New Data on Birth Order in Homosexual Men and Women and a Reply to Vilsmeier et al. (2021a, 2021b)

The fraternal birth order effect (FBOE) is the repeated finding that older brothers increase the odds of homosexuality in later-born males. It has been our working assumption, based on the majority of previous studies, that a similar FBOE does not occur in females. In an elaborate quantitative review posted last year to a preprint server, Vilsmeier et al. (2021a) concluded that there is no valid evidence for an FBOE in men or women. Ablaza et al. (2022) subsequently published a study of population-level data from the Netherlands with conclusions completely opposite to those of Vilsmeier et al., namely, that there is robust evidence of an FBOE in both men and women. The present research was initially undertaken to refute the assertion of Vilsmeier et al. that there is no proof of an FBOE in men and to investigate how they obtained such a discrepant conclusion. We found evidence that the discrepancy may relate to Vilsmeier et al.'s use of the large and demonstrably unreliable sample published by Frisch and Hviid (2006). After the publication by Ablaza et al., we expanded our article to address their finding of an FBOE in women. We argue that our preferred explanation of the FBOE in men-that it reflects the progressive immunization of some mothers to Y-linked antigen by each succeeding male fetus and the concomitantly increasing effects of anti-male antibody on sexual differentiation in the brain in each succeeding male fetus-could plausibly be extended to female homosexuality.

Mental Health Service Use Among Middle-aged and Older Lesbians: Application of Andersen's Health Service Use Model

Guided by Andersen's Health Service Use Model, this study examined the predisposing, enabling, and need factors of MH service use among middle-aged and older lesbians. Data were collected from 455 lesbians ages 50 and over through a national online survey. Ordered logistic regression was conducted to examine the predictors of mental health counseling use. Results show that those who were widowed and single were more likely to participate in MH counseling than those who were partnered. Being out to healthcare providers, the number of mental health conditions, and being unsatisfied with sex were positively associated with participation in MH counseling. The study highlights the need to tailor MH service among those who are widowed and single and the importance of enhancing MH referral and integrating MH service in primary care for this population. Further, sexual health should be treated as an integral part of psychological wellbeing in MH treatment.

Mental health disparities between German lesbian and bisexual women and a population-based sample

Lesbians are at greater risk of mental health problems than heterosexual women, and bisexual individuals are even more likely to report mental health problems. No study has yet tested whether there are any mental health differences between German lesbians, bisexual women, and female controls. We tested for mental health differences between matched groups of 161 lesbian and bisexual women and 161 women in the general population, as well as between matched groups of 79 lesbians and 79 bisexual women. Lesbian and bisexual women reported more mental health problems than population-based women. In contrast, bisexual women did not differ in mental health from lesbians. Therefore, German lesbian and bisexual women constitute a risk group for mental health problems. To improve lesbian and bisexual women's mental health, attempts should be made to lower the frequency of minority stressors, and best-practice mental health interventions made available.

The institutionalization of queer theory: Where has lesbian criticism gone?

This contribution brings to the fore the lesbian silences veiled by dominant theorizations of queer studies in academia, nowadays more concerned with analyzing social affections such as queer diasporas, terrorism, human rights and necropolitics and positing intersectionality as the key configuration of queer epistemology. Yet, I am interested in eliciting how such existing approaches can help chart queer horizons in more inclusive ways without ignoring lesbian voices. Concomitantly, I will posit such lesbian positions as critical epistemologies we cannot do without, since only by unfolding past accretive knowledge on gender and sexuality will queer discourses become inclusive and relational. Hence, this article traces the evolution and theoretical shifts that queer theory has undergone in the last decades and further explores why "the lesbian" continues being dismissed as a marginal site of knowledge and material production, enacting a closeted identity, muted by other legitimate discourses in academia. Such a move toward new queer and affective frameworks, while convincingly essential, should not overshadow lesbian criticism. By drawing on relational and affective modes of being, I suggest recasting "the lesbian" as both a textual and ontological possibility capable of embracing the variety of lesbian-identified persons traditionally silenced by queer theory's canonical institutionalization.

Sexual orientation and disordered eating in women: a meta-analysis

PURPOSE

Homosexuality is a clear risk factor for disordered eating in men; however, for women, research has yielded contradictory results. We conducted a meta-analysis to examine the association between sexual orientation and disordered eating in women.

METHODS

PRISMA guidelines were used. Studies comparing disordered eating between lesbians and heterosexual women were identified using PsycNet database and Google Scholar. Twenty-one studies met inclusion criteria. Overall disordered eating, restricting, binging and purging were examined for heterosexual, lesbian, bisexual and 'mostly heterosexual' women.

RESULTS

Whereas there was no significant difference in overall disordered eating between lesbians and heterosexual women, lesbians reported restricting less and binging more than heterosexual women. Bisexual women were more likely than lesbian women to restrict food intake and purge, and more likely than heterosexual women to have overall disordered eating and restrict food intake. "Mostly heterosexual" women were more likely than heterosexual women to restrict food intake, binge and purge.

CONCLUSIONS

Women of different sexual orientations show distinct patterns of disordered eating. Bisexual and "mostly heterosexual" women appear to be particularly at risk. Stress resulting from binegativity and rigid views of sexuality in a dichotomous society, rather than sexual orientation itself, may be associated with disordered eating in women. Findings should be viewed with caution because there were few studies with bisexual and "mostly heterosexual" women. This study elucidates the nature of the association between disordered eating and sexual orientation. Findings provide a possible explanation for previous inconsistencies, since opposing trends for different behaviors cancel each other out.

LEVEL OF EVIDENCE

Level I, systematic review and meta-analysis.

Cognitive-Emotional Predictors of Sexual Functioning in Lesbians, Gays, and Heterosexuals

Cognitive-emotional dimensions play a core role in predisposing and maintaining sexual difficulties. This study aimed to assess the role of personality traits, sexual beliefs, cognitive schemas, automatic thoughts and affective states in predicting sexual functioning in a Portuguese sample. A total of 226 lesbian women, 254 heterosexual women, 243 gay men, and 274 heterosexual men completed a web-survey. For each sample, hierarchical regression analyses were conducted, separately. Results indicated that positive affective states and fewer thoughts associated with failure and disengagement during sexual activity act as significant predictors for sexual functioning, in both lesbian and heterosexual women's groups. Specific predictors of better sexual functioning in lesbian women were lower activation of schemas of undesirability and incompetence, and fewer thoughts associated with sexual abuse, body-image and sexual passivity were, whereas particular predictors of better sexual functioning for heterosexual women were erotic thoughts, lower activation of schemas of undesirability and difference/loneliness, and beliefs related to sexual desire as a sin. For men's groups, the best predictor of sexual functioning was the presence of erotic thoughts. Particularly for gay men's group, fewer failure anticipation thoughts were also a predictor of better sexual functioning. Overall, this study supports the core and predictive role of cognitive-emotional dimensions in sexual functioning for lesbian and heterosexual women, as for gay and heterosexual men.

Through a glass, darkly: Human digit ratios reflect prenatal androgens, imperfectly

On average, the length of the index finger (digit 2) divided by the length of the ring finger (digit 4) on the right hand, is greater in women than in men. Converging evidence makes it clear that prenatal androgens affect the development of digit ratios in humans and so are likely responsible for this sex difference. Thus, differences in 2D:4D between groups within a sex may be due to average differences between those groups in prenatal androgen exposure. There have been many reports that lesbians, on average, have a smaller (more masculine) digit ratio than straight women, which has been confirmed by metaanalysis. These findings indicate that lesbians were, on average, exposed to greater prenatal androgen than straight women, which further indicates that greater levels of prenatal androgen predispose humans to be attracted to women in adulthood. Nevertheless, these results only apply to group differences between straight women and lesbians; digit ratios cannot be used to classify individual women as gay or straight.

'We are not infertile': challenges and limitations faced by women in same-sex relationships when seeking conception services in São Paulo, Brazil

The use of reproductive technologies has expanded beyond cases of infertility, and opportunities for individuals of different sexual orientations to use such technologies for conception have increased. The authors examined the challenges and limitations faced by women in same-sex relationships seeking conception services in São Paulo, Brazil. They interviewed 16 women in same-sex relationships who conceived children using reproductive technologies. Access to public health services for conception remains limited and exclusive to infertile heterosexual couples. Women in same-sex relationships are forced to select between costly medical treatments in the private sector, or self-insemination with sperm from a known donor. In this study, individuals reported that they experienced adverse effects of treatments; were treated with technologies for infertility when they were, in fact, fertile; and were exposed to unnecessary and invasive interventions. Growing political conservatism and the reduction of investment in public health services are factors that can directly affect sexual and reproductive health, including that of lesbians. Public policies that enable same-sex couples to conceive have yet to be developed in many countries, and a clearer articulation of the right to evidence-informed, rights-based care, consistent with national and international guidelines is a much-needed next step.

Humanizing lesbian characters on television: Exploring their characterization and interpersonal relationships

The present study examined representations of 39 lesbian characters' interpersonal relationships and characterological profiles in 20 "lesbian-centric" television shows from 2008 to 2018. Using a mixed-methods approach, the following variables were analyzed: the quality of lesbian characters' relationships with their parents, children, close friends, and romantic partners; their sense of acceptance from these relationships; their gender presentation and expression; the use of homonegative tropes in targeted programs; portrayals of sexual behaviors; and demographic characteristics. Results indicated that the majority of the lesbian characters were young, cisgender, white, middle-class, and portrayed within various homonegative tropes. Most of the lesbian characters shared positive relationships with their mothers, children, close friends, and romantic partners, but not with their fathers. Qualitative findings evidenced support for the quantitative analyses; however, they revealed that lesbian characters' friendships were not fully developed. The strengths and limitations of this study, and directions for future research are outlined.

The Gendered Self of Chinese Lesbians: Self-Esteem as a Mediator Between Gender Roles and Depression

Sexual minority women are at an elevated risk for depression compared to heterosexual women, yet less is known about how gender roles affect the mental health of sexual minority women. Existing studies examining the role of self-esteem in the relationship between gender roles and depression are scarce and have predominantly focused on heterosexual populations. Using a cross-sectional survey of Chinese lesbians in Hong Kong (N = 438), the study tested the direct and indirect effects of different types of gender roles (masculine, feminine, and androgynous) on depression through the mediating factor of self-esteem. We found that masculinity and androgyny were positively associated with self-esteem, while femininity was negatively associated with self-esteem. More importantly, self-esteem fully mediated the inverse relationship between masculinity and depression and that between androgyny and depression. The positive relationship between femininity and depression was also fully mediated by self-esteem. By examining different types of gender roles and incorporating gender roles, self-esteem, and depression into a unified framework, the research highlighted the particularly protective effect of androgyny, which had the strongest positive direct effect on self-esteem and indirect effect on depression through the mediation of self-esteem compared to the effects of other types of gender roles. Our results illuminate the importance of understanding how individual differences in gender roles relate to the mental health of sexual minority women in future research and interventions. Implications for interventions that help Chinese lesbians cope with gender expectations and improve their mental health are discussed.

Made wrong, excluded, and ignored: Introduction to a special issue on lesbians and the law

For some time now, the specific experiences that lesbians have with the law have been considerably overlooked. This is because there is a focus on how gay males have contact with the law, as gay males are the group whose same-sex intimacies are most often criminalized in legislative frameworks. It is rare for the same-sex intimacies of lesbians to be targeted explicitly in legislative frameworks. This special issue therefore focuses on how lesbians have contact with the law. It features articles focused on what the guest editors conceptualize as how lesbians are being made wrong, being excluded, and being ignored by the law, and each of these are outlined in further detail in this introduction. The articles highlight the relational nexus between lesbians and different frameworks, processes, rules, policies, institutions and applications of law, and the far-reaching impacts this nexus produces in the lives of lesbians around the world.

Laboring lesbians: Queering emotional labor

Through an ethnographic examination of the everyday lives of lesbians working in gas stations, this article highlights the ways in which sexuality matters within the workplace. One of the unique aspects of the service economy is the position of the body at the center of the market transaction. In other words, it is the body that serves as the point of production between the customer and the company. Within this productive space, the concept of emotional labor highlights how emotions are a critical aspect of labor within a position of service required in order to develop relationships with consumers. The goals of this article are to strengthen the original concept of emotional labor by complicating our understanding of the body with specific reference to sexuality, an intersectional analysis of the assumption of the heteronormative worker, examining the multiple ways in which workers interpret and enact emotional labor and the accompanying rewards and punishments that shape the experience of emotional labor and exploring how gender and sexuality are performed. Ultimately, laboring lesbian bodies are informing, resisting, and playing as well as conforming to this complex production.

"Lez be honest": Gender expression impacts workplace disclosure decisions

We introduce a theoretical framework of lesbian disclosure of sexual orientation in workplace contexts. Existing empirical research suggests (1) that disclosing one's sexual orientation results in positive, negative, and neutral workplace outcomes; and (2) that scholarship focused specifically on lesbian disclosure in workplace contexts is relatively limited. We extend this literature by introducing new theory that suggests that reactions to disclosure of lesbian identities will vary as a function of self-presentation. Specifically, we suggest that the extent of stereotypical gender expression (embodying stereotypically masculine vs. feminine traits or behaviors) will impact both the decision to disclose and the outcomes of disclosure in workplace contexts. We describe a conceptual model that includes intrapersonal, interpersonal, organizational, and societal considerations related to lesbian disclosure and present eight specific research propositions to advance this literature.

Lesbians' experiences and attitudes towards parenthood in Greece

Same-sex parenthood is controversial subject. In this paper, we provide insights into the attitudes and experiences of self-reported lesbians regarding parenthood or the prospect of becoming a parent in the current Greek social and cultural context. In Greece, lesbians are not allowed access to in vitro fertilisation (IVF), while a solitary ('single') woman is allowed access for medical reasons. Fifty-nine (59) semi-structured in-depth interviews were conducted with women. What emerged from our data was a clear trend for participants to wish to have their own biological children based mostly on the belief that pregnancy would lead to a sense of self-completeness and/or fulfilment. Women also reported the negative impact of prejudice and social oppression on their reproductive autonomy. Interviewees reported that their reproductive choices were negatively influenced by their family and the wider socio-cultural environment. Even within a semi-permissive legal framework, impaired social acceptance of lesbian parenthood prohibits lesbians from becoming mothers. A major reason responsible for the positive attitude of most participants to shared biological motherhood was an altruistic attitude towards their partners.

Disclosing Lesbian and Gay Male Sexual Orientation in Later Life: Attitudes of Younger and Older Generations in Eight Latin American Countries

The purpose of this research was to explore attitudes toward older lesbians and gay men disclosing their sexual preferences in eight Latin American countries. The sample consisted of 1,539 participants belonging to three age groups (18-29 years, 60-69 years, and 70 years and over). Their answers to two open-ended questions were content-analyzed, and binary logistic regressions were run on the extreme attitudinal categories. Results showed that although most attitudes were positive, a solid percentage of participants still expressed different kinds of derogatory attitudes. Men (as compared to women) and participants who were more religious and less educated tended to hold more negative attitudes toward lesbians and gay men. Both older samples were more prejudiced than the younger one, and attitudes also varied according to country. There was a general trend showing more positive attitudes toward older lesbians and gay men in those countries where sexual minorities' rights are better assured, which suggests that measures to protect sexual minorities and to make sexual diversity in older age visible could be advisable.

Physical and mental health inequalities among aging lesbian, gay, and bisexual Canadians: cross-sectional results from the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVE

International estimates suggest the presence of health inequalities among older sexual minorities (i.e., individuals who identify as lesbian, gay, or bisexual and are 65 years old or above). In this study, we investigated the presence of health inequalities among aging lesbian and bisexual females, as well as aging gay and bisexual males in Canada.

METHODS

We used baseline data from the Canadian Longitudinal Study on Aging (CLSA) Tracking and Comprehensive cohorts to cross-sectionally compare self-reported physical and mental health indicators by sex and sexual orientation. Within our analysis sample of 51,208 Canadians 45 years old and over, 2% (n = 1057) of respondents identified as lesbian, gay, or bisexual.

RESULTS

Compared to heterosexual female peers, lesbian and bisexual females had greater odds of heavy drinking (AOR = 1.8, 95% CI = 1.3-2.4) and being a former smoker (AOR = 1.5, 95% CI = 1.2-1.9). Gay and bisexual males had greater odds of reporting a diagnosis of cancer (AOR = 1.5, 95% CI = 1.0-1.9) and currently smoking (AOR = 1.5, 95% CI = 1.1-2.0), compared to heterosexual males. Female and male sexual minorities had greater odds of reporting mood disorders (including depression) and anxiety disorders relative to heterosexual peers of the same sex.

CONCLUSION

These findings highlight the importance of considering both sex and sexual orientation when developing approaches to support the physical and mental health of a diverse aging population in Canada.

Butch-Femme Identity and Visuospatial Performance Among Lesbian and Bisexual Women in China

Lesbian and bisexual women who self-identify as "butch" show a masculine profile with regard to gender roles, gender nonconformity, and systemizing cognitive style, whereas lesbian and bisexual women who self-identify as "femme" show a corresponding feminine profile and those who self-identify as "androgynes" show an intermediate profile. This study examined the association between butch or femme lesbian or bisexual identity and visuospatial ability among 323 lesbian and bisexual women, compared to heterosexual women (n = 207) and men (n = 125), from multiple cities in China. Visuospatial ability was assessed using a Shepard and Metzler-type mental rotation task and Judgment of Line Angle and Position (JLAP) test on the Internet. Heterosexual men outperformed heterosexual women on both mental rotation and JLAP tasks. Lesbian and bisexual women outperformed heterosexual women on mental rotation, but not on JLAP. There were significant differences in mental rotation performance among women, with butch- and androgyne-identified lesbian/bisexual women outperforming femme-identified and heterosexual women. There were also significant differences in JLAP performance among women, with butch- and androgyne-identified lesbian/bisexual women and heterosexual women outperforming femme-identified lesbian/bisexual women. The butch-femme differences in visuospatial ability indicated an association between cognitive ability and butch-femme identity and suggest that neurobiological underpinnings may contribute to butch-femme identity although alternative explanations exist.

Introduction: "Suffering Sappho!": Lesbian content and queer female characters in comics

Comics have been an important locus of queer female identity, community, and politics for generations. Whether taking the form of newspaper strips, comic books, or graphic novels and memoirs, the medium has a long history of featuring female same-sex attraction, relationships, and identity. This special issue explores the past place, current presence, and possible future status of lesbianism in comics. It features essays about cartoonists such as Jennifer Camper, characters such as Wonder Woman, and titles such as Lumberjanes. This special issue also includes a roundtable that examines underrepresented identities in lesbian comics. These pieces address subjects ranging from the depiction of a Latina lesbian protagonist in AMERICA: The Life and Times of America Chavez and the debut of the first lead Black lesbian female superheroine in Cyberzone to the presentation of queer women in graphic novels from South Asia and the experience of re-reading Hothead Paisan in the age of Trump.

Health Care of Sexual Minority Women

Sexual minority women may be invisible in health care settings unless practitioners ask every patient about sexual attractions/behaviors and identity. Sexual minority women need to feel comfortable and able to share information about their sexual identity, partners, and lives. No medical diagnoses are found more commonly in sexual minority women, but problems such as overweight/obesity, increased tobacco and alcohol use, increased mental health problems, and a past history of childhood sexual abuse are common. These factors intertwine when treating sexual minority women.

Are Outness and Community Involvement Risk or Protective Factors for Alcohol and Drug Abuse Among Sexual Minority Women?

Sexual minority women (SMW) are at increased risk for substance abuse compared to heterosexual women. Two psychosocial factors that have been implicated in SMW's substance abuse are outness and LGBT community involvement, but findings have been mixed as to whether these are risk or protective factors. One possible explanation is that they may have different consequences for subgroups of SMW (lesbians, bisexual women, and queer women). While being open about one's sexual orientation and involved in the community may be protective for lesbians, discrimination against bisexual women may lead these same factors to contribute to substance abuse for bisexual women. It is unclear how these associations will operate for queer women, given limited research on this subpopulation. The current study examined whether sexual identity moderated the associations between outness and community involvement with alcohol and drug abuse. We also examined whether perceived discrimination would help explain why these associations may be different for subgroups of SMW. A sample of 288 self-identified SMW (113 lesbians, 106 bisexual women, and 69 queer women) completed an online survey. Higher outness was associated with higher alcohol and drug abuse for bisexual women, but not for lesbians or queer women. Similarly, higher community involvement was associated with higher drug abuse for bisexual women, but not for lesbians or queer women. Among bisexual women, the association between community involvement and drug abuse was mediated by perceived discrimination. Further, the association between outness and drug abuse was mediated by both community involvement and perceived discrimination. Findings demonstrate that outness and community involvement function as risk factors for substance abuse for bisexual women, in part due to their associations with discrimination.

"Lesbian"/female same-sex sexualities in Africa

Understandings of African lesbian sexualities have been affected by silence, repression, and uncertainty. The subject of lesbian experiences and sexualities in Africa constitutes an opportunity for feminist scholars to address the transnational politics of knowledge production about African lesbians' lives and the contours of lesbian art, activism, and relationships in African nations. This article contextualizes the state of research on African lesbian sexualities and introduces the special issue.

[Becoming Another: Transformations in the Therapist Who Works with Gay and Lesbian Couples]

OBJECTIVE

To recognise the changes experienced by the therapist who works with gay and lesbian couples.

METHOD

Qualitative with biographical-narrative method. Seven therapists were interviewed in Medellin.

RESULTS

Three moments in the life trajectory of the participants were identified: Before: closeness and distances between families and the school were found (distances, makes reference, among others, to discourses about homosexuality. During: showed the conspiracy of silence in the undergraduate and postgraduate training of therapists, and in the clinical approach with homosexual couples they perceive in the reasons for consultation, a spectrum between everyday conflict and imposed exclusion. After: makes reference to the changes that this clinical work has generated in them, how they have become different, while others have been defined as: political subjects who resist normalization and become learners of artistic territories and artisans of their own lives.

CONCLUSIONS

The task of becoming another is a poetic, aesthetic and ethical process like the beautiful creation of the own existence. These transformations are connected with presence, social, politic and artistic contexts, reflexive labour and criticism about themselves.

Sexual Identity Mobility and Depressive Symptoms: A Longitudinal Analysis of Moderating Factors Among Sexual Minority Women

Sexual minority identity (bisexual, lesbian) is a known risk factor for depression in women. This study examined a facet of minority stress prevalent among women-sexual identity mobility-as an identity-related contributor to higher levels of depressive symptoms. We used three waves of data from the Chicago Health and Life Experiences of Women study, a longitudinal study of sexual minority women (N = 306). Random effects OLS regression models were constructed to examine the effect of sexual identity changes on depressive symptoms. We found that 25.6 % of the sample reported a sexual identity change between Wave I and Wave II, and 24.9 % reported a sexual identity change between Waves II and III. Women who reported a change in sexual identity also reported more depressive symptoms subsequent to identity change. This effect was moderated by the number of years participants had reported their baseline identity and by whether the participant had initiated a romantic relationship with a male partner.

Sexual Orientation and Behavior of Adult Jews in Israel and the Association With Risk Behavior

Estimating the size of key risk groups susceptible to HIV/sexually transmitted diseases (STI) is necessary for establishment of interventions and budget allocation. This study aimed to identify various dimensions of sexual orientation and practices in Israel, and correlate the findings with sexual risk behavior (SRB). It used a random representative sample of the Jewish population aged 18-44 years who completed online questionnaires regarding their self-identified sexual orientation, attraction and practices, and SRB. Concordant heterosexuals were those who self-reported heterosexual identity, were attracted and had sex only with the opposite gender. National estimates regarding prevalence of gay, lesbian, and bisexual men and women were based on the civil census. The sample included 997 men and 1005 women, of whom 11.3 and 15.2 % were attracted to the same-gender, 10.2 and 8.7 % reported lifetime same-gender encounters, while 8.2 and 4.8 % self-identified as gay or bisexual men and lesbian or bisexual women, respectively. The estimated population of self-identified Jewish gay or bisexual men and lesbian or bisexual women aged 18-44 in Israel was 94,176, and 57,671, respectively. SRB was more common among self-identified gays or bisexual men and among discordant heterosexual men and women. Those who reported same-gender sexual practices reported greater SRB than those who only had opposite-gender encounters. Interestingly, SRB among discordant heterosexuals was associated with same-sex behavior rather than attraction. Health practitioners should increase their awareness of sexual diversity among their clientele, and should recognize that risk for HIV/STI may exist among self-identified heterosexuals, who may not disclose their actual sexual attraction or practices.

A Comparative Analysis of a Community and General Sample of Lesbian, Gay, and Bisexual Individuals

Samples recruited at lesbian, gay, and bisexual (LGB) venues have certain benefits, but a major drawback is that these samples are prone to bias as they only contain LGB participants who visit such venues. Empirical data with regard to the potential differences between LGB community samples and LGB general samples may shed some light on the generalizability of research findings from convenience samples recruited through LGB venues. The current study attempted to contribute to existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and mental health between a convenience sample recruited at LGB venues ("community sample," N = 3,403) and an LGB sample recruited from a general research panel in the Netherlands ("panel sample," N = 1,000). Various differences were found. In general, community participants were younger, reported a more exclusive same-sex sexual orientation, were more open about their sexual orientation, had lower levels of internalized homonegativity, and encountered more negative social reactions on their LGB status. They also reported higher levels of psychological distress and suicidality. The Nagelkerke R (2) of the analyses (which were adjusted for sociodemographic differences) ranged from .08 (suicide plans among men) to .27 (sexual attraction among women). However, while the estimates of sociodemographics, sexual orientation, minority stress, and mental well-being differed, the relationships between these constructs were comparable in both samples. Implications and suggestions for future studies are discussed.

Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices

PURPOSE

Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities.

METHODS

We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps.

RESULTS

Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents.

CONCLUSIONS

This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented.

An alcohol, tobacco, and other drug use comparison of lesbian, bisexual, and heterosexual undergraduate women

BACKGROUND

Little research has focused specifically on alcohol, tobacco, and other drug (ATOD) use of lesbian and bisexual women in general or the college subgroup specifically. Previous research shows sexual minority women at increased risk when compared to their heterosexual counterparts.

OBJECTIVES

The purpose of the current study was to compare ATOD use of lesbian, bisexual, and heterosexual undergraduate college women.

METHODS

A secondary analysis of three fall semesters (2009-2011) of American College Health Association-National College Health Assessment (ACHA-NCHA-II) data was conducted. Women who self-identified as gay/lesbian (N = 538), bisexual (N = 1579), and heterosexual (N = 40,869) were compared on ATOD use. Chi-square Tests were used to analyze differences between the groups and logistic regression determined odds ratios of ATOD use.

RESULTS

Bisexual women had greater odds of using alcohol, tobacco, and marijuana than heterosexual women and lesbians. They also had greater odds of using all illicit drugs (except steroids) and misusing prescription drugs than heterosexual women and greater odds of using amphetamines other than meth, sedatives, and ecstasy when compared to lesbians. Lesbians had greater odds of using tobacco, marijuana, sedatives, hallucinogens, other illegal drugs and misusing prescription drugs than heterosexual women. Conclusions/Importance: The study confirms increased ATOD use among sexual minority women as compared to their heterosexual counterparts with bisexual women having the highest use. This is the first study to examine misuse of prescription drugs among a large number of lesbian and bisexual college women, and contributes to the scant literature addressing college women's ATOD use by sexual orientation.

A false sense of security: lesbian, gay, bisexual, and transgender (LGBT) surrogate health care decision-making rights

This article addresses the timely and ethically problematic issue of surrogate decision-making rights for lesbian, gay, bisexual, and transgender (LGBT) patients and their families in the American health care system. Despite multiple pro-LGBT recommendations that have been released in recent years by the Obama administration, the Institute of Medicine, and the US Department of Health and Human Services, such initiatives, while laudable, also have unfortunately occasioned a "false sense of security" for many LGBT patients, their families, and their caregivers. In particular, new regulations on surrogate decision making merely invoke a sense of universal patient rights rather than actually generating them. Therefore, it is imperative that primary care physicians urge all LGBT patients to take proactive steps to protect themselves and their loved ones by naming proxy decision makers well before the crises that would necessitate such decisions.

The politics of potlucks

Abstract "The Politics of Potlucks" examines the issue of how friends deal with the challenging dilemma of breakups in a lesbian community. While lover relationships often have a finite duration, the need for cohesiveness in the community requires strategies for integration. The lesbian potluck is an effective tool. This is a lighthearted look at a very real situation in our community.

Lesbian tomboys and "evolutionary butch"

ABSTRACT Lesbian tomboy development occurs within a psychosexual experiential field on a continuum from childhood gender dissonance to evolutionary butch in adulthood. Through the process of integrating gender development, sexual orientation, and identity development, tomboy lesbians learn how to maintain a sense of self and organize desire within a complicated familial/socio/cultural/context. Traversing these complications usually brings adolescent and adult lesbians into therapy where they need clinicians who understand this unique course of development.

Introduction

ABSTRACT This volume presents a collection of psychoanalytically influenced authors writing about lesbian concerns. Profound changes have occurred within psychoanalysis due to the efforts of lesbian, gay, and bisexual scholars and the evolution of psychoanalytic theory away from classical models. The writers in this volume represent a second generation of scholars who have more latitude in using psychoanalysis to study sexual orientation and gender. The article summarizes the major changes in this field and outlines areas where further improvements in psychoanalysis can occur.

The effects of sexual orientation on body image and attitudes about eating and weight

SUMMARY We assessed the effect of sexual orientation on body image and attitudes toward eating and weight using data collected from lesbians and heterosexual women in three US cities. Data were analyzed using ordinary least squares regression controlling for a number of demographic characteristics. Findings indicate that while lesbian sexual orientation is predictive of positive body image and fewer negative attitudes toward eating and weight, the effects are modest. Body mass index (BMI), frequency of exercise, race, and self-image were the strongest predictors of body image; BMI, race, and city of residence were the strongest predictors of attitudes toward eating and weight. The authors conclude that while belonging to a lesbian subculture may provide some protection against the societal imperative toward thinness, it likely does not counter the larger societal preference that women be thin.

Identity, stigma management, and well-being

SUMMARY This study investigated and compared predictors of well-being in lesbians/bisexual women and gay/bisexual men. Well-being was assessed using measures of self-esteem, life satisfaction, and depression. Predictor variables included involvement in lesbian/gay/bisexual (LGB) culture, rejection of negative stereotypes of LGBs, positivity of gay/lesbian identity, and perceived acceptance by family, heterosexual friends, and work/school associates. A survey instrument was developed and distributed in the Greater Buffalo area in Spring and Summer of 1994, to which 168 lesbians and bisexual women and 152 gay and bisexual men responded. Overall, results were very similar for lesbian/bisexual women and gay/bisexual men. Having a positive LGB identity was the most robust predictor of psychological well-being in both women and men who participated in the study. In addition, rejection of negative stereotypes predicted positive LGB identity. Results are discussed within the context of lesbian/bisexual women's mental health and suggestions for research and practice are described.

Internalized homophobia in lesbians

SUMMARY In this article we discuss the importance of studying internalized homophobia and provide a rationale for studying internalized homophobia in lesbians apart from gay men. We review published scales used to assess internalized homophobia in lesbians and describe recent studies on the correlates of internalized homophobia in lesbians. We discuss concepts of internalized homophobia as minority stress and identify variables that have been theoretically linked to internalized homophobia in lesbians but have not been empirically examined. Implications for practice and research are also discussed.

Traumatic victimization in the lives of lesbian and bisexual women

SUMMARY This paper takes a contextual approach to understanding traumatic victimization experiences of lesbian and bisexual women over the life span. Expanding on feminist perspectives on violence against women, the concept of "cultural victimization" is used to explore the role of societal homophobia in shaping the experience of victimization for lesbian and bisexual women. An overview of the existing literature on the prevalence and impact of childhood abuse, domestic violence, sexual assault, and hate crimes among this population is provided. The relationship between sexual identity development and trauma is discussed. This article provides a framework for understanding lesbian and bisexual women's victimization, lends insight to clinicians working with lesbian/bisexual survivors, and provides direction for future research.

The role of lay theories of the etiologies of homosexuality in attitudes towards lesbians and gay men

SUMMARY Previous research has demonstrated that those who believe that homosexuality is genetically or biologically caused have less negative attitudes towards gays and lesbians than those who believe it is acquired, learned, or chosen. This study, utilizing an undergraduate and graduate Psychology student sample, found significant relationships between attitudes towards lesbians and gay men and beliefs about causes and "treatments" for homosexuality. Level of personal contact with lesbians and gay men and demographic factors also influenced attitudes toward and beliefs about homosexuality. These results suggest that educational attempts to change attitudes towards lesbians and gay men should consider the role played by beliefs about the etiologies of homosexuality.

Lesbians in love

Abstract Lesbians often begin romantic relationships with high hopes that their relationships will be satisfying and long-lasting. Why do some women maintain committed and stable relationships while others do not? This article considers factors that affect commitment and stability among lesbian couples. We begin by reviewing previous empirical research on the topic. Next, we test a leading model of commitment using survey data from 301 lesbian couples who participated in the American Couples Study (Blumstein & Schwartz, 1983). According to Caryl Rusbult's model (1983), an individual's commitment to a relationship is affected by three general factors: satisfaction, the quality of alternatives to the current relationship, and investments made in the relationship. In turn, a woman's degree of commitment influences relationship stability. Path analysis provided strong support for Rusbult's model. Nonetheless, this model did not fully explain the sources of commitment and stability in lesbian relationships. Consequently, we consider unique aspects of the social environment that may affect commitment and stability in lesbian relationships.

The effects of coming out on relationships and health

SUMMARY This study set out to ascertain how open lesbians were about their sexual orientation, using a snowball sample of lesbians in New Zealand. The research looked at how disclosure impacted on lesbian sexual behaviour, self assessed health status, relationships and use of health services. The questions were part of a large survey modelled on a North Health Study (Parr, Whittaker, and Jackson, 1998) which included the SF-36 survey instrument. A standardized set of questions and calculated scoring were used to measure the self-assessed health of respondents (Ware et al., 1993). The 795 return results were compared with a sample of women from Northern New Zealand and a sample of lesbians from the New Zealand Census. The respondents were coded into three groups according to their degree of openness: those who were out to everybody, those who were out to all but one person of significance, and those who were out to a few. Lesbians who were not open to their doctors were more likely to have reported being closeted to employers and parents, to smoke more, to drink more alcohol, to have less sex, and to earn less money. Respondents who labeled themselves gay reported that they were not so open. of the 77% that were out to their health professional, 5% had received a negative response.

A truth of being

SUMMARY In an exploration of what it means to write from a lesbian perspective, Vanessa Scrivens examines the process and the power of self-writing. She states that writing gives one the strength to give birth to the inner conscience and the courage to look it in the eye. A short piece of autobio/fictional writing that follows this discussion will hopefully give an example of the true potential that self-writing has.

Nobody ever asked me if I had an agent

SUMMARY There are many ways to write about/think about how I became an author. I like to think I chose this way because I had a 'hidden talent' that was brought forth by being in another country. This story could also be the story of a divorce, a yearning for adventure, the love of a genre, the quest for identity. I like to tell the story in this way because I like the idea that we all have hidden talents that are revealed by circumstance. And I like to urge people to do radical things.

Shani mootoo

SUMMARY Shani Mootoo discusses her creative process, with a particular focus on her novel Cereus Blooms at Night. She elaborates on the writing process in relation to other forms of art, and explores the relationship of her characters in Cereus Blooms to her own life experiences.

Why writers make lousy lovers

SUMMARY Jess Wells takes a light-hearted look at the pit-falls of being in love with a writer, describing the difficulties with time and reality. Wells then encourages lesbian authors to develop diversity among their art forms,Income and inspiration sources. She wraps up with a call for lesbian writers to cultivate discipline and gratitude.

Memories in flesh and marble

SUMMARY This piece is about writing and having children and the places they occupy in my life. It describes a sense of isolation, of being cut off from others like me and my efforts to recreate connections, in fiction and in flesh. I explain how I came to be the mother of twins and recount some of the battles fought with doctors, midwives and strangers, as well as between my lover and myself. Lesbian motherhood may no longer be an oxymoron, but it is an awkward, uneasy category open to endless, hostile questioning from outsiders. Better to write our own stories, around lived contradictions, than accept our inscription under erasure on doctors' forms and birth certificates.

Karla jay

SUMMARY Karla Jay discusses Tales of the Lavender Menace: A Memoir of Liberation (published in 1999). She engages the connections between the personal and the political in her memoir. The reception by readers, family relations, the history of the feminist movement, racism, and homophobia are also deliberated in relation to the writing "process" and the motivations to write.

Writing my-self-body

SUMMARY The author traces her changes in attitude toward her body, sexuality, and public disclosure of her lesbianism through reflections upon her writings as the years pass. She addresses the connections between the body and writing, and celebrates the community of lesbian writers who push outward the boundaries of language to assert that there are no boundaries.

A state of mind in the garden

SUMMARY Nicole Brossard reflects on the writing process in relation to self, narrative voice, language, translation, lesbian desire and sexuality, genre-blurring, memory, and the cultural milieu. She explores her resistant negotiations of traditional autobiographical modes of writing.

Writing life

SUMMARY In her 1994 essay "Writing Life," Beth Brant discusses the role of writing in her life, the circumstances that surrounded her writing and editing endeavours, and her relationships with loved ones. Issues of racism, homophobia, and class oppression are explored through writing.

To Grandmother's House I Go

SUMMARY Within the mode of "biomythography" that owes its identification as a genre to Audre Lorde's ZAMI,Jewelle Gomez examines her own writing processes. Her explorations revolve around her work-in-process about her great grandmother's life. Issues of truth, memory, history, race, and community are considered. The author also discusses the embodied nature of writing.