(as distinct from sexual health) can be defined as the ability to have or not have children at a time and with a partner of one’s choosing. A few studies based on small, nonrepresentative samples suggest that pregnancy loss may be particularly difficult for lesbian women (Peel, 2010; Wojnar, 2007) and that lesbian and bisexual women may be at higher risk than heterosexual women for postpartum depression (Ross et al., 2007; see also Trettin et al., 2006). Among transgender individuals, hormone therapy may have an effect on fertility, although little research has been conducted on the reproductive health needs of this population.

Little research exists on patterns of motherhood or access to assisted reproductive technology among sexual-minority women. The American Society for Reproductive Medicine explicitly states that programs should treat all requests for assisted reproduction equally without regard to marital status or sexual orientation, and the American College of Obstetricians and Gynecologists states that sexual orientation should not be a barrier to fertility services for achieving pregnancy (American College of Obstetricians and Gynecologists, 2005; Ethics Committee of the American Society for Reproductive Medicine, 2009). In a study examining 2,431 self-identified lesbians and bisexual women and the coming out process, Morris and colleagues (2002) found that younger mothers were more likely than older mothers (those over 50) to have used nontraditional methods to conceive (e.g., donor insemination). They also found that, compared with mothers who had children before coming out, mothers who had children after coming out were more likely to have done so through insemination by a donor, through adoption, or through foster placement.

Unfortunately, many areas of reproductive health among LGBT adults remain entirely unstudied. These include the effects of hormone therapy on the fertility of transgender individuals and its implications for family planning in terms of both contraception and reproductive options (De Sutter, 2001, 2009). A survey of an international convenience sample of 121 transgender women demonstrated the desire for gamete banking prior to the onset of hormone therapy to allow for future insemination (De Sutter et al., 2002).

Cancer

The most comprehensive repository for cancer statistics in the United States is the National Cancer Institute’s Surveillance Epidemiology and End Results database. Information is collected on incidence, prevalence, and survival for specific geographic areas, and mortality data are collected for the entire country. Demographic data, including age, race/ethnicity, sex, education, income, and geographic location also are collected. However, no data are collected on sexual orientation and gender identity, making it



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