Pelvic inflammatory disease in the lesbian population—lesbian health issues: asking the right questions

Abstract

Background: It is widely believed that the lesbian population is at a lower risk for sexually transmitted diseases. This myth has been perpetuated by misperception of lesbian patients and sexual practices associated with this lifestyle. Physician failure to identify lesbian patients and address issues confronting these patients is a confounding factor. We report two patients whose diagnosis was obscured by their sexual orientation.Cases: We report a lesbian patient admitted with the diagnosis of pelvic inflammatory disease (PID) possible tuboovarian abscess (TOA). Although history and physical examinations were consistent with this diagnosis, the patient was taken to the operating room for diagnostic laparoscopy based partly on the assumption that because she was a lesbian she was at low risk for PID. The second patient presented with PID possible TOA. The patient was taken for diagnostic laparoscopy for worsening symptoms. Pelvic inflammatory disease was confirmed surgically in both cases. The more detailed history acquired after surgery would have been helpful if taken at the time of admission.Conclusions: The practices of the lesbians vary widely, risk factors for PID may be similar to heterosexual patients. It is essential as physicians to elicit good histories from patients. The lesbian population is often overlooked and important questions missed. As physicians and health care providers, patients can only be treated when their needs are understood.