At least one in two lesbian and bisexual women never disclose their sexuality to their GP and so never get an opportunity to discuss specific sexual and other health needs they may have, a women's health specialist has said.

According to Dr Mary Condren, a Dublin-based GP who specialises in women's health, lesbian and bisexual women often have specific health needs outside of the common issues seen in the heterosexual population. However, these issues may never be dealt with if the patient does not disclose their sexuality to their doctor.

Dr Condren believes that GPs should use ‘open, non-judgmental questions' during a consultation as this "may open the door for lesbian and bisexual women to disclose their sexual orientation in safety".

She noted that while for the most part, lesbian and bisexual women have the same health needs as heterosexual women, there are three areas that should be borne in mind when working with this population - mental health, sexual health and fertility and general health/screening.

In relation to mental health, Dr Condren pointed out that lesbian and bisexual women have been shown to be at an increased risk of mental health problems compared to their heterosexual peers.

"Reasons for this include the stresses associated with initial confusion over sexual orientation, worries about being accepted by family, peers and society and the high incidence of bullying, often a problem in the school or workplace," she explained.

Research also indicates an increased risk of suicide at the time of ‘coming out' if the person has poor support from family and friends.

"As a consequence of these extra stresses in life, they may be at increased risk of alcohol and/or drug abuse. However, if a woman has not disclosed her sexual orientation to her GP, how can she express her fears and anxieties during a consultation," Dr Condren asked.

In relation to sexual health and fertility meanwhile, Dr Condren said that it must not be assumed that lesbian and bisexual women are at lower risk of sexually transmitted infections (STIs).

She said that bisexual women are obviously at the same risk as heterosexual women, however ‘some lesbian women will have had sex with men before they were secure in their own sexuality', putting them at risk as well.

Furthermore, some STIs, such as herpes, are spread by skin-to-skin contact.

Dr Condren also noted that the issue of lesbian couples planning a pregnancy has become more common in recent years, although most couples ‘will opt to attend one of the private fertility clinics throughout the country which provide a high standard aid service for lesbian couples'.

In terms of general health, GPs should be aware of certain issues, such as a possible increased risk of ovarian cancer. This is due to the fact that lesbian and bisexual women have fewer pregnancies than their heterosexual peers, generally have more menstrual cycles in their lifetime and are unlikely to have used the oral contraceptive pill for long periods. These can all increase the risk of this type of cancer.

Dr Condren said that overall, in order for GPs to provide comprehensive care to lesbian and bisexual women, it is important to be aware of their specific needs.

"But until we are comfortable and skilled in knowing the sexual orientation of our patients, we cannot be in a position to provide this extra level of care," she added.

Dr Condren made her comments in Modern Medicine of Ireland, which is produced by MedMedia, publishers of Irishhealth.com.