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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.

The development of medical knowledge was a significant factor in further connotations of the term lesbian.

In the middle of the 19th century, medical writers attempted to establish ways to identify male homosexuality, which was considered a significant social problem in most Western societies.

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.

In Algernon Charles Swinburne's 1866 poem Sapphics the term "lesbian" appears twice but capitalized both times after twice mentioning the island of Lesbos, and so could be construed to mean 'from the island of Lesbos'.

In 1875, George Saintsbury, in writing about Baudelaire's poetry refers to his "Lesbian studies" in which he includes his poem about "the passion of Delphine" which is a poem simply about love between two women which does not mention the island of Lesbos, though the other poem alluded to, entitled "Lesbos", does.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 categorizing behavior that indicated what was referred to as "inversion" by German sexologist Magnus Hirschfeld, researchers categorized what was normal sexual behavior for men and women, and therefore to what extent men and women varied from the "perfect male sexual type" and the "perfect female sexual type".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.Invert described the opposite gender roles, and also the related attraction to women instead of men; since women in the Victorian period were considered unable to initiate sexual encounters, women who did so with other women were thought of as possessing masculine sexual desires.

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