Someone I will call Valerie came to me last week. She said that her gynecologist had diagnosed her with cervical condyloma and she wanted my opinion about what she should do in term of safe sex with her partner. When she asked her gynecologist this question the gynecologist said to use a condom. The gynecologist had not approacher her about her sexual preference. She said, ''I just don't feel comfortable coming out to my gynecologist."

J. Waitkevicz, Public Workshop, October 6-7, 1997

Washington, D.C.

Several studies have noted that the majority of lesbians (53 to 72%) do not disclose their sexual orientation to physicians when they seek medical care (Bybee and Roeder, 1990; Smith et al., 1985). Sixty percent of the women in the MLHS and 27% of respondents to the NLHCS reported experiences in which health care workers had assumed that they were heterosexual (Bradford and Ryan, 1988; Bybee and Roeder, 1990). Nonetheless, most of the respondents (61%) to the MLHS reported feeling that they could not disclose their sexual orientation to a health care provider. A much lower proportion of the respondents (16%) in the NLHCS said they would not feel comfortable letting their provider know they were lesbian.

Lack of Lesbian Focus in Preventive and Other Health Care. Primary care for women tends to be organized around reproductive health needs (Denenberg, 1995; Stevens, 1995; White and Dull, 1997). Public funding for women's health has centered on family planning and prenatal care, issues that are less salient for lesbians than for heterosexual women. Counseling for women about sexually transmitted disease, in addition, typically assumes sex with male partners. Furthermore, in many clinical environments the information forms or interviews that include questions about health history, educational materials, and insurance information assume that patients are heterosexually active (Lynch, 1993; Perrin, 1996; Rankow, 1995b; Stevens, 1995; White and Levinson, 1995). Women who are not sexually active with a man or who are not sexually active at

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