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Further information: LGBT in IslamFemale homosexual behavior may be present in every culture, although the concept of a lesbian as a woman who pairs exclusively with other women is not. Attitudes about female homosexual behavior are dependent upon womens roles in each society, and each cultures definition of sex. Women in the Middle East have been historically segregated from men. In the 7th and 8th centuries, some extraordinary women dressed in male attire when gender roles were less strict, but the sexual roles that accompanied European women were not associated with Islamic women. The Caliphal court in Baghdad featured women who dressed as men, including false facial hair, but they competed with other women for the attentions of men. 118Highly intelligent women, according to the 12th century writings of Sharif alIdrisi , were more likely to be lesbians their intellectual prowess put them on a more even par with men. 118 Relations between women who lived in harems, and fears of women being sexually intimate in Turkish baths were expressed in writings by men. Women, however, were mostly silent and men likewise rarely wrote about lesbian relationships. It is unclear to historians if the rare instances of lesbianism mentioned in literature are an accurate historical record or intended to serve as fantasies for men. A 1978 treatise about repression in Iran asserted that women were completely silenced: In the whole of Iranian history, no woman has been allowed to speak out for such tendencies ... To attest to lesbian desires would be an unforgivable crime. 118Although the authors of Islamic Homosexualities argued this did not mean women could not engage in lesbian relationships, a lesbian anthropologist in 1991 visited Yemen and reported that women in the town she visited were unable to comprehend her romantic relationship to another woman. Women in Pakistan are expected to marry men those who do not are ostracized. Women, however, may have intimate relations with other women as long as their wifely duties are met, their private matters are kept quiet, and the woman with whom they are involved is somehow related by family or logical interest to her lover. 119The United Nations estimate for the number of honor killings in the world is 5000 per year. Many womens groups in the Middle East and Southwest Asia suspect that more than 20,000 women are victims of honor killings in the world each year. 120The AmericasIndigenous people in North and South America conceptualized a third gender for menwomen and womenmen. These roles were recorded of the Coahuiltecan Indians in Texas, Timucuan in Florida, and Cueva in Panama. In Cree , the term for a man who took the role of a woman was ayekkwew the Zuni word for a woman who took the role of a man was katsotse (boygirl), 121 and the Mohave give women the term hwame. 122 The crossgender roles have less to do with sexuality than with spirituality and occupation. A twospirit woman who has a relationship with a non crossgender woman is thought to be a heterogender relationship. 123In Latin America , lesbian consciousness and associations appeared in the 1970s, increasing while several countries transitioned to or reformed democratic governments. Harassment and intimidation have been common even in places where homosexuality is legal, and laws against child corruption, morality, or the good ways (faltas a la moral o las buenas costumbres), have been used to persecute homosexuals. 124 From the Hispanic perspective, the conflict between the lesbophobia of feminists and the misogyny from gay men has created a difficult path for lesbians and associated groups. 125Argentina was the first Latin American country with a gay rights group, Nuestro Mundo (NM, or Our World), created in 1969. Six mostly secret organizations concentrating on gay or lesbian issues were founded around this time, but persecution and harassment were continuous and grew worse with the dictatorship of Jorge Rafael Videla in 1976, when all groups were dissolved in the Dirty War . Lesbian rights groups have gradually formed since 1986 to build a cohesive community that works to overcome philosophical differences with heterosexual women. 126The Latin American lesbian movement has been the most active in Mexico , but has encountered similar problems in effectiveness and cohesion. While groups try to promote lesbian issues and concerns, they also face misogynistic attitudes from gay men and homophobic views from heterosexual women. In 1977, Lesbos, the first lesbian organization for Mexicans, was formed. Several incarnations of political groups promoting lesbian issues have evolved 13 lesbian organizations were active in Mexico City in 1997. Ultimately, however, lesbian associations have had little influence both on the homosexual and feminist movements. 127In Chile , the dictatorship of Augusto Pinochet forbade the creation of lesbian groups until 1984, when Ayuqueln (joy of being in Mapuche ) was first founded, prompted by the very public beating death of a woman amid shouts of Damned lesbian! from her attacker. The lesbian movement has been closely associated with the feminist movement in Chile, although the relationship has been sometimes strained. Ayuqueln worked with the International Lesbian Information Service , the International Lesbian, Gay, Bisexual, Trans and Intersex Association , and the Chilean gay rights group Movimiento de Integracin y Liberacin Homosexual (Movement to Integrate and Liberate Homosexuals) to remove the sodomy law still in force in Chile. 125Lesbian consciousness began in Nicaragua in 1986, when the Sandinista National Liberation Front expelled gay men and lesbians from its midst. State persecution prevented the formation of associations until AIDS became a concern, when educational efforts forced sexual minorities to band together. The first lesbian organization was Nosotras, founded in 1989. An effort to promote visibility from 1991 to 1992 provoked the government to declare homosexuality illegal in 1994, effectively ending the movement, until 2004, when Grupo Safo Grupo de Mujeres Lesbianas de Nicaragua was created, four years before homosexuality became legal again. 128The meetings of feminist lesbians of Latin America and the Caribbean, sometimes shortened to Lesbian meetings, have been an important forum for the exchange of ideas for Latin American lesbians since the late 1980s. With rotating hosts and biannual gatherings, its main aims are the creation of communication networks, to change the situation of lesbians in Latin America (both legally and socially), to increase solidarity between lesbians and to destroy the existing myths about them. 129AfricaCrossgender roles and marriage between women has also been recorded in over 30 African societies. 130 Women may marry other women, raise their children, and be generally thought of as men in societies in Nigeria , Cameroon , and Kenya . The Hausa people of Sudan have a term equivalent to lesbian, kifi, that may also be applied to males to mean neither party insists on a particular sexual role. 131Near the Congo River a female who participates in strong emotional or sexual relationships with another female among the Nkundo people is known as yaikya bonsngo (a woman who presses against another woman). Lesbian relationships are also known in matrilineal societies in Ghana among the Akan people . In Lesotho , females engage in what is commonly considered sexual behavior to the Western world: they kiss, sleep together, rub genitals, participate in cunnilingus , and maintain their relationships with other females vigilantly. Since the people of Lesotho believe sex requires a penis, however, they do not consider their behavior sexual, nor label themselves lesbians. 132In South Africa, lesbians are raped by heterosexual men with a goal of punishment of abnormal behavior and reinforcement of societal norms. 133 The crime was first identified in South Africa 134 where it is sometimes supervised by members of the womans family or local community, 135 and is a major contributor to HIV infection in South African lesbians. 133 Corrective rape is not recognized by the South African legal system as a hate crime despite the fact that the South African Constitution states that no person shall be discriminated against based on their social status and identity, including sexual orientation. 136 137 Legally, South Africa protects gay rights extensively, but the government does not do anything to prevent corrective rape, and women do not have much faith in the police and their investigations. 138 139Corrective rape is on the rise in South Africa. More than 10 lesbians are raped or gangraped weekly, as estimated by Luleki Sizwe, a South African nonprofit. 140 It is estimated that at least 500 lesbians become victims of corrective rape every year and that 86 of black lesbians in the Western Cape live in fear of being sexually assaulted , as reported by the Triangle Project in 2008. 138 Yet, victims of corrective rape are less likely to report it because of the negative social view of homosexuality. 138AsiaA historic shunga woodblock printing from Japan depicting two women having sexChina before westernization was another society that segregated men from women. Historical Chinese culture has not recognized a concept of sexual orientation, or a framework to divide people based on their samesex or oppositesex attractions. 141 Although there was a significant culture surrounding homosexual men, there was none for women. Outside their duties to bear sons to their husbands, women were perceived as having no sexuality at all. 142This did not mean that women could not pursue sexual relationships with other women, but that such associations could not impose upon womens relationships to men. Rare references to lesbianism were written by Ying Shao , who identified samesex relationships between women in imperial courts who behaved as husband and wife as dui shi (paired eating). Golden Orchid Associations in Southern China existed into the 20th century and promoted formal marriages between women, who were then allowed to adopt children. 143 Westernization brought new ideas that all sexual behavior not resulting in reproduction was aberrant. 144The liberty of being employed in silk factories starting in 1865 allowed some women to style themselves tzushu nii (never to marry) and live in communes with other women. Other Chinese called them souhei (selfcombers) for adopting hairstyles of married women. These communes passed because of the Great Depression and were subsequently discouraged by the communist government for being a relic of feudal China. 145 In contemporary Chinese society, tongzhi (same goal or spirit) is the term used to refer to homosexuals most Chinese are reluctant to divide this classification further to identify lesbians. 146In Japan, the term rezubian, a Japanese pronunciation of lesbian, was used during the 1920s. Westernization brought more independence for women and allowed some Japanese women to wear pants. 147 The cognate tomboy is used in the Philippines , and particularly in Manila , to denote women who are more masculine. 148 Virtuous women in Korea prioritize motherhood, chastity, and virginity outside this scope, very few women are free to express themselves through sexuality, although there is a growing organization for lesbians named Kkirikkiri. 149 The term pondan is used in Malaysia to refer to gay men, but since there is no historical context to reference lesbians, the term is used for female homosexuals as well. 150 As in many Asian countries, open homosexuality is discouraged in many social levels, so many Malaysians lead double lives. 151In India, a 14thcentury Indian text mentioning a lesbian couple who had a child as a result of their lovemaking is an exception to the general silence about female homosexuality. This invisibility disappeared with the release of a film titled Fire in 1996, prompting some theaters in India to be attacked by extremists. Terms used to label homosexuals are often rejected by Indian activists for being the result of imperialist influence, but most discourse on homosexuality centers on men. Womens rights groups in India continue to debate the legitimacy of including lesbian issues in their platforms, as lesbians and material focusing on female homosexuality are frequently suppressed. 152DemographicsThe Kinsey ReportKinseys scale of sexual responses, indicating the varying degrees of bisexualityThe most extensive early study of female homosexuality was provided by the Institute for Sex Research , who published an indepth report of the sexual experiences of American women in 1953. More than 8,000 women were interviewed by Alfred Kinsey and the staff of the Institute for Sex Research in a book titled Sexual Behavior in the Human Female , popularly known as part of the Kinsey Report. The Kinsey Reports dispassionate discussion of homosexuality as a form of human sexual behavior was revolutionary. Up to this study, only physicians and psychiatrists studied sexual behavior, and almost always the results were interpreted with a moral view. 153Kinsey and his staff reported that 28 of women had been aroused by another female, and 19 had a sexual contact with another female. 154 note 10 Of women who had sexual contact with another female, half to twothirds of them had orgasmed . Single women had the highest prevalence of homosexual activity, followed by women who were widowed, divorced, or separated. The lowest occurrence of sexual activity was among married women those with previous homosexual experience reported they got married to stop homosexual activity. 155Most of the women who reported homosexual activity had not experienced it more than ten times. Fiftyone percent of women reporting homosexual experience had only one partner. 156 Women with postgraduate education had a higher prevalence of homosexual experience, followed by women with a college education the smallest occurrence was among women with education no higher than eighth grade. 157 However, Kinseys methodology was criticized. 158 159Based on Kinseys scale where 0 represents a person with an exclusively heterosexual response and 6 represents a person with an exclusively homosexual one, and numbers in between represent a gradient of responses with both sexes, 6 of those interviewed ranked as a 6: exclusively homosexual. Apart from those who ranked 0 (71), the largest percentage in between 0 and 6 was 1 at approximately 15. 160 However, the Kinsey Report remarked that the ranking described a period in a persons life, and that a persons orientation may change. 160 Among the criticisms the Kinsey Report received, a particular one addressed the Institute for Sex Researchs tendency to use statistical sampling , which facilitated an overrepresentation of samesex relationships by other researchers who did not adhere to Kinseys qualifications of data. 153The Hite ReportTwentythree years later, in 1976, sexologist Shere Hite published a report on the sexual encounters of 3,019 women who had responded to questionnaires, under the title The Hite Report. Hites questions differed from Kinseys, focusing more on how women identified, or what they preferred rather than experience. Respondents to Hites questions indicated that 8 preferred sex with women and 9 answered that they identified as bisexual or had sexual experiences with men and women, though they refused to indicate preference. 161Hites conclusions are more based on respondents comments than quantifiable data. She found it striking that many women who had no lesbian experiences indicated they were interested in sex with women, particularly because the question was not asked. 162 Hite found the two most significant differences between respondents experience with men and women were the focus on clitoral stimulation, and more emotional involvement and orgasmic responses. 163 Since Hite performed her study during the popularity of feminism in the 1970s, she also acknowledged that women may have chosen the political identity of a lesbian.Population estimatesLesbians in the U.S. are estimated to be about 2.6 of the population, according to a National Opinion Research Center survey of sexually active adults who had had samesex experiences within the past year, completed in 2000. 164 A survey of samesex couples in the United States showed that between 2000 and 2005, the number of people claiming to be in samesex relationships increased by 30five times the rate of population growth in the U.S. The study attributed the jump to people being more comfortable selfidentifying as homosexual to the federal government. note 11The government of the United Kingdom does not ask citizens to define their sexuality. However, a survey by the UK Office for National Statistics (ONS) in 2010 found that 1.5 of Britons identified themselves as gay or bisexual, and the ONS suggests that this is in line with other surveys showing the number between 0.3 and 3. 165 166 Estimates of lesbians are sometimes not differentiated in studies of samesex households, such as those performed by the U.S. census, and estimates of total gay, lesbian, or bisexual population by the UK government. However, polls in Australia have recorded a range of selfidentified lesbian or bisexual women from 1.3 to 2.2 of the total population. 167HealthPhysicalIn terms of medical issues, lesbians are referred to as women who have sex with women (WSW) because of the misconceptions and assumptions about womens sexuality and some womens hesitancy to disclose their accurate sexual histories even to a physician. 168 Many selfidentified lesbians neglect to see a physician because they do not participate in heterosexual activity and require no birth control , which is the initiating factor for most women to seek consultation with a gynecologist when they become sexually active. 169 As a result, many lesbians are not screened regularly with Pap smears . The U.S. government reports that some lesbians neglect seeking medical screening in the U.S. they lack health insurance because many employers do not offer health benefits to domestic partners. 170The result of the lack of medical information on WSW is that medical professionals and some lesbians perceive lesbians as having lower risks of acquiring sexually transmitted diseases or types of cancer. When women do seek medical attention, medical professionals often fail to take a complete medical history. In a recent study of 2,345 lesbian and bisexual women, only 9.3 had claimed they had ever been asked their sexual orientation by a physician. A third of the respondents believed disclosing their sexual history would result in a negative reaction, and 30 had received a negative reaction from a medical professional after identifying themselves as lesbian or bisexual. 171 A patients complete history helps medical professionals identify higher risk areas and corrects assumptions about the personal histories of women. In a similar survey of 6,935 lesbians, 77 had had sexual contact with one or more male partners, and 6 had that contact within the previous year. 171 note 12Heart disease is listed by the U.S. Department of Health and Human Services as the number one cause of death for all women. Factors that add to risk of heart disease include obesity and smoking , both of which are more prevalent in lesbians. Studies show that lesbians have a higher body mass and are generally less concerned about weight issues than heterosexual women, and lesbians consider women with higher body masses to be more attractive than heterosexual women do. Lesbians are more likely to exercise regularly than heterosexual women, and lesbians do not generally exercise for aesthetic reasons, although heterosexual women do. 172 Research is needed to determine specific causes of obesity in lesbians. 170 171Lack of differentiation between homosexual and heterosexual women in medical studies that concentrate on health issues for women skews results for lesbians and nonlesbian women. Reports are inconclusive about occurrence of breast cancer in lesbians. 171 It has been determined, however, that the lower rate of lesbians tested by regular Pap smears makes it more difficult to detect cervical cancer at early stages in lesbians. The risk factors for developing ovarian cancer rates are higher in lesbians than heterosexual women, perhaps because many lesbians lack protective factors of pregnancy, abortion, contraceptives, breast feeding, and miscarriages. 173Safer Sex Recommendations forWomen Who Have Sex with WomenAvoid contact with a partners menstrual blood and with any visible genital lesions.Cover sex toys that penetrate more than one persons vagina or anus with a new condom for each person consider using different toys for each person.Use a barrier (e.g., latex sheet, dental dam , cutopen condom, plastic wrap) during oral sex.Use latex or vinyl gloves and lubricant for any manual sex that might cause bleeding. 171Some sexually transmitted diseases are communicable between women, including human papillomavirus (HPV)specifically genital warts squamous intraepithelial lesions , trichomoniasis , syphilis , and herpes simplex virus (HSV). Transmission of specific sexually transmitted diseases among women who have sex with women depends on the sexual practices women engage in. Any object that comes in contact with cervical secretions, vaginal mucosa, or menstrual blood, including fingers or penetrative objects may transmit sexually transmitted diseases. 174 Orogenital contact may indicate a higher risk of acquiring HSV, 175 even among women who have had no prior sex with men. 176Bacterial vaginosis (BV) occurs more often in lesbians, but it is unclear if BV is transmitted by sexual contact it occurs in celibate as well as sexually active women. BV often occurs in both partners in a lesbian relationship 177 a recent study of women with BV found that 81 had partners with BV. 178 Lesbians are not included in a category of frequency of human immunodeficiency virus (HIV) transmission, although transmission is possible through vaginal and cervical secretions. The highest rate of transmission of HIV to lesbians is among women who participate in intravenous drug use or have sexual intercourse with bisexual men. 179 180MentalSince medical literature began to describe homosexuality, it has often been approached from a view that sought to find an inherent psychopathology as the root cause, influenced by the theories of Sigmund Freud. Although he considered bisexuality inherent in all people, and said that most have phases of homosexual attraction or experimentation, exclusive samesex attraction he attributed to stunted development resulting from trauma or parental conflicts. 181 note 13 Much literature on mental health and lesbians centered on their depression , substance abuse , and suicide . Although these issues exist among lesbians, discussion about their causes shifted after homosexuality was removed from the Diagnostic and Statistical Manual in 1973. Instead, social ostracism, legal discrimination, internalization of negative stereotypes, and limited support structures indicate factors homosexuals face in Western societies that often adversely affect their mental health. 182Women who identify as lesbian report feeling significantly different and isolated during adolescence. 182 183 These emotions have been cited as appearing on average at 15 years old in lesbians and 18 years old in women who identify as bisexual. 184 On the whole, women tend to work through developing a selfconcept internally, or with other women with whom they are intimate. Women also limit who they divulge their sexual identities to, and more often see being lesbian as a choice, as opposed to gay men, who work more externally and see being gay as outside their control. 183Anxiety disorders and depression are the most common mental health issues for women. Depression is reported among lesbians at a rate similar to heterosexual women, 185 although generalized anxiety disorder is more likely to appear among lesbian and bisexual women than heterosexual women. 182 note 14 Depression is a more significant problem among women who feel they must hide their sexual orientation from friends and family, or experience compounded ethnic or religious discrimination, or endure relationship difficulties with no support system. 186 Mens shaping of womens sexuality has proven to have an effect on how lesbians see their own bodies. Studies have shown that heterosexual men and lesbians have different standards for what they consider attractive in women. Lesbians who view themselves with male standards of female beauty may experience lower selfesteem, eating disorders , and higher incidence of depression. 172 More than half the respondents to a 1994 survey of health issues in lesbians reported they had suicidal thoughts , and 18 had attempted suicide. 187A populationbased study completed by the National Alcohol Research Center found that women who identify as lesbian or bisexual are less likely to abstain from alcohol. Lesbians and bisexual women have a higher likelihood of reporting problems with alcohol, as well as not being satisfied with treatment for substance abuse programs. 188 Many lesbian communities are centered in bars, and drinking is an activity that correlates to community participation for lesbians and bisexual women. 189Media representationFurther information: Media portrayal of lesbianismLesbians portrayed in literature, film, and television often shape contemporary thought about womens sexuality. The majority of media about lesbians is produced by men 190 womens publishing companies did not develop until the 1970s, films about lesbians made by women did not appear until the 1980s, and television shows portraying lesbians written by women only began to be created in the 21st century. As a result, homosexualityparticularly dealing with womenhas been excluded because of symbolic annihilation . When depictions of lesbians began to surface, they were often onedimensional, simplified stereotypes. 190LiteratureFurther information: Lesbian literatureIn addition to Sapphos accomplishments, note 15 literary historian Jeannette Howard Foster includes the Book of Ruth , 191 and ancient mythological tradition as examples of lesbianism in classical literature. Greek stories of the heavens often included a female figure whose virtue and virginity were unspoiled, who pursued more masculine interests, and who was followed by a dedicated group of maidens. Foster cites Camilla and Diana , Artemis and Callisto , and Iphis and Ianthe as examples of female mythological figures who showed remarkable devotion to each other, or defied gender expectations. 192 The Greeks are also given credit with spreading the story of a mythological race of women warriors named Amazons . Enheduana , a priestess in Ancient Iraq who dedicated herself to the Sumerian goddess Inanna , has the distinction of signing the oldestsurviving signed poetry in history. She characterized herself as Inannas spouse. 193For ten centuries after the fall of the Roman Empire, lesbianism disappeared from literature. 194 Foster points to the particularly strict view that Eve representative of all womencaused the downfall of mankind original sin among women was a particular concern, especially because women were perceived as creating life. 195 During this time, women were largely illiterate and not encouraged to engage in intellectual pursuit, so men were responsible for shaping ideas about sexuality. 196In 1516thcentury French and English depictions of relationships between women ( Lives of Gallant Ladies by Brantme in 1665, John Cleland s 1749 erotica Memoirs of a Woman of Pleasure , LEspion Anglais by various authors in 1778), writers attitudes spanned from amused tolerance to arousal, whereupon a male character would participate to complete the act. Physical relationships between women were often encouraged men felt no threat as they viewed sexual acts between women to be accepted when men were not available, and not comparable to fulfillment that could be achieved by sexual acts between men and women. 197 At worst, if a woman became enamored of another woman, she became a tragic figure. Physical and therefore emotional satisfaction was considered impossible without a natural phallus. Male intervention into relationships between women was necessary only when women acted as men and demanded the same social privileges. 198In Bed (1893) by Henri de ToulouseLautrec , a Parisian who employed the association between lesbianism and prostitution 199Lesbianism became almost exclusive to French literature in the 19th century, based on male fantasy and the desire to shock bourgeois moral values. 200 Honor de Balzac , in The Girl with the Golden Eyes (1835), employed lesbianism in his story about three people living amongst the moral degeneration of Paris, and again in Cousin Bette and Sraphta . His work influenced novelist Thophile Gautier s Mademoiselle de Maupin , which provided the first description of a physical type that became associated with lesbians: tall, wideshouldered, slimhipped, and athletically inclined. 201 Charles Baudelaire repeatedly used lesbianism as a theme in his poems Lesbos, Femmes damnes 1 (Damned Women), and Femmes damnes 2. 202Reflecting French society, as well as employing stock character associations, many of the lesbian characters in 19thcentury French literature were prostitutes or courtesans: personifications of vice who died early, violent deaths in moral endings. 199 Samuel Taylor Coleridge s 1816 poem Christabel and the novella Carmilla (1872) by Sheridan Le Fanu both present lesbianism associated with vampirism. 203 Portrayals of female homosexuality not only formed European consciousness about lesbianism, but KrafftEbing cited the characters in Gustave Flaubert s Salammb (1862) and Ernest Feydeau s Le Comte de Chalis (1867) as examples of lesbians because both novels feature female protagonists who do not adhere to social norms and express contrary sexual feeling, although neither participated in samesex desire or sexual behavior. 204 Havelock Ellis used literary examples from Balzac and several French poets and writers to develop his framework to identify sexual inversion in women. 205Gradually, women began to author their own thoughts and literary works about lesbian relationships. Until the publication of The Well of Loneliness, most major works involving lesbianism were penned by men. Foster suggests that women would have encountered suspicion about their own lives had they used samesex love as a topic, and that some writers including Louise Lab , Charlotte Charke , and Margaret Fuller either changed the pronouns in their literary works to male, or made them ambiguous. 206 Author George Sand was portrayed as a character in several works in the 19th century writer Mario Praz credited the popularity of lesbianism as a theme to Sands appearance in Paris society in the 1830s. 207 note 16 Charlotte Bront s Villette in 1853 initiated a genre of boarding school stories with homoerotic themes. 208In the 20th century, Katherine Mansfield , Amy Lowell , Gertrude Stein , H.D. , Vita SackvilleWest , Virginia Woolf , and Gale Wilhelm wrote popular works that had samesex relationships as themes. Some women, such as Marguerite Yourcenar and Mary Renault , wrote or translated works of fiction that focused on homosexual men, like some of the writings of Carson McCullers . All three were involved in samesex relationships, but their primary friendships were with gay men. 209 Foster further asserts 1928 was a peak year for lesbianthemed literature in addition to The Well of Loneliness, three other novels with lesbian themes were published in England: Elizabeth Bowen s The Hotel, Woolfs Orlando , and Compton Mackenzie s satirical novel Extraordinary Women. 210 Unlike The Well of Loneliness, none of these novels were banned. 211 note 17As the paperback book came into fashion, lesbian themes were relegated to pulp fiction. Many of the pulp novels typically presented very unhappy women, or relationships that ended tragically. Marijane Meaker later wrote that she was told to make the relationship end badly in Spring Fire because the publishers were concerned about the books being confiscated by the U.S. Postal Service. 212 Patricia Highsmith , writing as Claire Morgan, wrote The Price of Salt in 1951 and refused to follow this directive, but instead used a pseudonym. 213Following the Stonewall riots, lesbian themes in literature became much more diverse and complex, and shifted the focus of lesbianism from erotica for heterosexual men to works written by and for lesbians. Feminist magazines such as The Furies , and Sinister Wisdom replaced The Ladder. Serious writers who used lesbian characters and plots included Rita Mae Brown s Rubyfruit Jungle (1973), which presents a feminist heroine who chooses to be a lesbian. 214 Poet Audre Lorde confronts homophobia and racism in her works, and Cherre Moraga is credited with being primarily responsible for bringing Latina perspectives to lesbian literature. Further changing values are evident in the writings of Dorothy Allison , who focuses on child sexual abuse and deliberately provocative lesbian sadomasochism themes. 215FilmLesbianism, or the suggestion of it, began early in filmmaking. The same constructs of how lesbians were portrayedor for what reasonsas what had appeared in literature were placed on women in the films. Women challenging their feminine roles was a device more easily accepted than men challenging masculine ones. Actresses appeared as men in male roles because of plot devices as early as 1914 in A Florida Enchantment featuring Edith Storey . In Morocco (1930) Marlene Dietrich kisses another woman on the lips, and Katharine Hepburn plays a man in Christopher Strong in 1933 and again in Sylvia Scarlett (1936). Hollywood films followed the same trend set by audiences who flocked to Harlem to see edgy shows that suggested bisexuality. 216Overt female homosexuality was introduced in 1929s Pandoras Box between Louise Brooks and Alice Roberts . However, the development of the Hays Code in 1930 censored most references to homosexuality from film under the umbrella term sex perversion. German films depicted homosexuality and were distributed throughout Europe, but 1931s Mdchen in Uniform was not distributed in the U.S. because of the depiction of an adolescents love for a female teacher in boarding school. 217Lesbianism or homosexuality was never spoken of in The Childrens Hour , but it is clear why Shirley MacLaine s character hangs herself.Because of the Hays Code, lesbianism after 1930 was absent from most films, even those adapted with overt lesbian characters or plot devices. Lillian Hellman s play The Childrens Hour was converted into a heterosexual love triangle and retitled These Three . Biopic Queen Christina in 1933, starring Greta Garbo , veiled most of the speculation about Christina of Swedens affairs with women. 217 Homosexuality or lesbianism was never mentioned outright in the films while the Hays Code was enforced. The reason censors stated for removing a lesbian scene in 1954s The Pit of Loneliness was that it was, Immoral, would tend to corrupt morals. 218 The code was relaxed somewhat after 1961, and the next year William Wyler remade The Childrens Hour with Audrey Hepburn and Shirley MacLaine . After MacLaines character admits her love for Hepburns, she hangs herself this set a precedent for miserable endings in films addressing homosexuality. 219Gay characters also were often killed off at the end, such as the death of Sandy Dennis character at the end of The Fox in 1968. If not victims, lesbians were depicted as villains or morally corrupt, such as portrayals of brothel madames by Barbara Stanwyck in Walk on the Wild Side from 1962 and Shelley Winters in The Balcony in 1963. Lesbians as predators were presented in Rebecca (1940), womens prison films like Caged (1950), or in the character Rosa Klebb in From Russia with Love (1963). 220 Lesbian vampire themes have reappeared in Draculas Daughter (1936), Blood and Roses (1960), Vampyros Lesbos (1971), and The Hunger (1983). 221 Basic Instinct (1992) featured a bisexual murderer played by Sharon Stone it was one of several films that set off a storm of protests about the depiction of gays as predators. 222The first film to address lesbianism with significant depth was The Killing of Sister George in 1968, which was filmed in The Gateways Club , a longstanding lesbian pub in London. It is the first to claim a film character who identifies as a lesbian, and film historian Vito Russo considers the film a complex treatment of a multifaceted character who is forced into silence about her openness by other lesbians. 223 Personal Best in 1982, and Lianna in 1983 treat the lesbian relationships more sympathetically and show lesbian sex scenes, though in neither film are the relationships happy ones. Personal Best was criticized for engaging in the cliched plot device of one woman returning to a relationship with a man, implying that lesbianism is a phase, as well as treating the lesbian relationship with undisguised voyeurism. 224 More ambiguous portrayals of lesbian characters were seen in Silkwood (1983), The Color Purple (1985), and Fried Green Tomatoes (1991), despite explicit lesbianism in the source material. 225An era of independent filmmaking brought different stories, writers, and directors to films. Desert Hearts arrived in 1985, to be one of the most successful. Directed by lesbian Donna Deitch , it is loosely based on Jane Rule s novel Desert of the Heart . It received mixed critical commentary, but earned positive reviews from the gay press. 226 The late 1980s and early 1990s ushered in a series of films treating gay and lesbian issues seriously, made by gays and lesbians, nicknamed New Queer Cinema . 227 Films using lesbians as a subject included Rose Troche s avant garde romantic comedy Go Fish (1994) and the first film about African American lesbians, Cheryl Dunye s The Watermelon Woman , in 1995. 228Realism in films depicting lesbians developed further to include romance stories such as The Incredibly True Adventure of Two Girls in Love and When Night Is Falling , both in 1995, Better Than Chocolate (1999), and the social satire But Im A Cheerleader in 2001. 229 A twist on the lesbianaspredator theme was the added complexity of motivations of some lesbian characters in Peter Jackson s Heavenly Creatures (1994), the Oscarwinning biopic of Aileen Wuornos , Monster (2003), and the exploration of fluent sexuality and gender in Chasing Amy (1997), Kissing Jessica Stein (2001), and Boys Dont Cry (1999). 230 The film V for Vendetta shows a dictatorship in future Britain that forces lesbians, homosexuals, and other unwanted people in society to be systematically slaughtered in Nazi concentration camps . In the film, a lesbian actress named Valerie, who was killed in such a manner, serves as inspiration for the masked rebel V and his ally Evey Hammond, who set out to overthrow the dictatorship.TelevisionMain articles: List of television shows with LGBT characters and Lists of American television episodes with LGBT themesHomosexuality addressed by television started much later than films. Local talk shows in the late 1950s first addressed homosexuality by inviting panels of experts (usually not gay themselves) to discuss the problems of gay men in society. Lesbianism was rarely included. The first time a lesbian was portrayed on network television was the NBC drama The Eleventh Hour in the early 1960s, in a teleplay about an actress who feels she is persecuted by her female director, and in distress, calls a psychiatrist who explains she is a latent lesbian who has deeprooted guilt about her feelings for women. When she realizes this, however, she is able to pursue healthy heterosexual relationships. 231Invisibility for lesbians continued in the 1970s when homosexuality became the subject of dramatic portrayals, first with medical dramas ( The Bold Ones , Marcus Welby, M.D. , Medical Center ) featuring primarily male patients coming out to doctors, or staff members coming out to other staff members. These shows allowed homosexuality to be discussed clinically, with the main characters guiding troubled gay characters or correcting homophobic antagonists, while simultaneously comparing homosexuality to psychosis, criminal behavior, or drug use. 232Another stock plot device in the 1970s was the gay character in a police drama. They served as victims of blackmail or antigay violence, but more often as criminals. Beginning in the late 1960s with N.Y.P.D. , Police Story , and Police Woman , the use of homosexuals in stories became much more prevalent, according to Vito Russo, as a response to their higher profiles in gay activism. 233 Lesbians were included as villains, motivated to murder by their desires, internalized homophobia, or fear of being exposed as homosexual. One episode of Police Woman earned protests by the National Gay Task Force before it aired for portraying a trio of murderous lesbians who killed retirement home patients for their money. 234 NBC edited the episode because of the protests, but a sitin was staged in the head of NBCs offices. 235In the middle of the 1970s, gays and lesbians began to appear as police officers or detectives, facing coming out issues. This did not extend to CBS groundbreaking show Cagney Lacey in 1982, starring two female police detectives. CBS production made conscious attempts to soften the characters so they would not appear to be lesbians. 236 In 1991, a bisexual lawyer portrayed by Amanda Donohoe on L.A. Law shared the first significant lesbian kiss note 18 on primetime television with Michele Greene , stirring a controversy despite being labeled chaste by The Hollywood Reporter . 237Ellen DeGeneres s (pictured with her Emmy Award) coming out in the media as well as her sitcom, ranks, hands down, as the single most public exit in gay history, changing media portrayals of lesbians in Western culture. 238Though television did not begin to use recurring homosexual characters until the late 1980s, some early situation comedies used a stock character that author Stephen Tropiano calls gaystraight: supporting characters who were quirky, did not comply with gender norms, or had ambiguous personal lives, that for all purposes should be gay. These included Zelda from The Many Loves of Dobie Gillis , Miss Hathaway from The Beverly Hillbillies , and Jo from The Facts of Life . 239 In the mid1980s through the 1990s, sitcoms frequently employed a coming out episode, where a friend of one of the stars admits she is a lesbian, forcing the cast to deal with the issue. Designing Women , The Golden Girls , and Friends used this device with women in particular. 240Recurring lesbian characters who came out were seen on Married... with Children , Mad About You , and Roseanne , in which a highly publicized episode had ABC executives afraid a televised kiss between Roseanne and Mariel Hemingway would destroy ratings and ruin advertising. The episode was instead the weeks highest rated. 241 By far the sitcom with the most significant impact to the image of lesbians was Ellen . Publicity surrounding Ellens coming out episode in 1997 was enormous Ellen DeGeneres appeared on the cover of Time magazine the week before the airing of The Puppy Episode with the headline Yep, Im Gay. Parties were held in many U.S. cities to watch the episode, and the opposition from conservative organizations was intense. WBMALP , the ABC affiliate in Birmingham, Alabama , even refused to air the first run of the episode, citing conservative values of the local viewing audience, which earned the station some infamy and ire in the LGBT community. Even still, The Puppy Episode won an Emmy for writing, but as the show began to deal with Ellen Morgans sexuality each week, network executives grew uncomfortable with the direction the show took and canceled it. 242Dramas following L.A. Law began incorporating homosexual themes, particularly with continuing storylines on Relativity , Picket Fences , ER , and Star Trek: The Next Generation and Deep Space Nine , both of which tested the boundaries of sexuality and gender. 243 A show directed at adolescents that had a particularly strong cult following was Buffy the Vampire Slayer . In the fourth season of Buffy, Tara and Willow admit their love for each other without any special fanfare and the relationship is treated as are the other romantic relationships on the show. 244What followed was a series devoted solely to gay characters from network television. Showtime s American rendition of Queer as Folk ran for five years, from 2000 to 2005 two of the main characters were a lesbian couple. Showtime promoted the series as No Limits, and Queer as Folk addressed homosexuality graphically. The aggressive advertising paid off as the show became the networks highest rated, doubling the numbers of other Showtime programs after the first season. 245 In 2004, Showtime introduced The L Word , a dramatic series devoted to a group of lesbian and bisexual women, running its final season in 2009.Current issues of lesbiansLesbian chic and popular cultureThe cover of Vanity Fair that marked the arrival of lesbian chic as a social phenomenon in the 1990s.The invisibility of lesbians has gradually eroded since the early 1980s. This is in part due to public figures who have caused speculation and comment in the press about their sexuality and lesbianism in general. The primary figure earning this attention was Martina Navratilova , who served as tabloid fodder for years as she denied being lesbian, admitted to being bisexual, had very public relationships with Rita Mae Brown and Judy Nelson , and acquired as much press about her sexuality as she did her athletic achievements. Navratilova spurred what scholar Diane Hamer termed constant preoccupation in the press with determining the root of samesex desire. 246Other public figures acknowledged their homosexuality and bisexuality, notably musicians k.d. lang and Melissa Etheridge , and Madonna s pushing of sexual boundaries in her performances and publications. In 1993, lang and selfprofessed heterosexual supermodel Cindy Crawford posed for the cover of Vanity Fair in a provocative arrangement that showed Crawford shaving langs face, as lang lounged in a barbers chair wearing a pinstripe suit. The image became an internationally recognized symbol of the phenomenon of lesbian chic, according to Hamer. 247 The year 1994 marked a rise in lesbian visibility, particularly appealing to women with feminine appearances. Between 1992 and 1994, Mademoiselle , Vogue , Cosmopolitan , Glamour , Newsweek , and New York magazines featured stories about women who admitted sexual histories with other women. 248One analyst reasoned the recurrence of lesbian chic was due to the oftenused homoerotic subtexts of gay male subculture being considered off limits because of AIDS in the late 1980s and 1990s, joined with the distant memory of lesbians as they appeared in the 1970s: unattractive and militant. In short, lesbians became more attractive to general audiences when they ceased having political convictions. 249 All the attention on feminine and glamorous women created what culture analyst Rodger Streitmatter characterizes as an unrealistic image of lesbians packaged by heterosexual men the trend influenced an increase in the inclusion of lesbian material in pornography aimed at men. 250A resurgence of lesbian visibility and sexual fluidity was noted in 2009 with celebrities such as Cynthia Nixon and Lindsay Lohan commenting openly on their relationships with women, and reality television addressing samesex relationships. Psychiatrists and feminist philosophers write that the rise in women acknowledging samesex relationships is due to growing social acceptance, but also concede that only a certain kind of lesbianslim and elegant or butch in just the right androgynous wayis acceptable to mainstream culture. 251Sexuality and lesbian identityThe presence of sexual activity between women as necessary to define a lesbian or a relationship continues to be debated. According to feminist writer Naomi McCormick, womens sexuality is constructed by men, whose primary indicator of lesbian sexual orientation is sexual experience with other women. The same indicator is not necessary to identify a woman as heterosexual, however. McCormick states that emotional, mental, and ideological connections between women are as important or more so than the genital. 252 Nonetheless, in the 1980s, a significant movement rejected the desexualization of lesbianism by cultural feminists, causing a heated controversy called the feminist sex wars . 253 Butch and femme roles returned, although not as strictly followed as they were in the 1950s. They became a mode of chosen sexual selfexpression for some women in the 1990s. Once again, women felt safer claiming to be more sexually adventurous, and sexual flexibility became more accepted. 254The focus of this debate often centers on a phenomenon named by sexologist Pepper Schwartz in 1983. Schwartz found that longterm lesbian couples report having less sexual contact than heterosexual or homosexual male couples, calling this lesbian bed death . However, lesbians dispute the studys definition of sexual contact, and introduced other factors such as deeper connections existing between women that make frequent sexual relations redundant, greater sexual fluidity in women causing them to move from heterosexual to bisexual to lesbian numerous times through their livesor reject the labels entirely. Further arguments attested that the study was flawed and misrepresented accurate sexual contact between women, or sexual contact between women has increased since 1983 as many lesbians find themselves freer to sexually express themselves. 255More discussion on gender and sexual orientation identity has affected how many women label or view themselves. Most people in western culture are taught that heterosexuality is an innate quality in all people. When a woman realizes her romantic and sexual attraction to another woman, it may cause an existential crisis many who go through this adopt the identity of a lesbian, challenging what society has offered in stereotypes about homosexuals, to learn how to function within a homosexual subculture. 256 Lesbians in Western cultures generally share an identity that parallels those built on ethnicity they have a shared history and subculture, and similar experiences with discrimination which has caused many lesbians to reject heterosexual principles. This identity is unique from gay men and heterosexual women, and often creates tension with bisexual women. 17Researchers, including social scientists , state that often behavior and identity do not match: women may label themselves heterosexual but have sexual relations with women, selfidentified lesbians may have sex with men, or women may find that what they considered an immutable sexual identity has changed over time. 3 257 A 2001 article on differentiating lesbians for medical studies and health research suggested identifying lesbians using the three characteristics of identity only, sexual behavior only, or both combined. The article declined to include desire or attraction as it rarely has bearing on measurable health or psychosocial issues. 258 Researchers state that there is no standard definition of lesbian because the term has been used to describe women who have sex with women, either exclusively or in addition to sex with men (i.e., behavior) women who selfidentify as lesbian (i.e., identity) and women whose sexual preference is for women (i.e., desire or attraction) and that the lack of a standard definition of lesbian and of standard questions to assess who is lesbian has made it difficult to clearly define a population of lesbian women. How and where study samples were obtained can also affect the definition. 3Families and politicsFurther information: LGBT parentingAlthough homosexuality among females has taken place in many cultures in history, a recent phenomenon is the development of family among samesex partners. Before the 1970s, the idea that samesex adults formed longterm committed relationships was unknown to many people. The majority of lesbians (between 60 and 80) report being in a longterm relationship. 259 Sociologists credit the high number of paired women to gender role socialization: the inclination for women to commit to relationships doubles in a lesbian union. Unlike heterosexual relationships that tend to divide work based on sex roles, lesbian relationships divide chores evenly between both members. Studies have also reported that emotional bonds are closer in lesbian and gay relationships than heterosexual ones. 260Family issues were significant concerns for lesbians when gay activism became more vocal in the 1960s and 1970s. Custody issues in particular were of interest since often courts would not award custody to mothers who were openly homosexual, even though the general procedure acknowledged children were awarded to the biological mother. 261 262 Several studies performed as a result of custody disputes viewed how children grow up with samesex parents compared to single mothers who did not identify as lesbians. They found that childrens mental health, happiness, and overall adjustment is similar to children of divorced women who are not lesbians. Sexual orientation, gender identity , and sex roles of children who grow up with lesbian mothers are unaffected. Differences that were found include the fact that divorced lesbians tend to be living with a partner, fathers visit divorced lesbian mothers more often than divorced nonlesbian mothers, and lesbian mothers report a greater fear of losing their children through legal means. 261Improving opportunities for growing families of samesex couples has shaped the political landscape within the past ten years. A push for samesex marriage or civil unions in western countries has replaced other political objectives. As of 2012 update , ten countries and six U.S. states offer samesex marriage civil unions are offered as an option in some European countries, U.S. states and individual municipalities. The ability to adopt domestically or internationally children or provide a home as a foster parent is also a political and family priority for many lesbians, as is improving access to artificial insemination . 263See also

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