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No book on women's health would be complete without addressing the health concerns of lesbians. Dr. Ruth Simkin has moved to British Columbia from Calgary, Alberta where she was Associate Professor In Family Practice at the University of Calgary. For many years, she has written and taught about lesbian health care issues, and has graciously agreed to contribute this chapter.

Women often ask me why we need to speak about lesbian health care. After all, aren't lesbians women, and isn't all women's health care the same? Many studies have shown that lesbians do not get adequate health care a good deal of the time. As well, there are some very specific differences in terms of health risks.

It is presently thought that five to 20 percent of women are lesbians, although we can be an invisible group and difficult to quantify. What exactly is a lesbian? Trying to define a lesbian is akin to trying to define a heterosexual. Like heterosexuals, lesbians can be celibate, promiscuous and everything in between.

One definition: A lesbian is a woman who shows affectional preference for women, who is woman-identified and who, if sexually active with others at the present time, is sexually exclusive with women. However, the continuum of what defines a lesbian has a wide range.

Mary Hunt, a theologian from Washington, DC says: "Being a lesbian is very hard to quantify. From our various experiences of being a lesbian, we share the fact that we transgress fundamental cultural norms for love and we consider that transgression healthy, natural and holy."

Martha Barrett, in her book INVISIBLE LIVES, says: "Being a lesbian is a twenty-four-hour-a-day role. It's not just having sex. You are your sexual identity, perhaps unconsciously. It covers everything, your personal relationships, your job, your plans for the future, the way you deal with people, what you talk about."

Lesbianism is an identity, not an activity. It is not a lifestyle, but rather the way in which we live our lives, affecting every aspect of our thoughts and actions and feelings. To take a whole world and call it a "lifestyle" is a belittling and demeaning way to treat a person and is one way we experience homophobia.

Suzanne Pharr, from her excellent book HOMOPHOBIA: A WEAPON OF SEXISM, states: "Homosexuality is simply a matter of sexual identity, which along with heterosexual identity, is formed in ways that no one conclusively understands. The American Psychological Association has said that it is no more abnormal to be homosexual than to be left-handed. It is simply that a certain percentage of the population is."

General Quality Of Health Care

Most books on general health care say nothing about lesbians. One recent book on the Canadian health care system had no listing under "lesbian" and most articles and books assume the male imperative. There is very little research done on lesbians; we need only to rely on ourselves for information on our own health. If you look up "lesbianism" in the Index Medicus, you are directed to "homosexuality." Medical researchers assume that because we're all lumped together as homosexuals, that lesbians and gay men have similar concerns, although we know that lesbians differ from gay men in the same way heterosexual women differ from heterosexual men.

Society's assumption of heterosexuality is so strong that lesbians almost always have to volunteer information about our homosexuality to doctors. In one study, only 25 percent of heterosexuals in the U.S. reported knowing a homosexual. Many physicians claim they have never seen a lesbian. It's highly unlikely that any physician who treats females has not treated a lesbian, yet of 110 gynecologists surveyed in a Florida study, 50 percent said they had never seen a patient who they thought was a lesbian.

A 1981 study revealed that less than one percent of the lesbians surveyed had been questioned about their sexual preferences by doctors; one study released in 1985 found that 9.3 percent of lesbians had been asked.