• to adulthood and old age. In addition to these predictable challenges, lesbians may encounter special situations associated with their sexual orientation, such as adverse societal attitudes, family rejection, and internalized homophobia. In particular, lesbians must negotiate the process of coming out, or revealing their lesbian identity.
  • Specific physical and mental health concerns of lesbians, including risk and protective factors that affect these problems. There is a great deal of speculation, with some attendant evidence, that lesbians may be at heightened risk for some health problems. Large data gaps exist, however, in knowledge about lesbian health, and the population-based information necessary to determine relative health risks of lesbians is not available. The committee examined the available data on a number of possible health risks for lesbians and reviewed what is known regarding lesbians' risk for a variety of health conditions including cancer, cardiovascular disease, sexually transmitted diseases, HIV / AIDS, and mental health and substance abuse problems. Given the limited availability of data that would allow a comparison of lesbian with heterosexual women, the committee did not find that lesbians are at higher risk for any particular health problem simply because they have a lesbian sexual orientation. Rather, differential risks may arise, for example, because some risk or protective factors may be more common among lesbians (e.g., higher rates of nulliparity, which is associated with increased risk for breast cancer), they may experience differential access to health care services (e.g., because of fear of coming out to health care providers), and they are exposed to stress effects of homophobia. Little is known, however, about the specific impact of these risk factors on lesbian health, and even less about any unique protective factors and how they may operate. The committee further notes that misconceptions about risk for certain health problems can negatively affect both the ability of lesbians to seek health care and the treatment itself. For example, it is important for lesbians, just as it is for heterosexual women, to obtain regular Pap tests.

Conducting research on lesbian health presents numerous challenges. First, lesbians are a population subgroup without a standard definition, and partly because of this, they are a difficult subgroup to readily identify for study. Second, lesbians constitute a small percentage of women and, in



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