Dear Reader,

Being honest and complete with the information you give to your health care providers is one of the most important things you can do to insure yourself thorough health care. Of course, it's also understandable that you may be reluctant to tell your gynecologist that you're having sex with another woman, or to talk about your bisexuality. Like other women in your situation, perhaps you are worried that:

• talking about this will be awkward
• you will be misunderstood
• your health care provider will ask a lot of embarrassing questions
• your statement will be ignored
• you will be mistreated
• assumptions will be made about you and/or your behavior
• the provider will refuse to treat you

These are all reasonable concerns since, unfortunately, there are still many people out there, including health care providers, who don't understand or accept same-sex relationships. However, there are also lots of providers who are sensitive and open to all of their patients' needs and issues and, in fact, some who even specialize in providing services to lesbian, bisexual, gay, and/or transgendered people.

If you already have an established relationship with your gynecologist, you have an idea of how s/he has handled your needs in the past. Has s/he been sensitive when listening to your health concerns? Have you had the time to discuss all of the different aspects of your sexual health? Have the services provided been thorough, gentle, well explained, and followed up? These are some questions to ask yourself. Talking about this issue might be hard at first, but if you don't tell your gyn, it is quite possible, unfortunately, that s/he will assume that you're sexually active with only men (if you discuss being sexually active). This can lead to a lot of confusion, complicated, vague wording on your part, and possibly unnecessary or inappropriate discussion and suggestions for your health care.

If you have felt comfortable with your gyn up until now, you may want to just go ahead and mention the fact that you are having lesbian sex. Perhaps you consider yourself bisexual, but are currently only involved with women. You might have one partner, or multiple partners. You may have physical relationships with both men and women. Whatever your situation, choose the wording that's most comfortable for you, and that best describes you and your sexual activity. You can say something like, "I have a female partner now," or "I'm bisexual, and sometimes I have sex with women, and sometimes with men," or "I know the last time I saw you I wasn't having sex with anyone. Right now I'm involved with a woman." Your gynecologist will probably ask some questions to get more specific information. Having a productive discussion with her/him can allow you to explore some or all of the following issues:

• how this affects your need, or lack of need, for contraception
• how to effectively protect you and your partner(s) from sexually transmitted infections (STIs), including HIV
• whether you're also having sex with men, and the health care needs associated with this
• your possible interest in having children some day
• whether there's any stress for you associated with your same-sex relationship(s)
• anything in your intimate relationships, whether with women or with men, which is troubling to you: emotional, physical, or sexual abuse, for example

If you do not yet have a gynecologist that you work with, or are unhappy/too nervous about your current one, you can search out a good match for you in a number of ways. Word of mouth is definitely one of the best ways to find out how a particular provider deals with LGBT health care issues. Ask your friends, school-, or work-mates if they can recommend a gynecologist or nurse practitioner they like. While you're at it, ask about primary care providers, dentists, dermatologists, and others... you never know when you'll need a good specialist.

You can also contact your local gay and lesbian services center for some names. If you're in the New York area, contact The Lesbian and Gay Community Services Center. You can also try The Gay and Lesbian Medical Association.

If you're a Columbia student, all of the providers in Primary Care and throughout Health Services are open to discussing the needs of LGBT students.

Take care of yourself,

Alice

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