Mysteries of Female Sexuality
(ENIGMAS DE LA SEXUALIDAD FEMENINA)
Segunda edición, Federación de Mujeres Cubanas
Editorial de la Mujer, 2010.
Author: Cuban writer and journalist Aloyma Ravelo

-A CubaNews translation. Edited by Walter Lippmann.







(Excerpts from Chapter 4: PRIVATE CONFESSIONS)

LESBIAN LOVE

And what to say about the prejudice and lack of acceptance triggered by sex between two women, an act still rejected flat out by many people who won’t bother to be just or hear any arguments. They think that having a lesbian among their next of kin is a sort of curse from heaven or a disgrace to, and an indelible stain on, the family morals.

In as much as we live in an era of sophisticated technological progress that includes space city planning and major breakthroughs like the discovery of the human genome –and everything they mean to mankind’s future– the age-old conflict of human sexuality is yet to be resolved, particularly in Latin America and the Caribbean.

The word “lesbian” has been used in our vocabulary in reference to female homosexuality for a much longer time than we have spent gradually accepting it as a legitimate personal choice. This term is derived from the name of the Greek island of Lesbos (called Mytilene in Greece), home to the 6th-century B.C. poet Sappho, in whose poems she proclaimed passionate love for young women.

As a rule, we believe that a lesbian is a woman whose erotic desire and emotional preference are always focused on other women, but it’s not quite so, since their sexual behavior ranges from being strictly homosexual to bisexual and circumstantially heterosexual, depending on factors such as economic status, cultural level, or sexual desire.

Up until a few decades ago, male and female homosexuality was thought to be a disease, while men and women known to like same-sex relationships have long been showered with insulting names like perverts, degenerates, dissolute persons, etc. and submitted to prolonged, arduous courses of treatment to be “delivered from that evil”. Most were essentially useless, since as we all know both homo- and bisexuality are a natural thing that define an individual’s identity and sexual orientation, which can’t be just “snatched” from them as if by magic to change their orientation from gay to straight, the only “legal” sexual behavior accepted by religions, countries, and mainstream morality.

For all the literature in support of homosexuality and the fact that in countries like Spain civil gay marriage is now legal, there’s still a long way to go before lesbianism is accepted by socio-cultural thought.

Self-acceptance

Many lesbians have a complex about being so, but they must understand that in order to be accepted by others they have to start by accepting themselves. Granted, coming to terms with such orientation and having a same-sex relationship in plain sight is not exactly easy, let alone comfortable. Women have a tendency to hold other people’s views in very high regard and use it as a yardstick of their own self-esteem. This makes it a lot harder for lesbians than for homosexual men to come out of the closet in front of the whole society.

There are many different kinds of fear involved, especially when the female is no longer a girl taking her first steps in life but a married woman with children and parents still clung to the unshakeable moral traditions of the old days. This is the case of Adelaida, a desperate woman from Villa Clara province who sent me a long e-mail and, right away, wrote to me again begging me to never, ever disclose her real identity. Let’s take a look at her tragic predicament:

We went from being friends to lovers almost without realizing it. We had met at work several years before, and we soon became really close friends. For a long time I had to control myself to avoid taking the following step, until one day when the gate that I had worked so hard to keep shut between us suddenly started to open. I knew what it meant to cross the line, since as a teenager I had experienced erotic moments with other girls my age, and I really loved it, yes, and my  memories of it consist of equal parts fear and delight.

I also made sure to behave like a straight person, making a mental note of what was “bad” or “wrong” things about women who like women –the “abnormal”– and learning how to find the opposite sex attractive –the “normal” way. For the sake of our sex code, I engraved on my mind everything about heterosexuality, which is all around us since we first open our eyes to the world: at home, at school, at church, in the neighborhood, on TV, on the streets, everywhere and at all times of our life.

As a teenager I had the gall to be a transgressor, but I was scared, so scared that after a while I decided to hide my fire deep inside. It’s been 20 years since those youthful experiences, but now I’m overcome with fear all over again. I’m secretly enjoying the most passionate love I’ve ever had, but after the ecstasy, when I’m back home serving dinner, I shudder at the mere thought that my family could even imagine that I’m leading a double life.

For fear of being discovered I’ve said to myself a thousand times that I won’t do it again; I’ll find another job and move with my family to another city where they can’t be harmed by the rumors that always start to go around and spread in these cases. But it’s no use: I keep going back time and time again, my strength gone with the wind, because I always end up realizing that my love for that woman is what keeps me alive, and giving it up would make me fade away. But then again, I have to stop at any price. My life would definitely be over if my family, my children, my parents find out who I really am. What can I do to get this over with?

The problem facing gays and lesbians is precisely that their orientation won’t give them any respite or cut them any slack, as our societies remain too strict with those who wear their heart on their sleeve openly and free from any outside interference.

We’re aware that coming out of the closet is complicated to Adelaida, because such a decision is not only about coming to terms with our own desires, it often involves our beloved ones as well. This is maybe the reason why no studies have been made of middle-age lesbians.

It’s a very serious problem, even if the scientific community recognizes that homosexuality is completely valid and its essence is the object of discussion and research. Generally speaking, we heterosexuals are curious about homosexual behavior, but as such we believe it’s thanks to us that the world revolves around the sun and thus never search for answers about the root of our sexual orientation, identity and practices.

In the meantime, there’s a guilt-ridden lesbian struggling with her feelings in a silent world she won’t dare to share, unable to understand why she’s like that and why she likes women, and to whom no one has ever explained whether homosexuality is something you learn, inherit, or are born with.

Although Judeo-Christian religion already answered these questions centuries ago when they called it contrary to natural law and therefore impossible to tolerate, both medical and social science are still working with dedication to find a cause. In this debate about the origin of homosexuality, most views tend to favor heredity over learning, or a combination thereof,

Lesbian health

While no one can tell for sure whether homosexual women have to deal with more pros than cons, what’s certain is that they have the right to get quality healthcare, which can only be possible insofar as all medical institutions can promote it without regard for the patient’s sexual orientation.

However, those women won’t dare to come out of their own closet to get medical help for fear of hostility toward them from an environment ultimately turned into a barrier they can’t or feel unable to overcome. Be that as it may, their sexual and reproductive health goes unattended and becomes therefore compromised,

There’s still another closet that makes these women’s problem all the more difficult to cope with: their own one, i.e., the one they build around themselves by refusing to acknowledge their same-sex feelings and desire and strive to choke them back, a decision for which they pay dearly in terms of physical and mental health, social integration and personal development, the usual outcome of any urge-repressing effort.

Even a woman who has come to terms with her homosexuality could find herself forced into a closet situation by family, neighbors, friends, school or workplace, so sometimes staying in the closet proves an effective response to a homophobic milieu where their life and welfare are often at risk.

Prejudice stands out as the prime reason for the existence of these closets where many women have to scrape together an existence, yet some adult, economically self-sufficient women who may have no qualms about it choose instead to stay in for fear of losing their status, insecurity, shame and other reasons, regardless of the personal cost they have to pay for it.

Among the thousands of letters that women have sent me over the years during the course of my professional responsibilities, those written by lesbians can be counted on the fingers of one hand. Overwhelmed by degrading conventionalities that humiliate them as individuals, they find it hard to relate with and get to know one another, to the point that many of them are scared to be near homosexual hangouts. What few studies have been made on the subject have it that when they find a partner they tend to be faithful and keep the same partner for years. Bottom line: they are less promiscuous than gay men.

Many won’t even disclose their orientation with their closest friends, surrounding themselves instead with an aura of secrecy as if they were doing something wrong.

Dr. Ada Alfonso, a psychiatrist whose patients are women with sexual problems, told me that while reviewing some OB-GYN publications, she found some articles about gynecological care for lesbians. Until then she had never stopped to consider the need to make any distinction among female patients on the basis of their sexual orientation. Only long after that, when she specialized in female sexuality and became a trainer of primary health care professionals, did she realize there was a huge lack of information on every respect of female homosexuality and, particularly, on lesbian health issues.

On the other hand, lesbians are said to have higher risks of acquiring breast cancer than heterosexual women as they are less likely to get pregnant. We must stress that certain hormones released during pregnancy have a preventive effect on breast cancer. Likewise, factors that add to risk of breast cancer include obesity, smoking and drinking, all of which are more prevalent in lesbians, according to medical professionals.

As to cervical cancer, studies show that many lesbians are not screened regularly with pap smears, a test also useful to check for STDs like HPV –Human Papilloma Virus– which are communicable between women. However, the chief risk factor is the lack of regular consultations, a major obstacle to early detection and a longer life expectancy, considering that the HPV lesions can be treated and removed by microsurgery.

Lesbian organizations in the U.S. also point to other important risk factors, namely:

Many self-identified lesbians neglect to seek medical consultation due to their hesitancy to disclose sexual and emotional histories accurately to a physician.

Detecting cancer at early stages is more difficult because lesbians require no birth control or prenatal medical care and are therefore less likely to seek consultation with a gynecologist than heterosexual women.

They have less economic resources because as a rule their salaries are lower than men’s and they are denied their partner’s social security benefits.

Despite the fact that lesbians are not included in a category of frequency of HIV transmission, most lesbian organizations related to these issues disagree, holding that more research is needed on sexual contact between women and the risk of getting AIDS thereby. (Find further details about this topic in Chapter 7, Women who have sex with other women). Nor have diseases like gonorrhea, syphilis and fungous infections like vulvitis, vaginitis, cervicitis and monoliasis, among others that women can get through same-sex relationships, been sufficiently studied.

Prejudice and inhibition among the gynecologists themselves can lead to wrong diagnosis and treatment, insensitive and tactless questions, and sexist comments. What follows is a list of some prevailing myths:

Lesbians don’t have sexual relations.

Lesbians don’t have sex with men.

Lesbians are not at risk of getting an STD, including HIV.

Lesbians have no intercourse and, therefore, don’t need to be screened with pap smears as frequently as heterosexual women.

Add to these prejudices the fact that physicians and psychologists pay little or no attention to this topic and, consequently, hardly any serious and thorough research about lesbian health is ever undertaken, which definitely ties the hands of medical doctors, however unbiased they may be. Things have reached such extremes that a high number of lesbians think they’re either less at risk of getting an STD or less in need of gynecological care because of the kind of sex they practice. That only if there’s vaginal penetration can a woman be said to be having sex is a widespread misconception that many lesbians have grown to believe.

In spite of many years of specialization in the field of female sexuality, I was no less surprised than my friend the psychiatrist Ada Alfonso at how many diverse issues a homosexual woman can relate to. Only a fool never changes their mind, as the old saying goes, so it’s not by chance that I devote so much space in this chapter to this matter, both to make it better known and to do it justice by making my readers aware that it has been kept in the dark long enough and it’s about time we bring it to light, the sooner to blow the lid off a situation which is so common in our region in general and in Cuba in particular and of which most straight women have been silently complicit with.

Regardless of so much taboo subjects, prejudice and stereotyping, this issue is gradually coming to the fore in our country as more and more spaces spring up for reflection on and interchange about people’s freedom of choice when it comes to their sexual orientation.

Right in the middle of the maelstrom is CENESEX (Cuba’s National Center for Sex Education), from where strategies are devised at academic, medical, social and political level to make our society ever more inclusive and less discriminatory.

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(Excerpts from Chapter 7: HIV/AIDS: TOO MUCH SILENCE)

WOMEN WHO HAVE SEX WITH WOMEN

Very little is said about the risk that both lesbians and women who have sex with women (WSW) run of becoming infected with an STD, including HIV/AIDS, the incidence of which as a result of a same-sex relationship is almost nonexistent. Maybe that’s why there’s almost no statistical information available worldwide and so many scholars barely dabble in the subject.

By way of reference we can mention a U.S.-based study of over a million female blood donors with not one case of HIV infection, even if a high percentage of them had had sex with other women. However, much as these results prove that HIV infection is very low among WSW, the possibility cannot be ruled out, as the risk of getting the disease could go disregarded when a woman leads a different behavior.

Let’s bear in mind that women are usually brought up to keep their private matters to themselves and be very discreet even with their doctors, lest they reveal their lesbianism or an occasional same-sex attraction. On the other hand, very few of them ever share their sex toys without covering them with a new condom for each person, forgetting that otherwise such devices could pass an infected woman’s vaginal fluids on to a healthy one.

Other international studies have it that some WSW groups have increased risk of becoming infected because they take drugs intravenously and have unprotected sex with male homosexuals, bisexuals or drug addicts.

What can WSW do to reduce the risk of getting HIV or any other STD? Although the rate of woman-to-woman STD infection is rather low, as we said before, it can still happen, which means that a same-sex relationship must be considered a possible source of infection and women should therefore get acquainted with the following safer sex recommendations published in the Mexican website Letraese:

Exposure of the mucous membranes (e.g., the mouth and, especially, damaged tissues) to vaginal secretions and menstrual blood is a potential source of infection, mainly in early- and late-stage HIV disease, when the viral load in blood is at its highest.

Condoms should always be properly used during sex with a man or when a sex toy is involved. Sharing sex toys can be risky. While no barrier method has been held by the scientific community as effective for same-sex relationships, the use of a cut-open condom or a plastic wrap during oral sex is likely to provide some degree of protection against contact with bodily fluids and therefore reduce the risk of getting HIV or another STD.

It’s important to know our partner’s condition as well as our own regarding HIV, as this knowledge can help a healthy woman change her behavior and thus reduce the risk of becoming infected and an infected woman can get the treatment she needs at an early stage and avoid transmitting the disease to other people.

Individual behavior is not necessarily attached to sexual orientation. We must not lose sight of the fact that many WSW also have sex with men, be they a husband or a steady male partner. Besides, a significant number of women who self-identify as lesbians change partners –not unlike any heterosexual female– and are thus at higher risk of getting HIV by having unprotected sex with men.

MEN WHO HAVE SEX WITH MEN

I said earlier that not all men who have sex with men (MSM) are gay, as plenty of people mistakenly believe. A high number of these men have a wife, a family and heterosexual habits, and they set out to have an affair with another man once in a while. There are those who are bisexual and have a male and a female partner, and also those whose sexual partner is now a woman and then a man. In short, we’re talking about a motley collection of possible relationships.

Not long ago I heard someone saying, in specific reference to fully straight males, that there’s hardly any “pure” man left. I disagree, for there’s a little of everything in the house of God. What seems obvious to me is that more and more men decide to experiment, at least once, what is like to have a same-sex relationship.

In my view, this is neither good and normal nor bad and abnormal, but a healthy and positive thing to do as long as we do it of our own volition, with protection, and without causing any harm to anyone.

Leonardo Chacón, a researcher in Havana who has delved into this topic, led a team of his peers to inquire into risky sexual behavior among MSM in some areas of our capital city, the reasons why they engage themselves in such at-risk sexual activity, what makes them reluctant to wear condoms, and where they get their information about HIV/AIDS and STD prevention.

Since it’s hard to ascertain a person’s sexual orientation at first sight –let alone expect that they will volunteer such information by themselves, and to a complete stranger at that– the team had to work in public places frequented by MSM not only from nearby neighborhoods but from all over the city. Accordingly, they conducted the survey in the municipalities Plaza de la Revolución, La Habana Vieja, Centro Habana and Habana del Este, where they polled 275 MSM who pledged to tell the truth for the sake of reliability.

Let’s see the figures: 4.9% were HIV seropositive and 67.4% HIV seronegative, while 27.7% said they didn’t know. That there’s a high incidence of HIV carriers among the interviewees as compared to the general population in Havana is plain to see from these numbers.

Besides, the fact that a third of them are unaware of their condition is a remarkable finding, inasmuch as these are at-risk males unconcerned about their status as likely carriers.

Most youths between the ages of 15 to 25 have never tested for HIV, and those who have didn’t do it until very recently. Some of the former realize the risk they’re taking but choose not to have their blood tested because they prefer “not to know”. It’s obvious in these cases that they’re not prepared to deal with potential problems.

Around 84.2% of those polled have had unsafe sex at some point, whereas 52.4% hold they’ve had one or more sexual relations without a condom in the last year.

These males are walking “time bombs”: many of them have never had a cell count and others have been tested either too recently or at a hardly reliable time, and yet it’s their custom to get involved in risky sexual activities, which could get them infected and likely to infect other people.

No significant statistical difference was found between the subjects’ age and their risk factor, although a slight reduction was noticed in the 26 to 35 age group.

In the final report the team reaches a key conclusion: taking into account the high HIV prevalence among MSM and their exposure to HIV infection through anal sex practices, a man who have sex with men is more at risk than an exclusively straight male.

According to those polled, the most frequent low-risk sexual practices are:

Kissing (75.3%)
Masturbation (70.3%)
Caressing (68.1%)
Ejaculation on the partner’s body (52.9%)
Penetrate with a condom (47.5%)
Being penetrated with a condom (36.1%)
They mentioned the following as high-risk behavior:
Unprotected oral sex (47.5%)
Penetration without a condom (22.1%)
Receiving the partner’s semen in the anus (17.1%)
Receiving the partner’s semen in the mouth (16.0%)

Reasons why they have unprotected sex:

I have a steady partner (26.2%)
I’m sure my partner is seronegative (25.6%)
My partner looks healthy (22.8%)
I don’t like to wear a condom (17.6%)
I don’t have condoms (17.6%)
The person I have unprotected sex with has a steady partner (16.0%)
I’m usually drunk when I do it (15.3%)
The person I have unprotected sex with claims to be healthy (14.8%)
The person I have unprotected sex with tested negative for HIV (14.4%)
My partner refuses to wear a condom (10.7%)

Their status ranges from having had no partner in the six months prior to the survey to an undetermined number of up to 20 or more partners, while most have had between one and three partners in that period. However, those who claim to have either low-risk or risk-free sexual relations are the ones with the highest number of sex partners.

This interesting –and timely– research about MSM in Havana highlights the need to keep insisting that they practice responsible sexual conduct, as it also reveals that those who have a steady partner engage in as much risky sexual behavior as those who don’t.

The results produced also provide several starting points to step up the efforts to design specific campaigns for this social group, since it’s patently obvious that the general ones that involve homosexuals and heterosexuals alike have not been fully effective to raise awareness in the MSM community. Many of them self-identify as neither gay nor straight, while others see themselves as bisexual. Nevertheless, the nub of the matter is not what they feel to be, but the way they should take care of their sexual and reproductive health and that of other people instead of devoting themselves to habits that leave a lot to be desired.

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