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As a result, little in history was documented to give an accurate description of how female homosexuality is expressed.
Far less literature focused on female homosexual behavior than on male homosexuality, as medical professionals did not consider it a significant problem. However, sexologists Richard von Krafft-Ebing from Germany, and Britain's Havelock Ellis wrote some of the earliest and more enduring categorizations of female same-sex attraction, approaching it as a form of insanity.Krafft-Ebing, who considered lesbianism (what he termed "Uranism") a neurological disease, and Ellis, who was influenced by Krafft-Ebing's writings, disagreed about whether sexual inversion was generally a lifelong condition.Ellis believed that many women who professed love for other women changed their feelings about such relationships after they had experienced marriage and a "practical life".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.However, Ellis conceded that there were "true inverts" who would spend their lives pursuing erotic relationships with women.
These were members of the "third sex" who rejected the roles of women to be subservient, feminine, and domestic.
In 1890, the term lesbian was used in a medical dictionary as an adjective to describe tribadism (as "lesbian love").
The terms lesbian, invert and homosexual were interchangeable with sapphist and sapphism around the turn of the 20th century.
Little of Sappho's poetry survives, but her remaining poetry reflects the topics she wrote about: women's daily lives, their relationships, and rituals.
She focused on the beauty of women and proclaimed her love for girls.
The development of medical knowledge was a significant factor in further connotations of the term lesbian.