October 1st, 1997 to October 7th, 1997

Unique Womenâs Health Survey Highlights

Lesbian Data

by P.J. Engelbrecht
The results of a ground breaking survey comparing lesbians and heterosexual women were presented at the National Lesbian and Gay Health Association conference in Atlanta in late July. Study groups from Chicago, Minneapolis, and New York÷881 women in all÷contributed detailed gynecological, healthcare, and lifestyle data.

The July survey presentation highlighted analysis of "gynecological and breast disorder risks among lesbian and heterosexual women." Personal rates for breast disorders were roughly equal for the two study groups, though breast cancer has commonly been perceived as a lesbian "plague." Breast cancer rates were 1.8% for lesbian respondents, compared to 2.9% for heterosexual women, a statistically insignificant difference.

However, researchers were surprised to find that lesbians reported significantly higher incidence of breast, ovarian, or colon cancer among their mothers and sisters. A maternal family history of such cancers is considered a serious risk factor: 12.3% of lesbiansâ mothers, vs. 6.9% of heterosexual womenâs mothers had been diagnosed with these cancers; 2.8% of lesbiansâ sisters, vs. 0.4% of heterosexual womenâs sisters had.

Heterosexual women reported slightly more cancer incidences among maternal aunts (13.1% vs. 10.5% for lesbians); rates for maternal grandmothers were virtually equal. Breast self-exam and mammography rates were similar for the two groups÷less than half of all women examine their breasts monthly, which experts recommend for early cancer detection. A quarter of lesbians reported non-cancerous but suspicious breast lumps, as did one-fifth of heterosexual women. Researchers have not yet been able to account for the significant divergences between the groupsâ family cancer histories.

The Womenâs Health Survey was initiated in 1993 at Chicagoâs Lesbian Community Cancer Project by then-director Mary McCauley II, most recently of Howard Brown Health Center, and breast cancer survivor Ellie Emmanuel, Ph.D., now of the University of Wisconsin-Stout. Both were founding members of LCCP. They were later joined by Ann Pollinger Haas, Ph.D., of the City University of New York, and Tonda Hughes, R.N., Ph.D., of the University of Illinois at Chicago.

Earlier studies of lesbians were hampered by smaller, homogeneous samples and limiting methodological factors; no study had compared lesbians and heterosexual women. The unique Womenâs Health Survey sought to develop "data that had a base that could be analyzed and ... scientifically respected ... [and] truly representative of the community," says McCauley.

Participants ranged in age from 17-83 (average, about 40) and were ethnically representative of U.S. society: approximately 75% were white, 13% African-American, 6% Latina, 2% Asian-American, and 4% multi-racial. Identified by an elaborate behavioral scaling mechanism, lesbians accounted for 62% of the sample, heterosexuals 31%, bisexuals 5%, "transitionals" 1%, and women of unspecified sexual orientation 1%.

Why the comparative survey? Arenât all women alike? "In many [ways], yes ... womenâs health is womenâs health," agrees McCauley. Yet McCauley also notes that some women have greater access to healthcare, among other differences. For example, a fifth of heterosexual womenâs households earn over $76,000 per year; only an eighth of lesbian households were that wealthy, even though lesbians themselves tend to be better educated. The research study was specifically designed to uncover "what kinds of things are impacted by sexual orientation."

Previous research suggested that because lesbians are less likely than heterosexual women to give birth, lesbians could be "at higher risk for breast, uterine, ovarian, [and] colon cancer, heart disease [and] stroke," according to McCauley, because higher estrogen levels associated with pregnancy and birth control pills seem to diminish risks of these and other illnesses. The Survey found a quarter of lesbians have birthed one or more children; fully half of heterosexual women are birth mothers. But lesbians are less than half as likely to suffer miscarriages (8% vs. 20% of heterosexual women). Far fewer lesbians than heterosexual women have had an abortion (14% vs. 33%).

Among other gynecological health risk factors, lesbians were found to have significantly lower rates of lifetime sexual contact with men, though not as little contact as popularly believed. Fully two-thirds of lesbian respondents had had sex with at least one man; almost 25% had sex with five or more men; 25% had married men. One in eight lesbians had been sexually involved with men and women during the same time period.

Yet on average, lesbians and heterosexual women first participated in sexual encounters at the same age, about 17-1/2, and the average age for all womenâs first hetero-sex experience was just under 19. Hetero-sex has been statistically associated with various gynecological disorders, including STDâs and cervical cancer, particularly for women whose first experience occurred during the early teen years.

Survey results on STD incidence turn conventional wisdom on its head, as well: lesbians are not immune. Yeast infections, the most common STD, had afflicted more than 40% of both groups. Rates were also similar for genital warts, herpes, gonorrhea, bacterial vaginosis. Likewise, 1% of each group acknowledged being HIV+.

Lesbians reported a significantly lower rate only for chlamydia infection (2% vs. 5.8% of heterosexual women). Hard to detect in women, chlamydia can cause serious health problems, from pelvic inflammatory disease and cervical dysplasia to arthritic conditions. Whether lesbians were more likely to have contracted STDs during past hetero-sex than during lesbian sex is both unclear and beside the point. Many STDs linger invisibly and, left untreated, can be transmitted between women practicing unsafe sex.

Notable differences concerning other gynecological complaints were detected between the two groups. Significantly more lesbians reported irregular periods (23% vs. 18% of heterosexuals). Fewer than half as many lesbians suffered from endometriosis (3% vs. 7% of heterosexuals), for no apparent reason, though PMS/ chronic cramping complaints ran at about 30% of all women surveyed. Less than half as many lesbians had sought treatment for infertility, though some had done so (3% vs. 8%).

Rates of gynecological cancer and hysterectomy were similar for the two groups (3.5% of lesbians, vs. 4.4% of heterosexuals). Just under 9% of all women surveyed had undergone hysterectomy÷surgical removal of the uterus. heterosexual women reported slightly higher rates of abnormal Pap smears (31% vs. 25% for lesbians), perhaps because they are much more likely to get the recommended annual pap smear: 66% of heterosexual women do so; just 50% of lesbians do.

In fact, lesbians are significantly less likely to visit an ob/gyn, with an average 1.2 visits annually, compared to 1.9 for heterosexual women. The difference may reflect heterosexual womenâs higher reproductive rates. Heterosexual women somewhat more frequently seek out routine medical care than lesbians do: 73% of heterosexual women see a physician at least once a year. While 68% of lesbians get an annual check-up, 14% see a doctor less than every three years.

Conventional wisdom suggests lesbians avoid doctors due to poor finances or lack of insurance. The survey found that, although lesbians do cite these factors as prohibitive, almost 90% of lesbians are insured, 73% by their employer. Fewer than 4% of lesbians are covered by someone elseâs policy, though 14% of heterosexual women are, a disparity that domestic-partnership benefits plans may level in the future. Over a quarter of lesbians said that lack of money "often" prevented them from getting healthcare.

The survey also examines lifestyle choices related to health issues. According to McCauley, lesbians as a group have been perceived as drinking more alcohol, smoking more cigarettes, eating less healthy diets, and more frequently being exposed to environmental hazards, such as toxins in the workplace. McCauley indicates that "social mores were different for women who were out in the â50s and â60s [versus the â70s and â80s]."

The Womenâs Health Survey clears up some misconceptions. On average, lesbians do weigh 17% more than heterosexual women of the same height (average for both groups, 5â5"), but consume lower-fat diets and exercise slightly more. Lesbians consume far more artificial sweeteners, such as aspartame/Nutrasweet and saccharin/Sweet&Low, but are much less frequently exposed to hair dyes and certain other hazardous personal care products.

Lesbians are actually twice as likely as heterosexual women to be regularly exposed to paint thinners and asbestos. And perhaps the strangest disparity among environmental hazard-exposure was registered for "history of sleeping under an electric blanket": 56% of lesbians have used them; only 37% of heterosexual women have. The Survey does not account for this thermal divergence, though it might be linked to income differences and commensurate (lack of) control over home/apartment heating levels.

No significant differences were found in alcohol use. Heterosexual women drink slightly more often, statistically; lesbians are slightly more likely to overindulge when drinking. However, lesbians are far more likely to have gotten help for alcohol or drug problems (14% vs. 6% of heterosexuals). Currently, one in five women smoke; though 25% more lesbians have kicked the habit, over 20% more heterosexual women never smoked at all.

The survey does give lesbians a few reasons to crow. Among various problems related to menopause, rates for hot flashes and moodiness were similar. However, perhaps unsurprisingly, the study groups differed markedly in assessing their post-menopause sexual activities. Only 49% of menopausal lesbians complained of vaginal dryness, compared to 66% of heterosexual women. And 78% of menopausal heterosexual women complained of low sex drive; only 70% of menopausal lesbians had less interest in sex than before.

The inclusion of lesbians in this study marks an important stride in womenâs healthcare; as McCauley points out, not so long ago, women were virtually excluded from all medical research. "This study gives women in academia ÷and others÷the ability to work together to create a new paradigm, to work together ... to create a healthcare system thatâs more [able] to meet the needs of the [female] patient and to respect the patient," says McCauley.

Results of the Womenâs Health Survey appear in the second issue of the Journal of the Gay and Lesbian Medical Association (415-255-4547), a new peer-reviewed forum edited by Jocelyn White. A case study discussion, "Putting a Face to Lesbian Health Risk: A Collaborative Research Project" is included in the textbook Building Community: Social Science in Action (Pine Forge/Sage, 1997), co-edited by sociologist Anne Figert of Loyola University.

A new bimonthly magazine, MAMM, was launched this month for persons affected by breast, ovarian, and other womenâs cancers. The premier issue profiles cancer survivor Linda Ellerbee, a nationally known TV newswoman. Articles will regularly address cancer issues from chemotherapy to bioengineering breakthroughs, from awkwardness in relationships to the psychological impact of losing a breast. On sale at newsstands for $2.95, MAMM will also be distributed for free at health centers and community organizations. It is published by the same company as POZ magazine, and therefore is expected to be lesbian-inclusive.

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