Women in many cultures throughout history have had sexual relations with other women, but they rarely were designated as part of a group of people based on whom they had physical relations with.
As women have generally been political minorities in Western cultures, the added medical designation of homosexuality has been cause for the development of a subcultural identity.
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 the absence of any other material to describe their emotions, homosexuals accepted the designation of different or perverted, and used their outlaw status to form social circles in Paris and Berlin.
Lesbian began to describe elements of a subculture.
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.
Because of society's reluctance to admit that lesbians exist, a high degree of certainty is expected before historians or biographers are allowed to use the label.
Evidence that would suffice in any other situation is inadequate here... What our critics want is incontrovertible evidence of sexual activity between women. Female sexuality is often not adequately represented in texts and documents.
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".
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In 1890, the term lesbian was used in a medical dictionary as an adjective to describe tribadism (as "lesbian love").