Intimate partner violence in lesbian couples: A systematic review on the barriers to seeking help

The process of seeking help for violence in lesbian couples is complex due to the variety of factors and actors that can be involved. It is a process in which the women may or may not take action to ask for some kind of support, depending on the stage at which they find themselves. However, even though women may realise that they are in a situation of mistreatment or abuse in their relationship with their partner or ex-partner, there may be barriers that hinder them from seeking help. This paper presents a systematic review of the barriers that lesbian women encounter in seeking help or accessing support systems when they are victims of intimate partner violence. Out of 139 studies reviewed, 120 were selected for further review, and 8 studies meeting the methodological inclusion criteria were finally selected. The results of this research show that psycho-social and legal barriers exist, which, within a system of oppression - heterosexist society - do not occur in isolation, but are inter-related, making it difficult for lesbian women victims of intimate partner violence to seek help or access support services. This review finds limitations in the literature reviewed and makes recommendations for future research.

Examination of Gender Differences in Depression, Relationship Satisfaction, and Problematic Pornography Use Among Romanian Gay Men and Lesbian Women

This study investigates factors influencing the psychological well-being of gay and lesbian individuals in Romania. Participants (N = 172) included 61.6% gay and 38.4% lesbians, currently in relationships, aged between 18 and 62 years (M = 28.28; SD = 9.53). Surveys assessed relationship satisfaction, depression, and problematic pornography use. Significant associations were found among these variables, with gender differences observed. We tested a regression model for problematic pornography use, where depression provided additional explanatory power to the initial model. Age, gender, and depression accounted for 18% of the variance in problematic pornography use. The theoretical and practical implications are discussed.

Sexual Satisfaction among Lesbian and Heterosexual Cisgender Women: A Systematic Review and Meta-Analysis

BACKGROUND

Sexual satisfaction is a complex, multifaceted, and broad concept that is influenced by several factors. The minority stress theory posits that sexual and gender minorities are at a particular risk for stress due to stigma and discrimination at the structural, interpersonal, and individual levels. The aim of this systematic review and meta-analysis was to evaluate and compare the sexual satisfaction between lesbian (LW) and heterosexual (HSW) cisgender women.

METHODS

A systematic review and meta-analysis were conducted. We searched the PubMed, Scopus, Science Direct, Websci, Proquest, and Wiley online databases from 1 January 2013 to 10 March 2023 to identify the published observational studies on sexual satisfaction in women according to their sexual orientation. The risk of bias in the selected studies was assessed using the JBI critical appraisal checklist for the analytical cross-sectional studies.

RESULTS

A total of 11 studies and 44,939 women were included. LW reported having orgasms during a sexual relationship more frequently than HSW, OR = 1.98 (95% CI 1.73, 2.27). In the same direction, the frequency of women reporting "no or rarely" for having orgasms during their sexual relationships was significantly lower in the LW than the HSW, OR = 0.55 (95% CI 0.45, 0.66). The percentage of the LW who reported having sexual intercourse at least once a week was significantly lower than that of the HSW, OR = 0.57 for LW (95% CI 0.49, 0.67).

CONCLUSIONS

Our review showed that cisgender lesbian women reached orgasm during sexual relations more often than cisgender heterosexual women. These findings have implications for gender and sexual minority health and healthcare optimization.

The Effect of Education on Homophobia and Attitudes Toward Gay Men and Lesbian Women among Medical Faculty Students: A Turkish Sample

Problem: Gay men (GMs) and lesbian women (LWs) can be exposed to misunderstanding, pressure, condemnation, obstructed access to public services, social isolation, and discrimination in many countries. They may also encounter various difficulties in accessing health services. Being GM and LW is generally unacceptable in Turkey, and both are perceived as abnormal. Medical students may require education on the subject of sexual orientation to improve their knowledge of and attitudes toward LGBT individuals, to help them remain neutral and avoid prejudice in providing health services for such individuals, and to ensure that such care is unbiased. Intervention: This one-group pretest-post-test design study was performed with third-year students at the Ondokuz Mayıs University Medical Faculty (Samsun-Turkey) on 01-31 September, 2021. Three hundred twenty-five students took part. We evaluated students' attitudes toward homophobia and being GM and LW following a two-week multidisciplinary education program. The program included such topics as "Marginalization," "Interaction between cultures," "Sexual orientation," "Faith-based marginalization," "Sub-cultures," "Health protection," "Gender," and "Marginalized groups." For objective acquisition, we organized small group work, experience-sharing sessions (such as different orientation groups, different ethnic groups, and different behavioral templates), presentations, and panel activities. Context: Some circles in Türkiye regard LGBT individuals as representing an attack on national and spiritual values, and they are used as part of the political discourse. Studies are being performed in some medial faculties in Türkiye concerning the inclusion of subjects related to LGBT individuals in the educational curriculum. However, these studies have not yet assumed the form of a curriculum design including content, method, and testing. It is important for subjects concerning LGBT individuals to be considered more extensively in medical education in Türkiye, and for awareness of the rights of these individuals in the community and of combating discrimination to be improved. Outcome: We observed a significant decrease in students' homophobia after education. Significant decreases were observed in agreement with statements to the effect that being a GM or LW is a disease, that it can be treated, that people can be identified as GMs and LWs based on their behavior, and that they pose a major threat to society. Lessons Learned: It is unclear whether education aimed at all marginalized groups will produce different results to those of programs aimed specifically at GMs and LWs, but we think that applying programs directed toward discrimination and prejudice together will yield more effective results.

Epidemiological Profile of Intimate Partner Homicides of Sexual and Gender Minority Women in the United States, 2003 to 2017

Sexual and gender minority (SGM) women are among the many victims killed by intimate partner homicide (IPH) each year, though the differences between different SGM groups (and how these groups compare to non-SGM IPH) have not been well established. The objective of this article was to identify practicable, correlated risk factors of IPH of SGM women that may have utility in prevention of future IPH among these populations in the U.S. Homicide data from the National Violent Death Reporting System spanning 2003 to 2017 were used to identify a profile of IPH specific to SGM women compared to women who were neither sexual nor gender minorities. Situational and individual characteristics significantly differentiated sexual minority (SM) women from non-SGM women victims of IPH, including substance abuse history (adjusted odds ratio [AOR] = 4.80 [2.42, 9.51]), having themselves used a weapon during the incident (AOR = 3.63 [1.44, 9.16]), and the type of weapon(s) used, such as firearms (AOR = 0.61 [0.40, 0.91]), with notably different differentiating characteristics for gender minority (GM) women (vs. non-SGM women) such as the likelihood that the victim was known to have experienced interpersonal violence victimization in the previous month (AOR = 0.50 [0.07, 3.67]). Lesbian and bisexual women homicide victims were far more likely to have been killed via IPH than non-SGM women (AOR for Black SM women = 7.84 [3.65, 16.88], AOR for White SM women = 2.30 [1.03, 5.17]). There was no corresponding difference for GM women victims, whose likelihood of being killed by an intimate partner was similar to that of non-SGM women. Based on these findings, actionable public health recommendations-centered around evidence that neither "all women" nor "all LGBTQ people" are appropriate intimate partner violence prevention umbrellas-are proposed.

The Mediating Role of Insecure Attachment in the Gap in Parenthood Desire between Lesbian and Gay Individuals and Their Heterosexual Counterparts

Previous studies have shown that lesbian and gay (LG) individuals, in comparison to their heterosexual counterparts, tend to report lower levels of parenthood desire. While numerous variables have been suggested to explain this gap in parenthood aspirations, no study has investigated the mediating role of avoidant attachment in the association between sexual orientation and parenthood desire. For that purpose, a sample of 790 cisgender Israelis aged 18-49 years (M = 28.27, SD = 4.76) was recruited using convenience sampling. Among the participants, 345 self-reported as predominantly or exclusively lesbian or gay and 445 self-reported as exclusively heterosexual. Participants completed online questionnaires assessing their sociodemographic characteristics, parenthood desire, and avoidant and anxious attachment styles. Mediation analyses were performed using the PROCESS macro, and the results revealed that LG individuals reported lower parenthood desire, higher avoidant attachment, and higher anxious attachment compared to heterosexual individuals. Moreover, avoidant attachment had a significant mediation effect in the association between sexual orientation and parenthood desire. The findings suggest that LG individuals are more likely to report higher avoidant attachment due to possible rejection and discrimination from family members and peers, and this may be associated with lower parenthood desire. The results contribute to the growing body of research on family formation and parenthood aspirations among LG individuals, and specifically studies aimed at delineating the factors that contribute to the gap in parenthood aspirations between sexual minority individuals and their heterosexual counterparts.

Estimated likelihood of parenthood among sexual minority individuals associates with interpersonal vulnerability and traumatic outlook

BACKGROUND

Lesbian women and gay men (LG) tend to report lower levels of parenthood aspiration than their heterosexual counterparts. While several variables have been suggested to explain this phenomenon, no study has investigated the potential mediating role of interpersonal vulnerability and subjective traumatic outlook in the association between sexual orientation and the estimated likelihood of parenthood.

OBJECTIVE

To investigate whether interpersonal vulnerability and subjective traumatic outlook mediate the association between sexual orientation and a lower estimated likelihood of parenthood.

METHODS

A sample of 435 childfree, cisgender Israeli participants, aged 18-49 years (M = 27.82, SD = 4.47), were recruited through convenience sampling. 192 participants self-reported as LG (64 lesbian women and 128 gay men). Participants completed online questionnaires assessing their estimated likelihood of parenthood, interpersonal vulnerability, and subjective traumatic outlook. Mediation analyses were performed using the PROCESS macro.

RESULTS

LG individuals reported a lower estimated likelihood of parenthood than their heterosexual counterparts. Interpersonal vulnerability and subjective traumatic outlook significantly mediated the association between sexual orientation and a lower estimated likelihood of parenthood.

CONCLUSIONS

Despite improvement in the socio-political climate relating to sexual minority rights and access to fertility technologies, LG individuals are still more likely to report a lower estimated likelihood of parenthood in comparison to heterosexual individuals. Moreover, this gap appears to be partially mediated by interpersonal vulnerability and subjective traumatic outlook. The results contribute to the growing body of international research exploring family formation among sexual minority individuals and are relevant for researchers, clinicians, and policymakers.

Comprehensive systematic review and meta-analysis on physical health conditions in lesbian- and bisexual-identified women compared with heterosexual-identified women

BACKGROUND

Sexual minority individuals experience discrimination, leading to mental health disparities. Physical health disparities have not been examined to the same extent in systematic reviews so far.

OBJECTIVES

To provide a systematic review and, where possible, meta-analyses on the prevalence of physical health conditions in sexual minority women (i.e. lesbian- and bisexual-identified women) compared to heterosexual-identified women.

DESIGN

The study design is a systematic review with meta-analyses.

DATA SOURCES AND METHODS

A systematic literature search in MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science databases was conducted on epidemiologic studies on physical health conditions, classified in the Global Burden of Disease project, published between 2000 and 2021. Meta-analyses pooling odds ratios were calculated.

RESULTS

In total, 23,649 abstracts were screened and 44 studies were included in the systematic review. Meta-analyses were run for arthritis, asthma, back pain, cancer, chronic kidney diseases, diabetes, headache disorders, heart attacks, hepatitis, hypertension, and stroke. Most significant differences in prevalence by sexual identity were found for chronic respiratory conditions, especially asthma. Overall, sexual minority women were significantly 1.5-2 times more likely to have asthma than heterosexual women. Furthermore, evidence of higher prevalence in sexual minority compared to heterosexual women was found for back pain, headaches/migraines, hepatitis B/C, periodontitis, urinary tract infections, and acne. In contrast, bisexual women had lower cancer rates. Overall, sexual minority women had lower odds of heart attacks, diabetes, and hypertension than heterosexual women (in terms of diabetes and hypertension possibly due to non-consideration of pregnancy-related conditions).

CONCLUSION

We found evidence for physical health disparities by sexual identity. Since some of these findings rely on few comparisons only, this review emphasizes the need for routinely including sexual identity assessment in health research and clinical practice. Providing a more detailed picture of the prevalence of physical health conditions in sexual minority women may ultimately contribute to reducing health disparities.

Mental Health and Life Satisfaction on Chilean Gay Men and Lesbian Women: The Role of Perceived Sexual Stigma, Internalized Homophobia, and Community Connectedness

The Minority Stress Model has proposed that connectedness to a specific minority community may be a protective factor for stigmatized groups. This study evaluated the mediational role of connectedness with the gay men's and lesbian women's community on the relationship between two minority stressors (internalized homophobia and perceived sexual stigma) with anxiety-depressive symptomatology and life satisfaction. The sample consisted of 467 Chilean self-identified as gay men (57%) and lesbian women (43%). Results revealed that the two minority stressors were associated with anxiety-depressive symptomatology, but only internalized homophobia was associated with life satisfaction. The mediation hypothesis was partially supported by the relationship between internalized homophobia and life satisfaction. Unexpectedly, we found a negative association between connectedness with the gay men's and lesbian women's community and life satisfaction. This finding introduces a view that contrasts with the literature, which proposes that connectedness with the specific community would be a protective factor against sexual stigma.

Romantic Attachment, Internalized Homonegativity, and Same-Sex Intimate Partner Violence Perpetration Among Lesbian Women in Italy

Same-Sex Intimate Partner Violence (SSIPV) among lesbian women has been underestimated until few decades ago. While the association between romantic attachment and SSIPV has been widely demonstrated, mechanisms that mediate this association and the complex relationships between romantic attachment, SSIPV, and SSIPV-specific risk factors have not been adequately investigated to date. The current study assessed the influence of romantic attachment on SSIPV perpetration among lesbian women, exploring the mediating role of internalized homonegativity within this association. Three hundred and twenty-five Italian lesbian women with a mean age of 30 years were recruited and completed the following self-report measures: the Experiences in Close Relationships-Revised (ECR-R), the Measure of Internalized Sexual Stigma, and the Revised Conflict Tactics Scale Short Form. The results showed a positive association between attachment anxiety, and general and psychological SSIPV perpetration. Similarly, attachment avoidance was positively related with general, psychological, and physical SSIPV perpetration. The association between romantic attachment, and general and psychological SSIPV was partially mediated by internalized homonegativity. These findings have theoretical implications and provide valuable information to implement services and interventions tailored for SSIPV, to date scarce and not effective.

The Impact of Primary Care Providers' Bias on Depression Screening for Lesbian Women

Primary care providers' (PCPs) implicit and explicit bias can adversely affect health outcomes of lesbian women including their mental health. Practice guidelines recommend universal screening for depression in primary care settings, yet the guidelines often are not followed. The intersection of PCPs' implicit and explicit bias toward lesbian women may lead to even lower screening and diagnosis of depression in the lesbian population than in the general population. The purpose of this secondary analysis was to examine the relationship between PCPs' implicit and explicit bias toward lesbian women and their recommendations for depression screening in this population. PCPs (n = 195) in Kentucky completed a survey that included bias measures and screening recommendations for a simulated lesbian patient. Bivariate inferential statistical tests were conducted to compare the implicit and explicit bias scores of PCPs who recommended depression screening and those who did not. PCPs who recommended depression screening demonstrated more positive explicit attitudes toward lesbian women (p < .05) and their implicit bias scores were marginally lower than the providers who did not recommend depression screening (p = .068). Implications for practice: Depression screening rates may be even lower for lesbian women due to implicit and explicit bias toward this population. Training to increase providers' awareness of bias and its harm is the first step to improve primary care for lesbian women. Policies must protect against discrimination based on sexual orientation or gender identity.

Homonegativity Scores in Response to Static Same-Sex Imagery versus Observable Behavioral Change in Response to an Interactive Gay Male Target

Homonegativity research tends to focus on the identities of gay men and lesbian women through inauthentic means such as vignettes and signifiers like t-shirts with pro-gay slogans. Such research also tends to neglect sexual behavior. These issues were addressed in the present mixed-methods study. Heterosexual male (n = 196) and female (n = 219) participants were asked to complete measures of old-fashioned and modern homonegativity toward gay men and lesbian women after viewing a set of stimuli depicting gay male, lesbian female, or heterosexual couples. Participants also completed an interview with the researcher where he self-identified as a gay male and observed any changes in behavior following his disclosure. Findings indicated that male participants showed higher levels of modern homonegativity than female participants, regardless of the images viewed, and had higher odds of exhibiting negative behavioral change in response to the researcher's self-disclosure. Also, participants who viewed images of lesbian couples kissing or embracing had lower odds of showing negative behavioral change.

Measurement invariance of Female Sexual Function Index: a study with heterosexual and lesbian Portuguese women

The Female Sexual Function Index is a powerful screening tool for female sexual dysfunction extensively used worldwide. Nonetheless, its factorial structure and psychometric properties have been tested almost exclusively with heterosexual samples. The current study aimed to testing the original factorial structure, reliability and temporal stability in two samples of women (heterosexual and lesbian), and to assess the measurement invariance across sexual orientation. An online sample of 752 Portuguese women (376 lesbian women and 376 heterosexual women) recruited between May 2012 and 2013 participated in the study and completed a sociodemographic questionnaire and the FSFI. For temporal stability, 30 Portuguese women were recruited online in May 2017. Confirmatory factor analysis, reliability analysis and temporal stability were assessed independently for each sample. Measurement invariance (configural, metric, and scalar) was also assessed. Main findings for both samples corroborate the six-factor structure and revealed excellent levels of temporal stability, with Cronbach alphas and McDonalds Omega of .95 for heterosexual sample, and .96 for lesbian women sample. Results corroborate measurement invariance (configural, metric, and scalar) across sample type. Overall, the FSFI revealed a good-fit for the six-factor model in both heterosexual and women sample, with excellent levels of reliability and temporal stability, and showed measurement invariance across sexual orientation. These findings support the use of the FSFI with lesbian women.

Differences in Health-Related Quality of Life and Health Behaviors Among Lesbian, Bisexual, and Heterosexual Women Surviving Cancer from the 2013 to 2018 National Health Interview Survey

Purpose: Health-related quality of life (HRQoL) and health behaviors contribute to cancer morbidity and mortality, which are elevated in lesbian and bisexual women (LBW). The purpose of this study was to assess differences in HRQoL and health behaviors between heterosexual and lesbian women and heterosexual and bisexual women cancer survivors. Methods: We pooled 2013-2018 National Health Interview Survey data. HRQoL comprised physical, mental, financial, and social health domains. Health behaviors included tobacco and alcohol use, physical activity, and preventive health care. Weighted, multivariable logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (CIs). Results: The sample included 10,830 heterosexual, 141 lesbian, and 95 bisexual cancer survivors. Lesbian women reported higher odds of fair/poor self-rated health (OR: 1.68, 95% CI 1.02-2.78), chronic obstructive pulmonary disease (OR: 1.98, 95% CI 1.09-3.56), and heart conditions (OR: 1.90, 95% CI 1.16-3.12) than heterosexual women. Bisexual women reported higher odds of severe psychological distress (OR: 3.03, 95% CI 1.36-6.76), heart conditions (OR: 1.98, 95% CI 1.12-3.53), and food insecurity (OR: 2.89, 95% CI 1.29-6.50) than heterosexual women. For health behaviors, lesbian women reported greater odds of current (OR: 2.34, 95% CI 1.26-4.34) and former tobacco use (OR: 1.89, 95% CI 1.21-2.96), and bisexual women had lower odds of a recent mammogram (OR: 0.42, 95% CI 0.23-0.78) than heterosexual women. Conclusions: LBW cancer survivors reported disparities in HRQoL and health behaviors. In cancer care settings, identification of LBW patients requiring physical and mental health promotion, financial services, and supported tobacco cessation may improve health and survival.

Do relationships provide the same levels of protection against heavy drinking for lesbian and bisexual women? An intersectional approach

PURPOSE

Sexual minority women (SMW; e.g., lesbian, bisexual) are more likely than heterosexual women to be heavy drinkers, with bisexual women showing the highest risk. There is ample literature demonstrating that intimate relationships protect against stress-related health risk behaviors in the general population. However, very little research has focused on SMW's relationships and far less is known about the relationships of SMW of color. Using intersectionality theory as our framework, we tested two competing models to determine whether the effects of minority sexual identity (lesbian, bisexual) and race/ethnicity (African American, Latinx, White) are: 1) additive, or 2) multiplicative in the associations between relationship status and heavy drinking.

METHODS

Data are from a diverse sample of cisgender sexual minority women (N = 641) interviewed in Wave 3 of the CHLEW study, a 20-year longitudinal study of SMW's health.

RESULTS

Findings from two- and three-way interactions provide mixed evidence for both the additive and multiplicative hypotheses; support for each varied by sexual identity and race/ethnicity. Overall, we found that Latinx SMW, particularly single and bisexual Latinx SMW report the highest rates of heavy drinking compared to their cohabiting and lesbian counterparts, respectively. African American single SMW reported significantly higher rates of heavy drinking compared to their cohabiting counterparts.

CONCLUSION

Our findings suggest that the protective qualities of SMW's intimate relationships vary based on sexual identity and race/ethnicity-and the intersections between them. These results highlight that research among SMW that does not take into account multiple marginalized identities may obscure differences.

PUBLIC SIGNIFICANCE

Little research has focused on health within sexual minority women's relationships, particularly among sexual minority women of color. Given the potential additive or multiplicative effects of multiple sources of oppression such as heterosexism, racism, and sexism, understanding the potential protective effects of relationships is important. Our findings demonstrate that the protective qualities of intimate relationships among SMW vary based on sexual identity and race/ethnicity - and the intersections between them.

Disparities in Chronic Health Outcomes and Health Behaviors Between Lesbian and Heterosexual Adult Women in Pittsburgh: A Longitudinal Study

Background: Compared to heterosexual women, lesbian women experience higher rates of many chronic diseases, including depression, obesity, hypertension, and diabetes. Lesbian women report higher rates of risky health behaviors such as hazardous drinking and cigarette smoking. However, little longitudinal research has been done to examine changes in disparities between lesbian and heterosexual adult women. Methods: A total of 1,084 women were initially recruited from Pittsburgh, PA to participate in the Epidemiologic Study of HEalth Risk in Women (ESTHER) study and completed a baseline survey between 2003 and 2006. In 2015 or 2016, N = 483 women, 270 of whom were lesbian, completed a follow-up survey. Participants completed a questionnaire at both baseline and follow-up and completed a clinic visit for the baseline study to provide biometric data. Results: At baseline, lesbian participants reported higher rates of obesity (p = 0.03), depression (p = 0.02), and smoking (p = 0.04). Lesbian participants had elevated measured C-reactive protein levels (p = 0.05). By the time of the follow-up survey 10 years later, lesbian women continued to have higher rates of smoking (p = 0.04), but the disparity in depression (p = 0.53) and obesity (p = 0.24) rates had resolved. We found no differences in any other outcomes of interest. Conclusions: To our knowledge, this is the first study to report a resolution in obesity or depression disparities between lesbian and heterosexual women. Future research is necessary to determine if other disparities, such as respiratory conditions, appear over time and how lesbian women's health may continue to improve relative to heterosexual women and stem this public health inequity.

Anticipating Parenthood Among Lesbian, Gay, Bisexual, and Heterosexual Young Adults Without Children in Portugal: Predictors and Profiles

Parenthood is a highly valued life goal, independent of one’s sexual orientation. However, the majority of studies exploring young adults’ parenthood plans have relied exclusively on samples of heterosexual individuals. This study aimed (i) to explore differences in parenthood intentions as a function of sexual orientation, (ii) to investigate to what extent sociodemographic and psychological characteristics predict parenthood intentions of lesbian, gay, bisexual (LGB), and heterosexual individuals, (iii) to test the mediating effect of stigma between sexual orientation and parenthood intentions, and (iv) to identify and characterize profiles of prospective parenthood (through cluster analysis). Data were gathered using an online survey from 375 self-identified LGB and heterosexual young adults without children in Portugal, with a mean age of 25.83 years old (SD = 4.49). Findings indicated that LGB individuals were less likely to intend to have children than heterosexual individuals; furthermore, among LGB individuals, lesbian women expressed stronger intentions to have children than did gay men. Similarities between heterosexual and LGB young adults were observed concerning the psychological determinants of parenthood intentions. Four distinctive profiles of prospective parenthood were identified: aspiring parents not anticipating stigma, aspiring parents anticipating stigma, childfree intent, and childfree ambivalent. Lesbian and bisexual women mostly populated the childfree ambivalent cluster; in contrast, the aspiring parents anticipating stigma cluster contained an overrepresentation of men, including sexual minority men. Professionals may want to attend to communalities and specificities of prospective parenthood as a function of sexual orientation, in order to provide unbiased and culturally competent support to sexual minority individuals.

Affective responses to non-sexual imagery depicting gay men and lesbian women

When examining negative attitudes and behaviors directed toward gay men and lesbian women (i.e., homonegativity), researchers tend to use measures that require participants to respond to belief statements. This methodology is problematic for two reasons: 1) it focuses on the social categories "gay men" and "lesbian women" and ignores the practices of relational intimacy engaged in by gay and lesbian persons (practices that, arguably, are at the crux of homonegativity); and 2) it overlooks the affective responses that sexual minorities evoke in heterosexual people. These issues were tackled in the current study. Specifically, heterosexual participants (N = 241) were asked to report their affective state using six basic emotions while viewing photos depicting male-male, female-female, and heterosexual couples. Findings demonstrated that participants, regardless of gender, reacted most negatively to images of female-female couples engaging in everyday intimacies. Theoretical explanations for these findings are explored.

Anticipating Parenthood Among Lesbian, Gay, Bisexual, and Heterosexual Young Adults Without Children in Portugal: Predictors and Profiles

Parenthood is a highly valued life goal, independent of one's sexual orientation. However, the majority of studies exploring young adults' parenthood plans have relied exclusively on samples of heterosexual individuals. This study aimed (i) to explore differences in parenthood intentions as a function of sexual orientation, (ii) to investigate to what extent sociodemographic and psychological characteristics predict parenthood intentions of lesbian, gay, bisexual (LGB), and heterosexual individuals, (iii) to test the mediating effect of stigma between sexual orientation and parenthood intentions, and (iv) to identify and characterize profiles of prospective parenthood (through cluster analysis). Data were gathered using an online survey from 375 self-identified LGB and heterosexual young adults without children in Portugal, with a mean age of 25.83 years old (SD = 4.49). Findings indicated that LGB individuals were less likely to intend to have children than heterosexual individuals; furthermore, among LGB individuals, lesbian women expressed stronger intentions to have children than did gay men. Similarities between heterosexual and LGB young adults were observed concerning the psychological determinants of parenthood intentions. Four distinctive profiles of prospective parenthood were identified: aspiring parents not anticipating stigma, aspiring parents anticipating stigma, childfree intent, and childfree ambivalent. Lesbian and bisexual women mostly populated the childfree ambivalent cluster; in contrast, the aspiring parents anticipating stigma cluster contained an overrepresentation of men, including sexual minority men. Professionals may want to attend to communalities and specificities of prospective parenthood as a function of sexual orientation, in order to provide unbiased and culturally competent support to sexual minority individuals.

Concurrent Daily Alcohol and Tobacco Use among Sexual Minority and Heterosexual Women

Background: Studies show that sexual minority women (SMW) report more hazardous alcohol use patterns and higher rates of tobacco use than exclusively heterosexual women. Despite the public health implications of drinking and smoking, especially when they co-occur, little is known about SMW's daily use patterns or the factors that may facilitate concurrent use. Objectives: The present study seeks to identify patterns of daily concurrent alcohol and tobacco use among SMW and heterosexual women, including socio-environmental drinking contexts of concurrent use. Methods: Data come from a community sample of lesbian, bisexual, and heterosexual women (N = 246) who completed up to 84 consecutive days of web-based reports about substance use. Results: Participants reported 4,012 drinking days (24%), 2,019 smoking days (12%), and 769 concurrent drinking and smoking days (5%). No differences were found between SMW and heterosexual women in the proportion of drinking days; however, SMW consumed more drinks on drinking days. SMW also reported a greater proportion of smoking days, more cigarettes smoked on smoking days, and a greater proportion of concurrent drinking and smoking days. Reciprocal daily relationships between alcohol and tobacco use were identified, and these relationships were strongest for bisexual women. Socio-environmental factors-including certain locations, situations, and companions-increased the likelihood of concurrent use for all women; however, few sexual identity differences were found in concurrent use contexts. Importance: Results expand our understanding about daily concurrent alcohol and tobacco use risk among SMW, and potentially inform treatment research to better address the unique experiences of this vulnerable group.

Sexual minority women and parenthood: Perceptions of friendship among childfree and new parents

Many individuals experience shifts in their friendship networks after becoming parents. The current study investigated the narratives of how a sample of sixty-six sexual minority women, most of whom do not yet have children but who expect to be parents in the future, perceive the changes in friendship networks following becoming parents. A thematic analysis uncovered three themes: (1) general expectations surrounding future parenthood and friendships; (2) changes in lifestyle and priorities; and (3) LGBTQ + community attachment. Further, the theme of general expectations surrounding future parenthood and friendships was largely represented among lesbian and queer women, while the theme of changes in lifestyle and priorities was predominately represented among lesbian women, and finally, the theme of LGBTQ + community attachment was shared among all sexual minority women in our sample across different sexual identities. We discuss the diversity of shared and non-shared narratives among sexual minority women, the intentionality in how friendship during parenthood is perceived, as well as why some themes were particularly prevalent among women with specific sexual identities.

Parenting desires, parenting intentions, and anticipation of stigma upon parenthood among lesbian, bisexual, and heterosexual women in Portugal

We explored parenting desires, parenting intentions, and anticipation of stigma upon parenthood in a sample of 257 self-identified lesbian, bisexual, and heterosexual childfree women in Portugal. No differences between the groups were observed concerning parenting desires. However, lesbian and bisexual women reported lower intentions to have children than their heterosexual counterparts. Although lesbian women considered themselves to have a higher chance of being victims of social stigma as mothers, this was not associated with their parenting desires. Furthermore, younger lesbian women intended to have children to a greater extent than did older lesbian women; relational status did not relate to lesbian women's parenting intentions, desires, or anticipation of stigma. Overall, this study contributes to knowledge about family formation processes among Portuguese women diverse in sexual identity.

Nurses' perceptions of their relationships and communication with lesbian women seeking perinatal care

AIMS AND OBJECTIVE

To examine whether nurses' assessment of their relationships and communication with lesbian women seeking perinatal care is associated with their personal and professional characteristics and knowledge of homosexuality.

BACKGROUND

Recently, there has been a growing incidence of same-sex parenthood. Nurses administer health care to lesbian women from pregnancy planning through birth, providing consultation. Although there has been a shift in attitudes towards homosexuality, discrimination is still quite common.

DESIGN

This research is part of a larger cross-sectional study carried out at women's healthcare centres, concerning nurses' perceived quality of perinatal care provided to lesbian women.

METHODS

The study was conducted from December 2015-April 2016 at women's health centres in Israel encompassing 184 registered nurses who completed self-report questionnaires. They were assessed as to their knowledge of homosexuality and nurse-patient relationships and communication. The Squire checklist was used.

RESULTS

Most (73.4%) had prior acquaintance with lesbian women; only 17.9% had been educated as to lesbian women's unique health needs; of these, 66.7% thought that they had been given professional tools for working with lesbian women; 60.4% were unaware of the importance of knowing the patient's sexual orientation. The average score on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. A significant positive correlation was found between nurses' knowledge of homosexuality and assessment of their relationships and communication with lesbian women seeking perinatal care. In addition, nurses' personal and professional characteristics, such as place of birth, religiosity and familiarity with lesbian women, were related to their assessment of their relationships and communication.

CONCLUSION

Nurses' knowledge of homosexuality and personal and professional characteristics were associated with their perceptions regarding relationships and communication with lesbian women seeking perinatal care.

RELEVANCE TO CLINICAL PRACTICE

Further training might broaden, refine rigid perceptions and contribute to advancing equal perinatal nursing care of lesbian women.

Femininity, masculinity, and body image in a community-based sample of lesbian and bisexual women

This study expands the literature on body image among lesbian and bisexual women by examining the relationship between self-perceived gendered personality traits and expressions (i.e., sense of self in relation to cultural constructions of femininity and masculinity) and body satisfaction, a key body image construct. We used data from Wave 3 (2010-2012) of the Chicago Health and Life Experiences of Women (CHLEW) study. The CHLEW includes a novel measure of gender expression, with masculinity and femininity as distinct but overlapping constructs. In the large analytic sample (N = 553), we found both similarities and differences in the association between femininity/masculinity and body image in lesbian and bisexual women. Bisexual women reported significantly lower body satisfaction than lesbian women. Higher masculinity was associated with greater body satisfaction in the full sample, but the association was stronger for bisexual than lesbian women. Femininity was positively associated with body satisfaction only for bisexual women. These findings suggest that masculinity and femininity play different roles in body satisfaction for lesbian and bisexual women and highlight the importance of disaggregating sexual identity in studies of sexual minority women's health. Clinicians should routinely ask about sexual identity and gender expression, especially when presenting concerns involve body image or disordered eating.

Relationship Status and Drinking-Related Outcomes in a Community Sample of Lesbian and Bisexual Women

Although marriage tends to be protective against hazardous drinking among women in the general population, few studies have compared drinking rates, levels, or problems based on relationship status among sexual minority women (SMW; lesbian, bisexual). We examined associations between relationship status (committed relationship/cohabiting; committed/not cohabiting; single) and past-year drinking outcomes using data from a diverse sample of 696 SMW interviewed in wave 3 of the 17-year longitudinal Chicago Health and Life Experiences of Women study. The mean age of SMW in the sample was 40.01 (SD = 14.15; range 18-82). A little more than one-third (37%) of the sample was white, 36% was African American, and 23% Latina; 4% reported another or multi- race/ethnicity. Compared to SMW in committed cohabiting relationships, single SMW were significantly more likely to be heavy drinkers. SMW in committed non-cohabiting relationships were more likely to report alcohol-related problem consequences, and both single SMW and those in committed non-cohabiting relationships were more likely to report one or more symptoms of potential alcohol dependence. Findings underscore the importance of exploring relationship factors that may influence drinking and drinking-related problems among SMW.

Parenting desires, parenting intentions, and anticipation of stigma upon parenthood among lesbian, bisexual, and heterosexual women in Portugal

We explored parenting desires, parenting intentions, and anticipation of stigma upon parenthood in a sample of 257 self-identified lesbian, bisexual, and heterosexual childfree women in Portugal. No differences between the groups were observed concerning parenting desires. However, lesbian and bisexual women reported lower intentions to have children than their heterosexual counterparts. Although lesbian women considered themselves to have a higher chance of being victims of social stigma as mothers, this was not associated with their parenting desires. Furthermore, younger lesbian women intended to have children to a greater extent than did older lesbian women; relational status did not relate to lesbian women's parenting intentions, desires, or anticipation of stigma. Overall, this study contributes to knowledge about family formation processes among Portuguese women diverse in sexual identity.

Same-Sex Marriage and Language Appropriation Practices of Lesbians

Legal marriage has vacillated between being a private agreement made by two individuals and an agreement of social significance under the state's control (Nokov, 2008; Smart, 2013). Presently, we are without a definition of marriage that serves our diverse population. The discourse surrounding same-sex marriage in the United States is a topic of interest, as explicit attention to communication in reference to these relationships has rarely been documented (Land & Kitzinger, 2005; Richman, 2014). Using a qualitative framework and semistructured interviews, this study investigated the relationship between marriage equality and its impact on language appropriation for 20 lesbians in varying parts of the United States. Analysis employing grounded theory and constant comparative method indicated that for this sample, access to legal marriage did not serve as a determinant for the adoption of language traditionally associated with marriage. Additionally, it indicated that marriage equality hinges on more than the support of the law.

Measuring Sexual Minority Stressors in Lesbian Women's Daily Lives: Initial Scale Development

Lesbian women face unique sexual minority stressors (SMS) due to their stigmatized and marginalized status in society. Existing studies of SMS are primarily cross-sectional and use global measures of SMS. The goal of the present study was to develop a brief daily measure of SMS for use in daily diary or ecological momentary assessment (EMA) studies. Existing retrospective measures of SMS were reviewed, resulting in an initial pool of 29 items. Thirty-eight lesbian women (Mage=24.3 years, range: 19-30 years) completed a daily web-based survey including the SMS items for 12 days. Two response scales were tested; participants were randomized to receive a 3-point (for brevity) or 7-point (for precision) scale for the first 6 days and the other response scale for the remaining 6 days to counterbalance order. Findings suggest the 7-point scale was optimal because it provided greater variability. To reduce scale length, item correlations were examined to identify clusters and one item was retained from each cluster, reducing the scale to 18 items. Then, using HLM, null models with each item as the outcome were conducted to examine level-1 and level-2 variances; 8-, 10-, 12-, and 18-item scales were compared to identify the ideal number of items. The 8-item scale had the highest Cronbach's alpha (.85) and the smallest intraclass correlation (ICC; .13), suggesting these 8 items are optimal for capturing within-person variability in young lesbian women's daily SMS experiences. As researchers are increasingly interested in using EMA methods, this 8-item measure can assess SMS in lesbian women's everyday lives.

Alcohol Use, Age, and Self-Rated Mental and Physical Health in a Community Sample of Lesbian and Bisexual Women

PURPOSE

Given that self-perceptions of mental and physical health are important predictors of health outcomes and well-being, particularly among older adults, this study focuses on associations among age, alcohol consumption, and indicators of both self-rated mental health and self-rated physical health in a sample of sexual minority women (SMW).

METHODS

This study uses a community sample of SMW to examine the associations among age, drinking, and self-rated mental and physical health.

RESULTS

Heavy drinking among older adult SMW (55+) was less prevalent than among young SMW, ages 18-25 and ages 26-39, but similar to rates reported among SMW ages 40-54. In addition, older SMW reported significantly higher levels of self-rated mental health, compared with SMW in the other age groups, but we found no significant associations between age and self-rated physical health. Across all age groups, moderate drinkers reported better self-rated physical health than alcohol abstainers.

CONCLUSIONS

Overall, these results suggest that, among SMW, drinking does not decline as sharply with age as it does for heterosexual women in the general population. Given the current and projected increases in the aging population and the risks that heavy drinking presents for morbidity and mortality, interventions aimed at older SMW are needed.

Patterns of Mental Health Care Utilization Among Sexual Orientation Minority Groups

Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013-2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals; and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender gap seen among heterosexuals.

Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women

AIMS AND OBJECTIVES

To examine the unmet needs for mental health and substance use treatment among a diverse sample of sexual minority women (lesbian, bisexual).

BACKGROUND

Sexual minority women are more likely than heterosexual women to report depression and hazardous drinking. However, relatively little is known about sexual minority women's use of mental health or substance use treatment services, particularly about whether use varies by race/ethnicity.

DESIGN

Cross-sectional analysis of existing data.

METHODS

Analyses included data from 699 Latina, African American and white sexual minority women interviewed in wave 3 of the 17-year Chicago Health and Life Experiences of Women study. Using logistic regression, we examined the associations among sexual identity, race/ethnicity, use of mental health and substance use treatment, as well as potential unmet need for treatment.

RESULTS

Overall, women in the study reported high levels of depression and alcohol dependence, and these varied by sexual identity and race/ethnicity. Use of mental health and substance use treatment also varied by race/ethnicity, as did potential unmet need for both mental health and substance use treatment.

CONCLUSIONS

Our findings that suggest although use of treatment among sexual minority women is high overall, there is a potentially sizable unmet need for mental health and substance use treatment that varies by race/ethnicity, with Latina women showing the greatest unmet need for treatment.

RELEVANCE TO CLINICAL PRACTICE

Nurses and other healthcare providers should be aware of the high rates of depression and hazardous drinking among sexual minority women, understand the factors that may increase the risk of these conditions among sexual minority women, the potentially high unmet need for mental health and substance use treatment - perhaps particularly among Latina women and be equipped to provide culturally sensitive care or refer to appropriate treatment services as needed.

A Psychometric Review of Measures Assessing Discrimination Against Sexual Minorities

Discrimination against sexual minorities is widespread and has deleterious consequences on victims' psychological and physical wellbeing. However, a review of the psychometric properties of instruments measuring lesbian, gay, and bisexual (LGB) discrimination has not been conducted. The results of this review, which involved evaluating 162 articles, reveal that most have suboptimal psychometric properties. Specifically, myriad scales possess questionable content validity as (1) items are not created in collaboration with sexual minorities; (2) measures possess a small number of items and, thus, may not sufficiently represent the domain of interest; and (3) scales are "adapted" from measures designed to examine race- and gender-based discrimination. Additional limitations include (1) summed scores are computed, often in the absence of scale score reliability metrics; (2) summed scores operate from the questionable assumption that diverse forms of discrimination are necessarily interrelated; (3) the dimensionality of instruments presumed to consist of subscales is seldom tested; (4) tests of criterion-related validity are routinely omitted; and (5) formal tests of measures' construct validity are seldom provided, necessitating that one infer validity based on the results obtained. The absence of "gold standard" measures, the attendant difficulty in formulating a coherent picture of this body of research, and suggestions for psychometric improvements are noted.

Lesbian camp: An unearthing

Camp-a sensibility, a style, and a form of artistic self-expression-is an elusive concept said to be in the eye of the beholder. To refute Susan Sontag's ( 1966 ) claims that camp is apolitical and not especially homosexual, a number of recent scholarly works have been geared toward revealing camp's fundamental gayness. With the odd footnote aside, lesbian camp has been collapsed into the category of gay male camp, if not eclipsed entirely. Despite the negligible efforts made to legitimize lesbian camp, there are numerous salient cultural examples one might draw on to illustrate, typify, and substantiate a lesbian camp sensibility. I lay the ground work for this scholarly exercise by outlining various definitions and critiques of camp, and by discussing its history and application to queer theory. Then, to unveil lesbian camp, three non-mutually exclusive categories are discussed: classic, erotic, and radical. By gathering various strands of inquiry, and various textual examples (e.g., photography, artistic performances, and literary tropes), this article attempts to reach a more inclusive and nuanced understanding of lesbian camp.

Discrepant Alcohol Use, Intimate Partner Violence, and Relationship Adjustment among Lesbian Women and their Relationship Partners

This study examined the association between relationship adjustment and discrepant alcohol use among lesbian women and their same-sex intimate partners after controlling for verbal and physical aggression. Lesbian women (N = 819) who were members of online marketing research panels completed an online survey in which they reported both their own and same-sex intimate partner's alcohol use, their relationship adjustment, and their own and their partner's physical aggression and psychological aggression (i.e., verbal aggression and dominance/isolation). Partners' alcohol use was moderately correlated. Discrepancy in alcohol use was associated with poorer relationship adjustment after controlling for psychological aggression and physical aggression. Results are discussed in terms of the similarity and differences with previous literature primarily focused on heterosexual couples.

Assessing the Gender Invariance of the Modern Homonegativity Scale

The measurement invariance of the Modern Homonegativity Scale (MHS) was examined among heterosexual female (n = 449) and male (n = 329) university students who were predominantly Mexican American. The MHS demonstrated full invariance of factor loadings and partial invariance of latent intercepts. At the latent mean level, heterosexual men compared to heterosexual women held more negative attitudes toward both gay men and lesbian women. There were no latent mean differences in attitudes toward gay men and lesbian women when rated by either heterosexual men or heterosexual women. The MHS can be used by heterosexual men and heterosexual women to assess their homonegativity.

Clinical outcomes of enjoying sexualization among lesbian women

The Enjoyment of Sexualization Scale (ESS) was given to 150 lesbians in addition to measures of self-objectification, negative eating attitudes, and depression. The ESS was found to have acceptable levels of internal consistency reliability with a lesbian sample. Scores on the ESS were lower in this sample than in previously reported research with heterosexual women. Enjoying sexualization was found to moderate the relationship between body shame and both depressive symptomatology and negative eating attitudes. In contrast to findings from a heterosexual sample, lesbians who enjoyed sexualization had smaller relationships between these negative clinical outcomes and body shame than lesbians who did not. For lesbians, enjoying sexualization may serve a protective function against the negative effects of self-objectification. Findings are discussed in terms of body image and perceptions of ideal beauty among lesbians.

Sexual victimization and associated risks among lesbian and bisexual women

This study examines relationships among childhood sexual abuse (CSA), risky alcohol use, and adult sexual victimization among bisexual and lesbian women. Half (51.2%) of women reported CSA and 71.2% reported adult sexual victimization. Perpetrators were generally male, and 56.4% of women's most recent adult sexual victimization incidents occurred after coming out. Regression results indicated that adult sexual victimization severity was associated with a bisexual identity, more severe CSA history, more lifetime sexual partners, and higher alcohol severity scores. Compared to lesbians, bisexual women reported more severe adult sexual victimization experiences, greater revictimization, riskier drinking patterns, and more lifetime male sexual partners.