The Fenway Institute, Fenway Health, Boston, MA 02215, USA.
Sex Transm Dis. 2010 Jan;37(1):5-12. doi: 10.1097/OLQ.0b013e3181b41314.
A growing body of research documents mental health disparities among women who have sex with women (WSW) compared with women who have sex with men only (WSM). However, there remains a dearth of research exploring these indicators alongside sexually transmitted diseases (STDs) and WSW sexual health.
A retrospective chart review was conducted of all female patients (n = 368) screened for STDs between July 2007 and December 2007 at an urban community health center in Boston, MA. Deidentified electronic medical record data (e.g., demographics, psychosocial, sexual health) were analyzed and linked to STD positivity. Women who did not have sexual behavior documented in their medical chart (n = 58) were excluded from this analysis. Bivariate and multivariable logistic regression procedures examined sexual and psychosocial health indicators, including sexual preference.
Twenty-seven percent of participants were WSW (17% WSW only and 10% WSW/M). Overall, 5% of WSW were diagnosed with a new STD (human papillomavirus, anogenital warts, genital herpes, pelvic inflammatory disease) and 17% had a history of a prior STD. In multivariable models adjusting for demographics, WSW were disproportionately more likely to have mental health and psychosocial issues noted in their medical records, including: a clinical diagnosis of depression, anxiety, and posttraumatic stress disorder, history of suicide attempts, and inpatient psychiatric/mental health treatment. However, WSW were significantly less likely than WSM to engage in "high risk" HIV/STD sexual behavior. In a final multivariable model, same sex behavior was not associated with a different likelihood of being diagnosed with an STD, compared with opposite sex behavior. However, WSW diagnosed with STDs were at increased odds of having bipolar disorder and utilizing outpatient mental health counseling services compared with WSW without STDs. WSW with a history of STDs were at increased odds of having attempted suicide in the past, utilizing both outpatient and inpatient mental health treatment services, and having a history of injection drug use compared with WSW without a history of STDs.
WSW with STDs may have presenting psychosocial problems. Further research is warranted to better understand the relationship between sexual behavior and health, as well as to guide the development of interventions to ameliorate health disparities among WSW, particularly in the psychosocial domain.
越来越多的研究文献表明，与仅与男性发生性关系的女性（WSM）相比，女性同性恋者（WSW）存在心理健康方面的差异。然而，目前仍然缺乏研究来探索这些指标与性传播疾病（STD）和 WSW 性健康之间的关系。
对 2007 年 7 月至 2007 年 12 月期间在马萨诸塞州波士顿市一家城市社区卫生中心接受 STD 筛查的所有女性患者（n=368）进行了回顾性图表审查。对电子病历数据（如人口统计学、社会心理、性健康）进行了分析，并与 STD 阳性结果进行了关联。在病历中没有记录性行为的女性（n=58）被排除在这项分析之外。采用二变量和多变量逻辑回归程序检查了性和社会心理健康指标，包括性偏好。
27%的参与者是女性同性恋者（17%的女性同性恋者和 10%的女性同性恋者/男性）。总的来说，5%的女性同性恋者被诊断患有新的 STD（人乳头瘤病毒、肛门生殖器疣、生殖器疱疹、盆腔炎），17%的人有过既往 STD 的病史。在调整人口统计学因素的多变量模型中，女性同性恋者在病历中记录的心理健康和社会心理问题明显更为常见，包括：临床诊断为抑郁症、焦虑症和创伤后应激障碍、自杀未遂史，以及住院精神病/心理健康治疗。然而，与 WSM 相比，女性同性恋者进行“高风险”HIV/STD 性行为的可能性显著较低。在最终的多变量模型中，同性行为与异性行为相比，被诊断为 STD 的可能性并没有不同。然而，与没有 STD 的女性同性恋者相比，被诊断患有 STD 的女性同性恋者患有双相情感障碍的几率更高，并且使用门诊心理健康咨询服务的几率也更高。与没有 STD 史的女性同性恋者相比，有 STD 史的女性同性恋者过去自杀未遂的几率更高，使用门诊和住院精神卫生治疗服务的几率更高，并且使用注射毒品的几率更高。
患有 STD 的女性同性恋者可能存在心理健康问题。需要进一步的研究来更好地理解性行为和健康之间的关系，以及指导制定干预措施，以减轻女性同性恋者的健康差异，特别是在社会心理领域。
