LGBT Sexual Health
(Lesbian, Gay, Bisexual, Transgendered)

DEFINITIONS/LABELS

• Lesbian: A woman who has physical and emotional attraction and desire for other women.
• Gay: A person who has physical and emotional attraction and desire for people of the same gender. The term “Gay” is usually used to describe men who form their primary loving and sexual relationships with other men, although it can be used to describe both gay men and lesbians.
• Bisexual: Someone who is attracted to people of both genders romantically, emotionally and physically. The degree to which a person prefers men or women; or the times throughout their lives at which, they prefer men or women, varies for each bisexual.
• Transgender: A broad term that covers many aspects in the gender experience. Transgender people’s appearance may reflect the opposite gender because they prefer being treated as if they were the other gender. Transgender people can be, but are not always, transsexuals. Transgender people may be anywhere along the continuum of the gender experience and may or may not be taking steps in transitioning to the opposite gender.
• Transsexual: Someone who believes that his/her gender identity is different from their biological sex, and often feels deeply that they were born into the wrong body and should be the other gender. Therefore, some people elect to use sex hormones, electrolysis, plastic surgery, or sex reassignment surgery to help them make the physical change that is more congruent with their internal identity and self-image.
• Intersexed: Some babies are born with genitalia of both sexes. Some doctors and parents elect surgery for the infant and assign a gender. A person’s true gender cannot be known by their genitalia, and therefore an assignment at birth can be wrong.

It's important to remember that people are individuals and each of us has deep feelings about the labels that we apply to ourselves. Some may reject all labels. The best course is to find out what term, if any, an individual prefers and then use it respectfully and responsibly.

COMING OUT

• “Coming out” refers to the process of identifying one’s sexual orientation to oneself and then disclosing it to others. First, people must “come out” to themselves and accept that they are lesbian, gay, or bisexual. It is a continual process.
• Coming out can be a scary thing for some people. Before coming out to a friend or family member, it's very important that you consider whether the person will be supportive of your sexuality.
• If you do not think you can count on support, you may want to consider talking to an objective trusted source such as a counselor, sibling, or religious adviser who you think may be more supportive. That person also may be able to help you talk to your friends/family about your sexual orientation.
• Each person chooses for themselves how and when to come out.

SEXUAL ORIENTATION

• Sexual orientation is a basic part of each person's identity, and LGBT people are just as loving, ethical, productive, smart, beautiful, and human as heterosexual people. Same-sex love is just as likely to lead to fulfilling, happy, committed relationships as "straight" love.
• Looking back, some gay adults will say they knew very early that they were gay, as early as third or fourth grade. Others were not sure until they were in college or even later. There is no formula for coming out and there is no rush. If you have questions about yourself, start paying attention to the signals that you're getting from your brain and your body; eventually you'll have a very clear picture of what types of relationships you would like to form.
• Sexual orientation is not a matter of choice.
• It is not a disease.
• It can not be “cured” through therapy or medical treatment.
• No amount of pretending will make you different than you are.
• Both LGBT and heterosexual orientations are perfectly healthy.

HEALTHY SEX FOR LESBIANS
If you're a woman and you're involved in a sexually active, same-sex relationship, don't assume that you don't have to be concerned with reproductive healthcare or sexually transmitted infections (STI’s). Here are some factors to consider in reducing your risk:

• Being heterosexual, bisexual, or lesbian is not the most important aspect in determining your risk - your behavior is. It is your behavior that will determine your risk level for contracting STI’s. The risk of woman-to-woman sexual transmission of serious infections such as HIV is generally considered to be less common than in man-to-man or man-to-woman transmissions. But women who have contracted HIV are still at risk of transmitting that infection to other women if they participate in behaviors that transmit infected fluids to their partner(s).
• Don’t forget to include past sexual behaviors with women and/or men when considering the potential for risk.
• Safer sex also means protecting your partner, so return the favor. Don't allow your body fluids to get into your partner's body. Don't have sex if you have sores or other symptoms.
• Get Gynecological Exams! Research shows lesbians access exams less frequently than heterosexual women. It is important to get breast exams and cervical samples to screen for cancer. In addition, get checked for sexually transmitted infections every year, and get the correct treatment if you become infected.
• The most important way to reduce your risk for contracting a sexually transmitted infection is to keep your partner's body fluids out of your body and avoiding genital skin-to-skin contact. The body fluids that lesbians should be most careful about are blood, vaginal fluids, and the discharges from sores caused by sexually transmitted infections.
• Oral sex and penetration can lead to STI’s for lesbians. Remember, the only way to be completely safe is to practice abstinence. If you are in a sexual relationship as a lesbian, be aware that safer sex is for you too. Use of a latex barrier can decrease the risk of passing fluids between you and your partner. Remember to clean sex toys if you share them with your partner or if you insert them into the rectum and then want to insert them into the mouth or vagina.

Lower Risk Lesbian Sex Play Includes:

• Masturbation
• Mutual Masturbation (masturbating your partner, or in front of your partner)
• Outercourse
• Erotic Massage
• Body Rubbing
• Kissing
• Deep Kissing
• Finger Sex
• Oral Sex with a barrier
• Penetration with a barrier

MEN WHO HAVE SEX WITH MEN: THING TO KNOW ABOUT SAFER SEX
Safer sex is anything we do to lower our risk of getting a sexually transmitted infection. These are the most important ways to reduce your risk:

• Keep your partner's body fluids out of your body – mouth, urethra or anus. The body fluids to be most careful about are blood, semen, pre-ejaculatory fluid, and the discharge from sores caused by sexually transmitted infections.
• Safer sex also means getting checked for infections at least once a year (or following exposure), and getting the correct treatment if you get a sexually transmitted infection.
• Sex play that involves the lowest amount of risk includes body rubbing ("dry humping"), deep kissing, mutual masturbation, and erotic massage. But remember, some infections, like herpes and genital warts, can be passed by skin-to-skin contact.
• Oral Sex - Compared to anal intercourse, oral sex is less risky. However, whether a guy gives or receives genital stimulation, oral sex still puts him at risk for infections. To reduce risks, some men do not perform oral sex to ejaculation. Other people use condoms for even safer oral sex. Non lubricated or flavored condoms are usually preferred for oral sex.
• Rimming - Rimming is a slang expression that refers to oral stimulation of the anus. The official term for this is analingus. Analingus can put both partners at risk for hepatitis, herpes, HPV, and parasites.
• For safer rimming, people use latex barriers - thin pieces of latex - placed over the anus. This acts as a barrier between the mouth and anus. Plastic wrap and cut-open condoms can also be used as a barrier for analingus. Like condoms, some latex barriers come in different flavors.
• Anal Intercourse - Unprotected anal intercourse is considered a high-risk activity. Men who have unprotected anal intercourse are at high risk for many sexually transmitted infections, such as gonorrhea, HIV, Chlamydia, syphilis, herpes, HPV and hepatitis. Proper use of latex condoms or female condoms can reduce the risk of contracting dangerous infections. Use water-based lubricants with latex condoms. Usually, the anus does not produce a sufficient amount of lubricant for comfortable intercourse therefore it is very important to use a lubricant during anal sex. Lubricant also reduces the risk of tearing anal tissue and having a condom break.

HEALTH CARE AND DISCRIMINATION FOR LGBT POPULATIONS

• LGBT individuals often face additional obstacles to staying healthy, such as dealing with discrimination and homophobia in the health care system.
• LGBT individuals often face financial, structural, personal, and cultural barriers as they attempt to access competent, sensitive health care services. These barriers and anxiety about facing them can prevent LGBT individuals from receiving the screening and prevention services they need, and cause delays in receiving care for acute conditions.
• In addition to difficulties in accessing health care, LGBT individuals face significant obstacles in communication with health care providers. Negative attitudes toward LGBT persons are held by many providers and can be a barrier to health care.
• Since lesbians and gay men have less need for birth control, they generally visit their health-care practitioners less often and, consequently, receive less routine health care than heterosexuals. As a result, they may develop more health problems because they avoid regular checkups.
• A recent report "Lesbian Health: Current Assessment and Directions for the Future" from the Institute of Medicine, notes that fear of discrimination may keep lesbians from seeking routine medical care, and that the stress experienced due to homophobia and anti-gay discrimination can have a negative impact on lesbian health. The Gay and Lesbian Medical Association offers a free referral service to help patients find doctors who are sensitive to lesbian, gay, bisexual and transgender health care needs on their Web site at: http://www.glma.org.

REFERENCES AND ADDITIONAL READING
The information in this handout was obtained from:
http://www.teenwire.com
http://www.plannedparenthood.org/sti-safesex/lesbian.html
http://www.glma.org
Ally Network Training Manual. University of Illinois’ Office of LGBT Concerns

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