should develop measures that gather information about the aspects of lesbian orientation that are relevant to the specific project at hand. Adopting this approach does not avoid the issue of establishing a lesbian definition. Rather, it builds on the need to accept the complexity of sexual orientation and the social context in which it is embedded. In essence, "lesbian" should be defined to reflect the needs of specific research studies, interventions, or programs of care within generally accepted conceptual boundaries, with a recognition of the three dimensions through which sexual orientation is most often defined: behavior, desire, and identity (see Figure 1).

The committee examined lesbian health from several different perspectives. When examined together, these various approaches can provide a more complete picture of the complexity involved in looking at lesbian health:

  • Lesbians in the larger contexts of society, the health care system, and women in general. The contexts in which lesbians live provide a framework for understanding the complexity of their lives. For example, lesbians have historically been the target of prejudice and discrimination, both public and private, and the stigmatization of homosexuality remains widespread in our society. Although many kinds of abuse and discrimination against lesbians have been documented clearly, their impact on physical and mental health still remains to be studied. Lesbians' access to health care services may be affected by such factors as the lack of culturally competent providers1 and the presence of homophobia2 among providers, more limited access to health insurance because lesbians cannot share in spousal benefits, and the growing development of managed care systems that may potentially limit lesbians' access to lesbian-friendly providers. Finally, it is important to remember that lesbians confront the same kinds of health risks as do all women.
  • Health of lesbians across the life span. All women face developmental challenges as they grow from childhood through adolescence

1  

Culturally competent provider refers to having a set of skills to give appropriate high-quality services to individuals from cultures different from the provider's.

2  

Meaning fear of homosexuality.

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