Before the influence of European sexology emerged at the turn of the twentieth-century, in cultural terms female homosexuality remained almost invisible as compared to male homosexuality, which was subject to the law and thus more regulated and reported by the press. However with the publication of works by sexologists like Karl Heinrich Ulrichs, Richard von Krafft-Ebing, Havelock Ellis, Edward Carpenter and Magnus Hirschfeld, the concept of active female homosexuality became better known.
As female homosexuality became more visible, it was described as a medical condition. In Three Essays on the Theory of Sexuality (1905), Sigmund Freud referred to female homosexuality as inversion or inverts and characterised female inverts as possessing male characteristics. Freud drew on the "third sex" ideas popularized by Magnus Hirschfeld and others. While Freud admitted he had not personally studied any such "aberrant" patients, he placed a strong emphasis on psychological, rather than biological, causes. Freud's writings did not become well-known in English-speaking countries until the late 1920s.
This combination of sexology and psychoanalysis eventually had a lasting impact on the general tone of most lesbian cultural productions. A notable example is the 1928 novel The Well of Loneliness by Radclyffe Hall, in which these sexologists are mentioned along with the term invert, which later fell out of favour in common usage. Freud's interpretation of lesbian behavior has since been rejected by most psychiatrists and scholars, although recent biological research is now providing some findings that may bolster a Hirschfeld-ian "third sex" understanding of same-sex attraction.
During the twentieth century, lesbians such as Gertrude Stein and Barbara Hammer were noted in the US avant-garde art movements, along with figures such as Leontine Sagan in German pre-war cinema. Since the 1890s, the underground classic The Songs of Bilitis had been influential on lesbian culture, and this book provided a name for the first campaigning and cultural organisation in the United States, the Daughters of Bilitis.
During the 1950s and 1960s, there was a rise in lesbian pulp fiction in the US and UK, many of which carried "coded" titles such as Odd Girl Out, The Evil Friendship by Vin Packer and the Beebo Brinker-series by Ann Bannon. British school stories also provided a haven for "coded", and sometimes outright, lesbian fiction.
During the 1970s, the second wave of feminist era lesbian novels became more politically oriented, works often carried the explicit ideological messages of separatist feminism, and the trend carried over to other lesbian arts. Rita Mae Brown's debut novel Rubyfruit Jungle was a milestone of this period. By the early 1990s, lesbian culture was influenced by a younger generation who had not taken part in the "Feminist Sex Wars", which strongly informed post-feminist queer theory and the new queer culture.
Since the 1980s, lesbians have been increasingly visible in mainstream culture: in music (Melissa Etheridge, K.D. Lang and the Indigo Girls), in sports (Martina Navrátilová), and in comic books (Alison Bechdel and Diane DiMassa). More recently, lesbian homoeroticism has flowered in fine art photography and the writing of authors such as Pat Califia, Jeanette Winterson and Sarah Waters. There is an increasing body of lesbian films such as Desert Hearts, Go Fish, Watermelon Woman, Oranges Are Not The Only Fruit, Everything Relative and Better than Chocolate (See List of lesbian, gay, bisexual or transgender-related films.) Classic novels such as those by Jane Rule have been reprinted.