College of Liberal Arts & Social Sciences Theses and Dissertations

Graduation Date


Document Type


Department/Program Conferring Degree

Public Service Management


sexual healthcare services, WSW, sexual identity and behavior, lesbian, risk


Variable inconsistencies and conflicting theories on female sexual orientation compromise women’s sexual health research. Subsequently, health risks associated with female-to-female sex play are largely unknown and providers continue framing services for sexual identities. The study’s focus was first, to establish whether discordance between sexual behavior and identity among women who have sex with women (WSW) correlates with risky sexual behaviors and then, to explore healthcare providers’ and practitioners’ methods for addressing the intersection of patients’ sexual identity and reported behaviors. After WSW sexual health-related response outcomes from a NYC Community Health Survey sample were assessed, practitioners from three providers were interviewed on best practices. Quantitative research revealed associations between incongruent identity-behavior and high-risk behaviors, while qualitative research found four themes in optimal patient care (avoid assumptions, communicate confidentiality, inclusive language, let the client lead). Observations of sexual discordance among WSW strengthen the case against identity-based healthcare, while shared tactics between providers set a standard for prompting WSW patient satisfaction.