S.F. summit looks at lesbian health issues SAN FRANCISCO

The first problem surfaced when Dulce Garcia went to a San Francisco clinic two years ago for her annual physical. As she filled out the intake form, all the questions assumed she was straight.

Then in the examining room, a nurse repeatedly offered her a pregnancy test and birth control.

"She kept telling me Latino women have a high risk of pregnancy," said Garcia, a health educator who teaches youths about disease prevention. "I had to out myself right there and then. The nurse seemed shocked that I wasn't heterosexual. Even here in San Francisco, this kind of thing happens."

The health concerns of lesbians, from interpersonal difficulties in doctors' offices to the high prevalence of risk factors for heart disease and many cancers, will be highlighted at a national summit this weekend in San Francisco.

"This conversation is long overdue," said Dr. Sandra Hernandez, chief executive of the San Francisco Foundation and an assistant clinical professor at UCSF. "This is the first summit to bring together clinicians, scientists, leaders in their communities to discuss these issues.

"The summit will call for more research into lesbian health, and more funding for research."

Women's health has become a focal point of medical study relatively recently.

"For research purposes, women used to be thought of as smaller men," said Diane Sabin, executive director of the Lesbian Health & Research Center at UCSF. "We were once outside the research structure, our body chemistry was viewed as too complex to be able to isolate individual variables for a research focus."

The subset of lesbians has emerged even more recently as a field of medical research, she said.

"One thing we still need to do are more studies on resiliency - to learn why so many lesbians not only function but thrive despite having so many health obstacles."

For reasons that are not yet well understood, studies show that lesbians weigh more than their heterosexual counterparts, smoke more, drink more, abuse drugs more often, and have more fat around their midsections, putting them at a higher risk of heart disease, said Dr. Katherine O'Hanlan, a Bay Area gynecologic cancer surgeon and healthy policy advocate.

"The health profile of lesbians is significantly more unhealthy," she said. "Lesbians have a higher concentration of risk factors for cancer, heart disease and stroke than heterosexual women."

Research has shown that lesbians undergo fewer mammograms than heterosexual women and perhaps as a consequence, may suffer higher rates of breast cancer, she said.

Additionally, they may have a higher risk for ovarian and uterine carcinomas due to "less frequent use of oral contraceptives, combined with higher rates of obesity and endometriosis," O'Hanlan wrote in an article published three years ago in Obstetrics & Gynecology.

She said many lesbians fail to get Pap tests, believing they don't need them, despite having had prior sexual relations with men.

In general, lesbians don't go to the doctor as much as they should, O'Hanlan said.

"They think they don't need to if they don't have aches and pains and they don't need contraception," she said.

As a result, though, they may be diagnosed at a later stage in the course of a disease, she said.

Influencing many lesbian health issues is their experience with societal discrimination and a resulting lack of self-esteem, said Dr. Caitlin Ryan, a clinical social worker at San Francisco State University and director of the Family Acceptance Project.

Ryan, who has spent more than 30 years studying lesbian health, published a groundbreaking study in January documenting serious health consequences to lesbian, gay and bisexual adolescents due to family rejection. The youths were at greater risk for HIV infections, depression, illegal drug use and suicide attempts, the research found.

"Social stress has an enormous impact on their health," said Ryan. "Many avoid going to doctors - a significant portion of lesbians have had negative experiences with health providers who didn't want to work with them or provided rough or inappropriate care. As a result, the women avoid medical care until their health problems become very serious."