sexual contact; it occurs in celibate as well as sexually active women. BV often occurs in both partners in a lesbian relationship; a recent study of women with BV found that 81% had partners with BV. Lesbians are not included in a category of frequency of human immunodeficiency virus (HIV) transmission, although transmission is possible through vaginal and cervical secretions; the highest rate of transmission of HIV to women is among those who have sexual intercourse with men or participate in intravenous drug use.