The term lesbian herein refers to any individual who identifies within the feminine gender and / or sex spectrum and identifies as wsw or women who have sex with women. The information herein attempts to be all encompassing of all gender identities within the wsw community

Protecting Your Visitation & Decision-Making Rights

In times of emergency, you may be unable to make medical decisions or state who you want to visit you. In these situations, hospitals may restrict visitation rights to a narrow interpretation of family that excludes those not legally or biologically related to the patient. Similarly, state laws around medical decision-making often limit these rights to a patient’s biological family members when no documentation is designating a surrogate decision maker.

It is especially important for the LGBT community to take steps to ensure that the people we choose may visit us and make medical decisions on our behalf in times of emergency.

1. Complete advance healthcare directives and visitation authorization forms.

  • Advance healthcare directives are legal documents that allow you to designate someone else to make medical decisions on your behalf in the event that you are incapacitated (health care proxy) and to make clear your preferences for life-saving procedures (living will).
    • Download Tools for Protecting Your Health Care Wishes from Lambda Legal [PDF]
      • This document from Lambda Legal defines terms related to decision making in healthcare settings and answers FAQs for LGBT community members looking to protect their rights.
    • Download Legal Planning for Same-Sex Couples: Preparing for the Unexpectedfrom GLAD [PDF]
      • In this document, Gay & Lesbian Advocates and Defenders answers FAQs related to the steps necessary for securing your decision-making rights. This document also includes a glossary of terms.
    • Download Life Lines from NCLR [PDF]
      • This packet from the National Center for Lesbian Rights contains information about documents that will help you protect yourself and your loved ones in the event of illness, disability, or death – including advance healthcare directives.
    • Learn More from National Healthcare Decisions Day
      • April 16th is National Heathcare Decisions Day and this site includes answers to frequently asked questions on advance healthcare directives and state-specific resources.
    • Download Your State’s Forms
      • This resource from Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), directs you to your state’s advance directives forms.
  • Hospital visitation authorization forms instruct your doctor, care providers and hospital staff about who is allowed and given priority to visit you if you are hospitalized.

2. Talk with your primary care physician about your preferred visitors and advance healthcare directives.

3. Work with your local hospitals to get these completed forms on file.

4. Carry information related to your advance healthcare directives and visitation authorization forms in your wallet or other readily accessible area for emergencies.

  • Store Your Documents with DocuBank Healthcare Directives Registry
    • You receive a customized wallet card that makes your documents instantly available 24 hours a 7, 365 days a year via automated fax or secure webpage. You also get stickers for your driver’s license. A special discounted rate is available for HRC members and supporters.
  • Read “Put It In Writing” from AHA
    • This brochure from the American Hospital Association provides basic facts about advance healthcare directives and encourages patients to explore their preferences for care at the end of life. It includes a template for a Wallet ID Card [PDF] that alerts healthcare workers of directives.

Coming out to your doctor

One of the keys to good healthcare is being open with your healthcare provider. Doctors, nurses, physician assistants, psychotherapists and other professionals treating you need to know about your sexual orientation and gender identity to give the best care possible. Yet surveys consistently show that many lesbian, gay and bisexual patients aren’t open about their sexual orientation with healthcare providers, and transgender patients often face unique challenges finding competent care.

Tips for Finding and Being Open with Healthcare Providers:

  • Ask for referrals. Ask friends or local LGBT centers for the names of LGBT-friendly healthcare providers. You can also check the Gay and Lesbian Medical Association’s Healthcare Provider Directory.
  • Inquire by phone. When you call to make an appointment, ask if the practice has any LGBT patients. If you’re nervous about asking, remember you don’t have to give your name during that initial call.
  • Bring a friend. If you’re uneasy about being open with your healthcare provider, consider asking a trusted friend to come with you.
  • Bring it up when you feel most comfortable. Ask your doctor for a few minutes to chat while you’re still fully clothed – maybe even before you’re in the exam room.
  • Know what to ask. Learn about the specific healthcare issues facing LGBT people.

Keeping yourself Safe – Safe Sex 101

Generally lesbians are at low risk of HIV infection and unplanned pregnancy. However sex between women is not always safe, and lesbians are just as vulnerable to certain sexually transmitted diseases (STDs) as women who have sex with men. Therefore women need to know the risks and how to protect themselves.

‘Safe sex’ is any activity through which you are at no risk of becoming infected with HIV or an STD. ‘Safer sex’ refers to sex in which the risk of becoming infected with HIV or an STD is minimised. Lesbians can protect themselves from HIV and many STDs by ensuring that infected fluids, such as blood or vaginal fluids, do not enter their body during sex. Precautions that can be taken include not sharing sex toys, or if doing so, using a new condom for each partner. Certain sexual activities are also considered to be lower risk, for example hugging, touching, massage and masturbation.

However, STDs such as herpes and crabs can be passed on through skin contact alone. The only way for two women to be sure that they are not at risk during sex is if both have been fully tested, and have not had sexual contact with any other women or men since.

Lesbians, Sex and HIV

Lesbian or bisexual women are not at high risk of becoming infected with HIV – the virus that causes AIDS – through woman to woman sex.

However, like many women:

  • Some lesbians have unsafe sex with men – one British study found that 85 percent of women who have sex with women reported also having sex with men.
  • Some lesbians inject drugs and share needles – research into injecting drug users has shown higher HIV prevalence among women who have sex with women, compared to heterosexual injecting drug users.
  • Some lesbians wanting to get pregnant face decisions about sperm donors – legitimate sperm banks screen donor’s semen for HIV and other STDs. However, many lesbians chose to use the sperm of someone they know, rather than using a sperm bank.
  • Some lesbian sexual practices are risky (see underneath for more details)
  • It is argued that the widespread assumption that lesbians are a low-risk population increases some lesbians risk of HIV infection as they believe HIV is not something that they need to be concerned about.

What are the HIV risks for lesbians?

HIV is in the blood, breast milk, vaginal fluid or semen of someone with HIV, so you are at risk if you get any of these fluids inside your body. The risks of sexually transmitting HIV between women are low. Very few women are known to have passed HIV on to other women sexually.5 However, some lesbian sexual practices do carry a risk of HIV transmission and precautions need to be taken to protect against infection.6

  • Oral sex– the risk of HIV being passed on through oral sex is low, but it is increased if a woman has cuts or sores in her mouth, or if the partner receiving oral sex has sores on her genitals or is having her period. Oral sex is safer if you use a ‘dental dam’ (a square of latex or cling film) to stop any vaginal fluid or menstrual blood getting into your mouth. A condom cut open and spread flat can also be used for this.
  • Sharing sex toys – sharing sex toys (for example vibrators) can be risky if they have vaginal fluids (juice), blood or faeces on them. Always clean them well and have one each. This is one area of sex where sharing is a bad idea!
  • Rough sex – any sexual activity that can lead to bleeding or cuts/breaks in the lining of vagina or anus is risky, including ‘fisting’ or certain S&M (sadomasochism) activities.
  • Donor insemination – if a woman is thinking about using a sperm donor to get pregnant, she needs to be aware of the potential donor’s detailed medical history and any possible risk factors – including drug use and sexual history. It is important that the donor has taken an HIV test.

What other STD risks are there for lesbians?

Although we have seen that lesbian and bisexual women are at low risk of getting HIV from sex with another woman, many other STDs – such as herpes or thrush – are just as common for lesbians as for women who have sex with men.

  • Thrush is an overgrowth of yeast causing vaginal itching and soreness, often with a white discharge. It can be passed via sex between women, though oral sex is low risk.
  • Bacterial vaginosis (BV) is an overgrowth of vaginal bacteria causing a smelly discharge, which lesbians often experience. There is a possible link with perfumed soaps and bath oils.
  • Genital warts are painless bumps on the vulva, in the vagina, on the cervix or round the anus. They can be passed through contact with the wart, for example by touching, rubbing or sharing sex toys. It is unlikely non-genital warts, such as on hands, can be transferred to the genitals.10 Read more about genital warts.
  • Trichomonas vaginalis (TV) gives a frothy, itchy vaginal discharge and is passed on by contact with the vagina only, for example by touching or sharing sex toys.
  • Herpes can cause painful sores on the inside of the vulva/vagina or anus (these are genital herpes) or on the mouth (cold sores). Herpes can be passed on through contact with a sore, for example by touching, fondling or sharing sex toys. Oral sex when a cold sore is present can also transmit the virus. It can be possible to have the herpes virus, be infectious and yet never have had any symptoms. An American study found that the majority of women who have sex with women, who are infected with herpes, are unaware of their infection.
  • Crabs/pubic lice cling to pubic and other body hair causing itching and sometimes blood spots from bites. They are spread through naked body/skin contact.
  • Chlamydia and gonorrhea are rare in lesbians but if they are present may be passed on through sharing sex toys or rubbing vulvas together. Often there are no symptoms, though there may be a discharge. The first sign of both infections may be pain in the pelvic region (pelvic inflammatory disease or PID). There is a risk of infertility for women who have had untreated chlamydia. Read more about chlamydia and gonorrhea.
  • Syphilis is very infectious and close skin contact during sex can pass it on. Syphilis causes painless ulcers (or chancres) to appear where the bacteria entered the body. A chancre on the vagina can be almost unnoticeable.13 Read more about syphilis.
  • Hepatitis refers to viral infections that cause inflammation of the liver. Certain forms of hepatitis can easily be passed on in sex – for example by touching or sharing sex toys. There are often no symptoms, though it can cause jaundice (yellow skin) or nausea. Read more about hepatitis.

Treatment is available for all the STDs mentioned above, often with antibiotics, and most can be cleared up quite rapidly. It is vital you seek help as soon as you notice any symptoms and that you do not have sexual contact that could pass on any infection until it has been dealt with.

Seeing an ob/gyn isn’t just for cis-women. If you have a vagina, surgically created or otherwise, regular checkups and screening are important for your health and the health of your partner(s). It is important to be up front and honest with your provider, whether your a cisgender lesbian, a trans* questioning female bodied individual or otherwise.

If you have a cervix, regardless of how you identify, looking after yourself also means having regular cervical smears, even if you have never had sex with a man, or not for years. The reason for this is because sex between women can transmit HPV, the virus associated with cervical cancer. Smear tests can detect pre-cancerous cells and early treatment can mean cancer never develops. Despite this, clinic-based studies and surveys have shown that women who have sex with women are less likely to receive routine smears than heterosexual women of similar age.

It is just as important for a lesbian to have regular smear tests as it is for a heterosexual woman. You can talk to your doctor about having a cervical smear, or alternatively you can contact a family planning or sexual health clinic.