Women in homosexual relationships responded to this designation either by hiding their personal lives or accepting the label of outcast and creating a subculture and identity that developed in Europe and the United States. Following World War II, during a period of social repression when governments actively persecuted homosexuals, women developed networks to socialize with and educate each other. Greater economic and social freedom allowed them gradually to be able to determine how they could form relationships and families. With second wave feminism and growth of scholarship in women's history and sexuality in the 20th century, the definition of lesbian broadened, sparking a debate about sexual desire as the major component to define what a lesbian is. Some women who engage in same-sex sexual activity may reject not only identifying as lesbians but as bisexual as well, while other women's self-identification as lesbian may not align with their sexual orientation or sexual behavior; sexual identity is not necessarily the same as one's sexual orientation or sexual behavior, due to various reasons, such as the fear of identifying their sexual orientation in a homophobic setting.
Portrayals of lesbians in the media suggest that society at large has been simultaneously intrigued and threatened by women who challenge feminine gender roles, and fascinated and appalled with women who are romantically involved with other women. Women who adopt a lesbian identity share experiences that form an outlook similar to an ethnic identity: as homosexuals, they are unified by the heterosexist discrimination and potential rejection they face from their families, friends, and others as a result of homophobia. As women, they face concerns separate from men. Lesbians may encounter distinct physical or mental health concerns arising from discrimination, prejudice, and minority stress. Political conditions and social attitudes also affect the formation of lesbian relationships and families in open.