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Lesbian, Bisexual and Queer Women’s Health Issues

In September 2008, our guest experts in Le Club's Ask the Expert segment were part of an interdisciplinary team at Sherbourne Health Centre.

Sherbourne Health is an urban primary health-care centre serving the diverse communities of southeast Toronto. Since its inception in 2003, they have worked with LGBT (lesbian, gay, bisexual and trans) communities and community partner agencies to address the physical, mental and emotional needs of the diverse and vibrant communities of lesbian, gay, bisexual, transgender, transsexual, two-spirited, genderqueer, intersex, queer and questioning.

They also participate in important community-based research and advocacy for healthy public policies.

The centre’s LGBT programs and services include medical and nursing care; mental health services; health promotion and education; the LGBT Parenting Network; LGBT Youth Services, including Supporting Our Youth’s community-based programs and supports; and Rainbow Health Ontario, a provincial health promotion resource.

The questions you sent in were answered by the following team members at Sherbourne Health Centre:

  • Carole Baker is a counsellor in the LGBT program. She balances her clinical work with non-talk therapy including expressive arts and nature-focused therapy.
  • Daniel Bois, RN, is a nurse in the LGBT program. He has been nursing for eight years, and has experience working in the field of mental health and addictions.
  • Michèle Clarke, MSW,is the communications coordinator for Rainbow Health Ontario. Her health promotion work involves the use of communication techniques and technologies to improve LGBT health.
  • Rachel Epstein, MA, PhD candidate, is the coordinator of the LGBT Parenting Network. She has been doing research, writing, education and community organizing on issues related to queer parenting for 17 years.
  • Dr. Kate Greenaway, is a family physician in the LGBT program. 
  • Mary Potter, RN, is a nurse in the LGBT program. Her recent post-graduate professional pursuits have included nursing in the community, focusing on youth sexual health and within acute pediatric care settings.

Here are the team’s answers to your questions on Lesbian, Bisexual and Queer Women’s Health Issues:

Q: Are there any known cases of childhood sexual abuse causing homosexuality?  I continue to believe that this may be my case.  Signed, Lesbian stressed in Toronto.

A: There are many different theories about what causes heterosexuality, homosexuality, and bisexuality but so far scientific research suggests that sexual orientation is probably a combination of genetics, and environmental factors. We still don’t know for sure which genes and environmental factors contribute to determining sexual orientation, but many studies look at the childhood experiences of LGBT people to try to discover these factors.

While a few studies have found that lesbians and gay men are more likely to have experienced childhood sexual abuse compared to heterosexual women and men, experts in the human sexuality field do not believe that childhood sexual abuse plays a significant role in determining adult sexual orientation.

Since there are no studies that have followed individual people to examine the causal relationship between abuse and sexual orientation over time, these experiences remain poorly understood. Some researchers have suggested that it may be that young children who grow up to be lesbian or gay are more likely to be abused because they may not conform to gender roles, or they may behave in different ways that end up putting them at greater risk for abuse.

Childhood sexual abuse is damaging in many ways and many people who have been sexually abused, gay and straight, experience confusion about their sexual identity and orientation. It is not surprising that you have concerns about how your experiences of sexual abuse may have played a role in determining your sexual orientation. If this is causing you distress, you may want to consider talking to your health care provider or with a counsellor who can provide some support and help you with these concerns.


Q: How does one find a gay/gay positive doctor in the suburbs?

A: The relationship between you and your healthcare provider is key to achieving good health. Everyone should have a supportive, knowledgeable doctor, no matter where they live. Coming out to your doctor is about taking better care of your health, and it is important that your doctor be receptive and sensitive to your concerns. It may be easier or more difficult to find a LGBT-positive provider depending on where you are located.

Here are some tips that everyone can try:

  1. Ask your friends, family members and co-workers for a referral. Find out who their doctors are and whether they think they would be LGBT-positive.
  2. If there is a LGBT-specific community organization or group in your area, contact them to see if they have a list of LGBT-positive health care providers. AIDS Service Organizations and women’s health centres may also be able to provide a helpful referral.
  3. Call and ask the doctor about their experience with LGBT clients. Find out how familiar they are with LGBT clients and health concerns.
  4. Visit the doctor’s office or clinic to see if the atmosphere is welcoming and makes you feel comfortable.
  5. If you feel that your healthcare provider is not LGBT-positive, don’t be afraid to discuss your needs with your provider or to leave their practice if they are not willing to work with you.


How often do lesbians and bi women need pap tests?  I have been given lots of different answers over the years.

A: Many queer women and health care providers continue to be misinformed about the need for regular Pap test screening, and the common myth persists that lesbians are not at risk of cervical cancer and therefore don't need Pap tests.

Some types of the Human Papillomavirus (HPV) can cause cervical cancer and research has demonstrated that HPV can be passed from woman to woman during sex by genital skin contact, or on fingers or shared toys.

The current Ontario Screening Guidelines recommend that all sexually active women have yearly Pap tests, including women who have sex with women. Once you have had normal tests for three years in a row, then you will only need to have a Pap test every two to three years, but make sure to check this with your doctor or nurse.


Q: I had read somewhere that obesity rates for gay women are much higher than for straight women. Is bigger considered better in lesbian communities? Is this strictly due to cultural reasons, or are there medical reasons for this as well?

A: Several research studies have suggested a higher prevalence of obesity among lesbians, and a 2007 study published in the American Journal of Public Health showed that lesbians are twice as likely to be overweight or obese compared to heterosexual women.

We are not really sure why lesbians are more prone to obesity, but studies suggest that yes, these differences are due to social, behavioural and cultural factors. While lesbian communities are extremely diverse, in general, there are different attitudes concerning weight and body shape compared to heterosexual women. Lesbians have been shown to have a better body image and cultural norms in queer women’s communities tend to encourage acceptance of heavier body weights. Dieting and thinness are rejected as heterosexual standards of attractiveness, and bodies of all shapes and sizes are considered desirable.

Other suggested contributing factors include the stress of dealing with prejudice and discrimination, which may lead some women to resort to comfort food and overeating. Some researchers also suggest that women who have been through a psychologically demanding coming out process are much more likely to be comfortable with their bodies, and less concerned about their weight. Higher body weights may also offer a certain type of protection in allowing some women to avoid unwanted male attention.

In considering the broader health care context, the barriers to accessing health care faced by lesbians could be considered to be a contributing medical factor. For lesbians and other women who have sex with women, getting good health care can be hard. Health care providers may be homophobic or they may not know much about queer women’s health concerns. Some women may just avoid seeking health care altogether and this reduces the likelihood that they will receive health information and medical advice regarding their body weight.


Q: I am almost a senior, and within the past five years, my brother became my sister. She is a very active member of her community. I am still having trouble adjusting to this. I had no clue that there were issues in her past, and the announcement came out of left field to me. Originally, I felt like I had been orphaned. Mum and dad are both deceased.

We now have a good relationship. However, my husband and friends have offended me with their amusement with this development (the reassignment surgery). Please suggest books or pamphlets that I may read to understand this and the issues with which my sister is dealing. My own investigations have led me to believe that this surgery was inevitable, based on what I know of medications Mum needed to take while she was pregnant with my sis.

A: No one knows exactly how gender identity is determined. However, most experts agree that it is a complicated matter involving biological factors such as genetic influences and prenatal hormone levels, early experiences in a person’s family of origin, and other social factors.

No matter what is involved in someone being transsexual, it is important that they are loved and accepted by their family and friends, and it sounds like you are providing valuable support to your sister. It is not uncommon for people to experience feelings of grief and loss when a transsexual family member comes out, but ultimately your loved one is the same person as before. There is a lot for everyone involved to learn about, and it is great that you are trying to educate yourself.

Here are some resources that can help:

1. Trans Forming Families: Real Stories About Transgendered Loved Ones, edited by Mary Boenke (2003). Available through aiyiyi.com/transbook.

2. The Transgender Child: A Handbook for Families and Professionals, by Stephanie Brill and Rachel Pepper (2007). Available through www.genderspectrum.org

3. Families In TRANSition: A Resource Guide for Parents of Trans Youth, by Dr. Nicola Brown (2008). Available through www.ctys.org/about_CTYS/FamiliesInTransition.htm

4. Answers to Your Questions About Transgender Individuals and Gender Identity, by the American Psychological Association (2006). Available through www.apa.org/topics/Gender3.pdf

5. Our Trans Children, by the PFLAG Transgender Network (2007). Available through

If you would like to speak to someone who has shared your experience, you may also want to try PFLAG Canada which has support groups and contacts in more than 70 communities across Canada. You can visit www.pflagcanada.ca/ to see if there is a chapter in your area.


Hello. I am a heterosexual female, but sometimes I find women attractive. I have trouble picturing myself ever acting on these feelings, however, as it would seem so strange (for me) to do this, because of my upbringing, my friends, etc. I often think if society's conventions weren't so strong, a lot more people would admit to be attracted to individuals (of both sexes), rather than just to members of their opposite gender groups. And they wouldn't be afraid of exploring new relationships with people who just so happen to be the same gender at they are. Do you think it's true what people say, that all of us, to some extent, have bisexual tendencies?

A: The belief that everyone is really bisexual is fairly common, and can largely be traced to Alfred Kinsey’s research on human sexual behaviour in the late 1940s and early 1950s. Kinsey introduced the concept of the Kinsey Scale which describes a person’s sexual behaviour by using a scale from 0, meaning exclusively heterosexual, to 6, meaning exclusively homosexual.

Kinsey’s findings suggested that a significant portion of his research sample had both heterosexual and same-sex “experiences or reactions”, even though only a very small minority of adults identified themselves as bisexual on his rating scale. Kinsey’s research was focused on sexual behaviour and the majority of sexuality research since then has also only measured sexual behaviour, primarily focusing on same-sex behaviour in studies of sexual orientation.

So are we all really bisexual? The data is very difficult to gather as sexuality is such a complex phenomenon involving not just sexual behaviour, but also sexual identity and sexual attraction which can be quite different for individuals. Also, many people are hesitant to answer questions on sexuality surveys and different studies have used different standards for defining bisexuality.

What we can tell you is that based on limited studies over the past 50 years, research suggests that somewhere between 10 to 20 percent of the population has experienced either same-sex attraction/behaviour at some point in their lives. In a recent survey conducted by the Center for Disease Control (CDC) and the National Center for Health Statistics (NCFHS) in the U.S., among men 18 to 44 years of age, 92 percent said they were attracted “only to females,” and among women, 86 percent said they were attracted only to males.

These findings suggest that most people do not experience bisexual attractions, but as you mentioned, homophobia and biphobia continue to have a tremendous impact on how comfortable some people are to admit their same-sex attractions and to act on them with sexual partners. Ultimately, everyone has to make their own choices about how they express their sexuality, whatever their attractions might be.


Q: From a mental health perspective, I am always curious to know if there are higher rates of depression/anxiety in the LGBT community due to isolation/loneliness/unacceptance by family and friends?  Also, where does someone who recently moved to the city and just "came out of the closet" go to in order to find "like-minded" people for support? I am not meaning clubs or places to pick up people, but just a place to find friends who can relate to their situation.  This can be particularly more challenging in the suburbs, as city-minded people and resources tend to be more open and available. Thank you.

A: There are many reasons why people may develop emotional or psychological problems during their lives, but LGBT people face particular challenges in coping with homophobia, biphobia, transphobia and heterosexism. Negative attitudes, discrimination and violence can contribute to mental and emotional distress for queer and trans people. Coming out can be emotionally tough with many people having to deal with rejection from family and friends. Staying in the closet can also be stressful, leading to isolation and fear of discovery for some LGBT people. These stressors have a profound impact on the self-esteem and self-identities of LGBT people, and yes, studies do show that there are higher rates of depression and anxiety compared to the heterosexual population.

In a 2008 study by Statistics Canada, 11 percent of gay men and 11 percent of bisexual men reported having a mood disorder and 9 percent of gay men and 10 percent of bisexual men reported having an anxiety disorder compared to 4 percent and 3 percent of heterosexual men, respectively.

Similarly, 11 percent of lesbians and 25 percent of bisexual women reported having a mood disorder and 9 percent of lesbians and 18 percent of bisexual women reported having a anxiety disorder compared to 8 percent and 6 percent of heterosexual women, respectively. While there is little published evidence of the depression and anxiety rates of transsexual and transgender people, studies suggest that trans people also experience these mental health issues at higher rates than the general population.

Whatever your mental health status, connecting with others who support you can be helpful. Depending on where you live, there may be LGBT social and recreational groups such as book clubs or soccer teams where you can meet other queer and trans people. You might consider volunteering for a LGBT program or organization near you, such as your local Pride committee. Also, Metropolitan Community Churches, United Church of Christ and Unitarian Churches, among others are known to be welcoming of LGBT people.

While most people think of the Internet as a place to meet people for dating, it can also be a great place to put up an ad on websites geared to LGBT people specifying that you are just looking to make new friendships. You might also find information about LGBT groups and events in your area through the Internet. Finally, you could start a new group focused on an activity that you already enjoy, such as a book club or a movie group, and invite other LGBT people to join you in making new friends together.


Q: I am a heterosexual woman over fifty. What if I met a fellow who I thought might be bisexual? If he is interested in me, is it okay to ask him if he is bisexual?  Does it mean he may like men more than women, or the same?

A: Sexual attraction is one of the most fascinating, intriguing and deeply personal experiences that we have as human beings. We all get drawn to different people because of a mixture of physical, mental and spiritual attraction and bisexual people are no different. Some bisexual people are equally interested in men and women, and some aren’t. Some are attracted to men and women in different ways, and some may feel that they have a preference for one gender over another. Other bisexual people say that gender just isn't relevant to who they're interested in and their attractions are based on the individual qualities that they see in a person.

If you were dating a bisexual man, think about why knowing his sexual orientation would be important to you and why it would be different than if he were heterosexual. If you had concerns about him seeing other people or about his sexual history, then you should raise these issues as topics of conversation just as you would in any other relationship. Knowing that someone is bisexual might be important but it only tells you a little bit about that person, so think of it as just one aspect of learning about a new partner.


Q: My daughter, who is 14, has expressed that she is bi/lesbian (she's not sure yet). Both my husband and I have a good relationship with our daughter and so far she has been able to talk about anything with us.

Unfortunately I am getting stumped when it comes to lesbian sexual health issues - I can find books on heterosexual guidance for parents - but not for bi or lesbian teens. Can you suggest anything? Our daughter has a girlfriend, so I want to be able to answer questions that arise.

A: Talking about sexual health issues can be challenging for both parents and teenagers, and it is wonderful that you have already established good open communication with your daughter. The issues that she will be facing right now will be very similar to heterosexual teens her age – being in a healthy relationship, learning about safer sex and birth control, making responsible choices and enjoying sexual pleasure.

Unfortunately, there are no resources that we know of that specifically address talking to a lesbian or bisexual teen about sexual health issues, but there are several other resources that you might find helpful.

YouthResource is a website, created by and for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people, which takes a holistic approach to sexual health. General youth sexual health websites that we would also recommend include Go Ask Alice!, Teenwire and Scarleteen.

For information and resources regarding sexual health and sexually transmitted infections in women who have sex with women, visit LesbianSTD.com, a website overseen by Dr. Jeanne Marrazzo at the University of Washington in Seattle.

And if your daughter expresses interest in knowing more about lesbian sex and sexual techniques, two popular guides designed for adults are The Whole Lesbian Sex Book: A Passionate Guide for All of Us (2004) by Felice Newman and The New Lesbian Sex Book (2008) by Wendy Caster.


Q: We, as a family are fairly open about our daughter's choice, (she has expressed that she is bi/lesbian), while maintaining her dignity and confidentiality.  However, her girlfriend must keep it secret from her father, who would not accept her choice.  We have an open communication with her Mom and that has worked out well.  Can you provide any advice on how to deal with this?

A: Coming out should be a choice and your daughter’s girlfriend should be able to tell her sexual orientation to who she wants, when she wants. The act of coming out can involve taking great risks and for many people, it may result in real significant losses and it can even be physically dangerous in some situations. Your daughter’s girlfriend has her own reasons for not coming out to her father and it is important that you show your support, acceptance and respect for her choice at this time, even though it may be difficult or awkward for you.

Family members and friends who find themselves in this position often feel that they do not know what to say to the person who does not know, or they may feel like they are lying. But each time an LGBT person comes out to someone, it is an act of trust, and it is important that you honour that trust and maintain the person’s privacy. You may want to think about any situations where you would just be too uncomfortable interacting with your daughter’s girlfriend’s parents and discuss these with your daughter ahead of time, so that everyone can be prepared should such a situation arise. 


Q:  I just had a question about the cliché portrayals of homosexuals in pop culture. Why are gay men usually shown as carefree, flamboyant, creative and happy, while lesbians seem to be portrayed as angry, frumpy, militant man haters? (And I hate to admit it, but there is often a grain of truth in these portrayals, at a very general level, in reality.) Where do these stereotypes come from, and do you think they will ever stop being perpetuated?

A: Stereotypes are useful to the media because they act like codes, providing a quick common identity for a person or group that is easily recognized by an audience. They reflect simple ideas about a person’s class, ethnicity or race, gender, sexual orientation, social role or occupation. Since we all get taught the same stereotypes, we all recognize them whether we agree with them or not.

These stereotypes about gay men and lesbians arose because gay men and lesbians often do not conform to traditional gender roles, rules and boundaries. The cultural assumption is that heterosexuality is the “norm”, so if a man is attracted to another man, then he is seen to adopt the gender role and femininity of a woman. Similarly, if a woman is attracted to another woman, then she is seen to adopt the gender role and masculinity of a man. For lesbians, sexism also comes into play, so there is an assumption that the only possible reason she is attracted to women is because she hates men or she is too unattractive (i.e. angry, frumpy) to have men be sexually interested in her.

While stereotypes can be rooted in observations of some members of a group, they also usually include a number of these types of inaccurate and frequently negative assumptions that are used to explain and justify differences between groups. So even though they are not supported by evidence, the stereotypes you mentioned are often used to condemn, dismiss, or trivialize lesbians and gay men and to excuse prejudice and discrimination against them.

But yes, stereotypes do change with time and we are beginning to see more realistic portrayals of LGBT people in popular culture. As legal conditions and social attitudes continue to change, eventually these stereotypes will appear awkward and dated to a future audience.


Q: My husband and I have a trans-gendered son who has recently had a hysterectomy and chest reconstruction surgery.  We are fully affirming and supportive, but most of our friends and community (largely church-based) are not. Could you provide a brief, scientifically-based response that might help people understand this condition and its treatment? Thank you.

A: Gender Identity Disorder (GID) is a well known and established condition that is recognized by the Diagnostic Statistical Manual of Mental Disorders which is the authoritative handbook relied upon by mental health professionals in Canada and around the world. A person with GID experiences a persistent and recurrent discordance between their anatomical birth sex and psychological gender.

This conflict between gender identity and physical sex is often present from a very early age and is the cause of enormous discomfort and distress. Gender Identity Disorder can cause severe depression and anxiety, and can interfere with a person's ability to function, often leading to problems in school or work, with developing relationships, or possibly suicide.

The exact cause of Gender Identity Disorder is not known, but most experts believe that biological factors such as genetic influences and prenatal hormone levels, and early social and cultural experiences can all contribute to the development of transsexual behaviors and identities.

The medical treatment plan for a person diagnosed with GID can involve several different components, depending on the individual’s needs:

1. Hormone therapy is recommended to suppress biological sex characteristics and to accentuate those of the opposite sex;

2. Surgical treatments are recommended to change the genitalia and other sex characteristics (sometimes referred to as a "sex change" operation); and

3. Counselling is recommended to treat the associated problems of depression and anxiety, to improve self-esteem and to help the individual cope with all of the changes associated with the period of transition.

Treatment plans are based on standards of care developed by the World Professional Association of Transgender Health. For more information, you can visit www.wpath.org.


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