Lesbian access to health care is compromised even in regions of the world where homosexuality is accepted as a variant of the normal spectrum of human sexuality. In Lebanon, lesbians are even further alienated. Pre-marital sexual activity is shunned; being a lesbian is a taboo. A lesbian woman might be challenged in the doctor’s office by coming out as sexually active and also coming out as a homosexual.

It is worth mentioning that most of the points below apply to homosexual and non-homosexual womyn. We chose issues that research has shown to be more prevalent among lesbians and bisexual womyn.

Great, you are now in your doctor’s office, what are important health issues to discuss?

1. Heart disease. Did you know that heart disease is the #1 killer of womyn? Did you know that lesbian and bisexual womyn have a higher risk for heart disease? Yes, this is true, not because you were born lesbian or bisexual, but because you might acquire habits that increase your risk – such as obesity, smoking, life stressors, lack of daily activity (sedentary lifestyle), late presentation to medical care, and many others. Only few factors that can lead to heart disease are not under your control: getting older or heart disease that runs in the family. However, you have the power to change many other risks like smoking, high blood pressure, lack of exercise, diabetes, and high blood cholesterol.
2. Exercise & Nutrition. We know that heart disease and even some cancers happen more to persons who exercise less. Inactivity doubles your risk for heart disease. Any daily activity can be considered an exercise, just don’t spend hours behind your computer screen, or stay all the weekend on the couch. Regular exercise and good nutrition help you lose weight, stay fit, protect your vessels from clots, high blood pressure and cholesterol. Research has shown that LBTQ womyn have higher risks of obesity then heterosexuals due to a number of factors. One such study can be found here.
3. Smoking. Smoking can lead to heart disease and multiple cancers, including cancers of the gum, lung, throat, stomach, breast, bladder, colon, and cervix. Lesbians are more likely to smoke, compared to heterosexual womyn. Living in Lebanon does not help you quit smoking. Most of the people around you smoke, there is no well enforced no-smoking public policy and people still think it is cool to smoke. Ironically, it is more of a social taboo in Lebanon to be lesbian than it is to smoke. Even though the first is a healthy sexual identity you were born with and the other is an unhealthy habit you picked along the way. Go figure! But we will not solve the Lebanese smoking crisis today. Smoking is very bad for you, I know it is hard to quit, but your health is on stake here. If you need further advice on smoking cessation, please do not hesitate to contact me at hasan.abdessamad@gmail.com.
4. Depression and Anxiety. Studies have shown that lesbian and bisexual womyn report higher rates of depression and anxiety than heterosexual womyn do. This may result from their higher exposure to social stigma, rejection by friends and society, loss of family members’ support, possible abuse, violence (hate crimes), blackmailing, unfair treatment by the legal system, lack of police protection, hiding some or all aspects of one’s life, pressure to abide by social rules (dress code, marriage…), lack of access to adequate health care, feeling religiously sinful. Surround yourself with people who understand and accept you as you are. Start planning on building a supportive circle of friends if you do not have one yet. Meem offers a safe space that might be helpful, Helem offers psychologist consultations for only 5000 LL.
5. Alcohol and drug abuse. We have no data from Lebanon about drug and alcohol use among lesbians. Studies from the western countries suggest an increase in drug and alcohol abuse among lesbians. Alcohol can cause addiction, liver damage and stomach problems when taken in access. Drug use might involve you with multiple health and legal problems. For a healthier lifestyle, avoid drugs and decrease your alcohol use whenever possible. Now I sound like your dad, but I do not know how else to say it.
6. Cancers. With more obesity, smoking and poor nutrition, and fewer pregnancies, breast feeding and regular doctor visits, lesbians are more likely to develop cancers. Lesbians may be at a higher risk for cancers of the uterus, breast, cervix, and ovary. Regular doctor visits are essential. You should see your Obstetrician/Gynecologist every year. Ask your doctor about self breast exams, mammograms, PAP smears, the new vaccine for cancer of the cervix, what the symptoms for cancer of the uterus and ovaries are, and how to decrease your risks for cancer. Be prepared to answer detailed questions about cancers that run in the family so make sure to prepare a good family tree of illnesses before you show up.
7. Domestic Violence. Intimate partner violence occurs when one partner purposely causes either physical or mental harm to another. Domestic violence can occur in lesbian relationships as it does in heterosexual relationships. There are no statistics available in Lebanon about domestic violence among homosexual partners. In Lebanon, heterosexual victims tend to remain silent about the violence; it is expected to be even harder for homosexual victims to speak up. The silence is frequently caused by fear of social stigma, loss of partners support, fear of physician’s reaction and lack of physician’s adequate support or understanding. If you or someone you know are a victim of domestic violence, I strongly encourage you to contact Kafa http://www.kafa.org.lb (You might also find Helem’s pshychologists helpful)
8. Osteoporosis. This is the term that refers to weakening of the bones. When bones get weak, they can break easier. The cause is usually aging. Osteoporosis can also result from hereditary factors and also from lack of calcium and vitamin D in our diets. Lebanon was found to be endemic for Vitamin D deficiency, which means that you are likely to have low levels of this important vitamin. We do not know if lesbians are at higher risk for osteoporosis, however, it is recommended that all womyn increase their intake of Calcium and Vitamin D starting from teen age.
9. Sexual Health. You are not protected unless you play it safe. Yes, woman-to-woman sex can still give you STIs (Sexually Transmissible Infections). If sexually active, it is a healthier option to limit your sexual encounters to one partner. If you are not sure you are in a monogamous relationship, always use condoms on shared sex toys and wash toys in between uses and before sharing (If applicable). Dildos and vibrators can be cleaned with warm water and soap. Silicone can be cleaned by boiling for 2-3 minutes or in the dishwasher. Use latex or vinyl gloves and lubricant for any manual sex (ya3ni fingering/fisting, if applicable). To play safe, consider using dental dams for oral sex. Dental dams might be hard to obtain in Lebanon so you can always buy flavored condoms and cut them to create your personal dam. Common STDs that can be passed between womyn include: Bacterial vaginosis (BV), Human papillomavirus (HPV), Trichomoniasis “Trich”, Herpes, and Syphilis. Contrary to common disbeliefs, HIV can be transmitted by woman-to-woman sex. For more info about specific STIs do not hesitate to email me at hasan.abdessamad@gmail.com
10. “Coming Out”. Coming out is the process of disclosing ones sexual orientation. It is essential to come out to your physician. This will affect the quality of care you receive. If you do not disclose this information, the physician will most likely miss on essential issues to discuss, counseling to perform and preventative care to implement. However, always assess the hostility of the environment right in front of your closet’s door. It is strongly urged to seek medical care with physicians who are either aware or tolerant of your sexual identity. Upon your request, Helem and Meem might be able to provide you a list of LGBT-friendly physicians practicing in Lebanon.

Hasan Abdessamad, MD, is a Obstetrician & Gynecologist. You can reach him by email: hasan.abdessamad@gmail.com