Lesbians are also at higher risk for STDs and other health problems than heterosexuals.1 However, the health consequences of lesbianism are less well documented than for male homosexuals. This is partly because the devastation of AIDS has caused male homosexual activity to draw the lion’s share of medical attention. But it is also because there are fewer lesbians than gay men,2 and there is no evidence that lesbians practice the same extremes of same-sex promiscuity as gay men. The lesser amount of medical data does not mean, however, that female homosexual behavior is without recognized pathology. Much of the pathology is associated with heterosexual activity by lesbians.
Among the difficulties in establishing the pathologies associated with lesbianism is the problem of defining who is a lesbian.3 Study after study documents that the overwhelming majority of self-described lesbians have had sex with men.4 Australian researchers at an STD clinic found that only 7 percent of their lesbian sample had never had sexual contact with a male.5
Not only did lesbians commonly have sex with men, but with lots of men. They were 4.5 times as likely as exclusively heterosexual controls to have had more than 50 lifetime male sex partners.6 Consequently, the lesbians’ median number of male partners was twice that of exclusively heterosexual women.7 Lesbians were three to four times more likely than heterosexual women to have sex with men who were high-risk for HIV disease-homosexual, bisexual, or IV drug-abusing men.8 The study “demonstrates that WSW [women who have sex with women] are more likely than non- WSW to engage in recognized HIV risk behaviours such as IDU [intravenous drug use], sex work, sex with a bisexual man, and sex with a man who injects drugs, confirming previous reports.”9
Bacterial vaginosis, Hepatitis B, Hepatitis C, heavy cigarette smoking, alcohol abuse, intravenous drug use, and prostitution were present in much higher proportions among female homosexual practitioners.10 Intravenous drug abuse was nearly six times as common in this group.11In one study of women who had sex only with women in the prior 12 months, 30 percent had bacterial vaginosis.12 Bacterial vaginosis is associated with higher risk for pelvic inflammatory disease and other sexually transmitted infections.13
In view of the record of lesbians having sex with many men, including gay men, and the increased incidence of intravenous drug use among lesbians, lesbians are not low risk for disease. Although researchers have only recently begun studying the transmission of STDs among lesbians, diseases such as “crabs,” genital warts, chlamydia and herpes have been reported.14 Even women who have never had sex with men have been found to have HPV, trichomoniasis and anogenital warts.15
 Gay and Lesbian Medical Association Press Release, “Ten Things Lesbians Should Discuss with Their Health Care Providers” (July 17, 2002), http://www.publichealth.pitt.edu/docs/10things_lesbi.pdf (accessed 3/18/10). The list includes Breast Cancer, Depression/Anxiety, Gynecological Cancer, Fitness, Substance Use, Tobacco, Alcohol, Domestic Violence, Osteoporosis and Heart Health.
 Michael, et al., p. 176 (“about 1.4 percent of women said they thought of themselves as homosexual or bisexual and about 2.8% of the men identified themselves in this way”).
 See Appendix A.
 Skinner, et al., Abstract; Ferris, et al. p. 581; James Price, et al., p. 90; see Appendix A.
 Katherine Fethers, et al., “Sexually transmitted infections and risk behaviours in women who have sex with women,” Sexually Transmitted Infections, 76(5): 345-349, p. 348 (2000).
 Ibid., p. 347.
 Ibid., p. 348.
 Ibid., p. 347, Table 1; Susan D. Cochran, et al., “Cancer- Related Risk Indicators and Preventive Screening Behaviors Among Lesbians and Bisexual Women,” American Journal of Public Health, 91(4): 591-597 (April 2001); Juliet Richters, Sara Lubowitz, et al., “HIV risks among women in contact with Sydney’s gay and lesbian community,” Venereology, 11(3): 35-38 (1998); Juliet Richters, Sarah Bergin, et al., “Women in Contact with the Gay and Lesbian Community: Sydney Women and Sexual Health Survey 1996 and 1998,” National Centre in HIV Social Research, University of New South Wales, 1999.
 Fethers, et al., p. 347 and Table 1.
 Barbara Berger, Shelley Kolton, et al., “Bacterial vaginosis in lesbians: a sexually transmitted disease,” Clinical Infectious Diseases, 21: 1402-1405 (1995).
 E. H. Koumans, et al., “Preventing adverse sequelae of Bacterial Vaginosis: a Public Health Program and Research Agenda,” Sexually Transmitted Diseases, 28(5): 292-297 (May 2001); R. L. Sweet, “Gynecologic Conditions and Bacterial Vaginosis: Implications for the Non-Pregnant Patient,” Infectious Diseases in Obstetrics and Gynecology, 8(3): 184-190 (2000).
 Kathleen M. Morrow, Ph.D., et al., “Sexual Risk in Lesbians and Bisexual Women,” Journal of the Gay and Lesbian Medical Association, 4(4): 159-165, p. 161 (2000).
 Ibid., p. 159.