Most lesbians live in a world where nothing fits into reality. Almost every magazine we look at, every television show or movie, every advertising image, novels, mainstream music, etc., constantly shows a way of life that is not ours. Some of us live decades with another woman and are not able to share with her families' celebrations. Some of us have become experts at genderless pronouns or we change pronouns or lie to protect our jobs, our homes, our children and our lives. The effect on our emotional health can be devastating. Living in such a homophobic world, there has to be some self-doubt in all but the strongest women. If the community does not validate a person or a relationship, then the individuals involved don't either, or if they are able to validate themselves, they do so at great emotional cost. This is really brought home when the American Medical Association advises practitioners to at least mention to patients the fact that therapies for "reversals" do exist. Of course, nowhere does it say to tell the patients that these therapies don't work. There is no cure for lesbianism because there is no illness.

Lesbian culture or community is necessary for self-esteem. It is evidence that we are viable human beings. Our identity becomes tangible, more than just an idea. Jewel Gomez, a writer, says: "It's very hard to want to be something and not have a reflection for it." If a community doesn't validate the relationship then the individuals don't either.

A lesbian couple, patients of mine, had been living together for years and it did not occur to them to bequest personal belongings to their partner in their wills, only to their families of origin, because they have never heard of two women doing that before. We need to begin to open up options for lesbians living in a heterosexual world.

The question of choice comes up often. Some people feel that lesbians have the choice of not being lesbians. In other words, they say that we don't have to act out our sexual identities. If we put this in the context of heterosexuals not acting out their sexual identity, we can see how absurd this concept really is. Choice is involved in the degree of openness in which a lesbian can live her life, not in being a lesbian which is inherent.

Doctors have the exclusive right to define disease and order treatment. Too often this is done without considering minority health differences, cultural, religious, class or social contexts, or the invisibly disadvantaged. When any person is denied her right to decide what is best for her, she can end up feeling vulnerable and powerless. What we need to do is educate ourselves, read books on lesbian health care, and women's health care that are considerate of lesbians. Ask questions. Write letters. And above all, we must feel free to demand all the rights and considerations that are ours as citizens in a democratic society.

If a lesbian tells her doctor she is a lesbian and the doctor responds that it doesn't matter, then the doctor has missed the point. It does matter or it would not have been brought up. Suzanne Pharr, in her excellent book HOMOPHOBIA: A WEAPON OF SEXISM, states: "To say that lesbianism is just a bedroom issue is to deny the wholeness of sexual identity and its social expression, and it denies the presence and effects of homophobia."

It is important for health care providers not to assume we are heterosexual. It can be as simple as asking us whether we are lesbians or inquiring whether we need birth control and accepting our response. Instead of asking if we are married, we can be asked what support systems we have and with whom we live. A patient's partners and friends can be included in medical discussions and recovery.

Lesbians function in families of lovers, children, house-mates and friends. When one of our family members, albeit extended family, has a medical emergency or otherwise enters the health care system, we must be recognized as family and allowed to participate in the recovery of those we love.

Until society has learned to treat lesbians with the same respect and caring as other valued members of society, then our heath care must involve some activism as well. We need to be aware of our medical and legal rights, and if the medical profession is not, we need to help educate them. Read books on lesbian health, read alternative newspapers, make contact with lesbian organizations and status of women organizations, know who represents you in government who is supportive of your views. And don't be afraid to ask for whatever it is that you need.