Barriers to infectious disease care among lesbians.

Despite the considerable number of women in the United States who identify as lesbian, few data exist that address lesbians' health needs. The Institute of Medicine emphasized that data on sexually transmitted infections, Pap smear screening, and cervical dysplasia among lesbians were needed to guide clinical practice, policy development, and patient education. Use of surveillance data for this purpose is limited because risk classifications exclude same-gender sex among women or subsume it under behavior considered as higher risk. However, sexual transmission of human papillomavirus, HIV, Treponema pallidum, and Trichomonas vaginalis between women has been reported. Data indicate that lesbians receive routine Pap smear screening less frequently than is optimal. Moreover, lesbians commonly report previous pregnancy, induced abortion, and hormonal contraceptive use. Education of lesbians and their care providers should counter assumptions that sex between women confers no risk for transmission of sexually transmitted infections, and lesbians should receive Pap smears according to current guidelines.