Ask anyone in the LGBTQ community about safe sex, STD prevention and risks of HIV/AIDS, and you’ll notice that the conversation usually shifts to gay male-to-male sex.
But what about lesbian safe sex? It’s true that STD rates are significantly lower for women who only sleep with women. But how many lesbians really only sleep with women?
There are no hard numbers. But experts say it may be more common than anecdotal evidence suggests. Because you may not know whether your sexual partner ever has had unprotected sex with a man, it’s better to be safe than sorry.
Women who have slept with men “puts them at risk for STDs,” said Jill Dispenza, Director, HIV/STD Hotline and HIV Testing & Prevention at Chicago’s LGBTQ Center on Halsted. “A lot of the issue, too, is that women who have sex with women, when they do have sex with a man, that partner is usually bisexual or even gay, just because of the circles they’re in—so that can put them at greater risk.”
According to a 2003 study assessing the risk of perception of a sample of self-defined lesbians, “lesbians believe that if they are at no or low-risk for contracting HIV, the benefits of engaging in safer sex practices would be minimal.”
But because behavior of lesbian-identified women varies, a perceived low-risk for HIV infection may actually increase the risk, because women don’t take proper precautions. For example, does your sexual partner engage in unprotected sex with male partners, or have a problem with drugs or alcohol, which might lead to fewer sexual precautions (or HIV transmission, if they use intravenous drugs)? You might not know.
With this knowledge in mind, how can lesbians stay safe? And what STDs are we at risk for?
STDS: Beware!
Because much of lesbian sexual activity involves oral sex, it’s important to know that you can transmit the Human Papilloma Virus (HPV) and herpes orally.
Herpes can be transmitted during oral sex when a cold sore is present, or through contact with a sore, especially through touching, fondling or sharing unprotected sex toys. Get a bloodtype-specific test if you feel that you may have herpes, especially since it’s possible to have the virus, yet never have had any symptoms or an outbreak.
If you have Chlamydia pneumonia in your mouth, there’s also a chance of passing Chlamydia. But unless you have an open sore in your mouth, you’re not going to transmit things like hepatitis B or HIV; they are usually passed through blood or semen.
Lesbians should also be aware of Bacterial Vaginosis/BV or Gardnerella, an overgrowth of vaginal bacteria that can cause a smelly discharge.
But BV is “not technically considered a sexually transmitted disease because it has to do with your natural balance of bacteria within the vaginia, and that can be caused by many things—tampons, douching, things that aren’t sexual,” Dispenza says. “They’ve found that women have the same sort of strain of vaginosis, so they’re thinking they are using sexual practices—that there’s a sexual aspect to it.”
Then there’s Trichomonas Vaginalis (TV), a parasite that can be contracted through sharing wet towels, underwear or sex toys. It produces a frothy, itchy vaginal discharge, and may cause pain during urination; you can treat it using antibiotics.
Risky behaviors
Risky behaviors include sex without the presence of a barrier—such as a dental dam (a sheet of latex placed over the vagina) or a condom—during vaginal-vaginal contact, digital-vaginal and digital-anal contact, oral sex, sharing of sex toys and razors, or sadomasochistic activities that draw blood.
If you’re using sex toys, make sure you cover them with condoms. When sharing the toys—a potential high-risk behavior—never reuse the same condom on both persons. Be aware of any cuts on your fingers or in your mouth; transmission could occur.
Something else that lesbians should be doing is getting regular pap smears—and the Gardasil vaccination, which helps guard against HPV. (Alhough the drug itself is controversial, information from MERCK, the pharmaceutical company that produces it, states that it “is the only vaccine that can help guard you against 4 types of HPV, the virus that can cause cervical cancer and other diseases.” You must be 26-years-old or younger to get the vaccination.
Finding a gynecologist
But in order to get a pap smear or vaccinations of any kind, you’ve got to visit the gynecologist. And because lesbians have different health issues than their heterosexual counterparts, it’s necessary to disclose sexuality-related information. But many lesbians don’t feel comfortable doing so.
In a 2003 article by Patricia A. Robertson, MD, in Contemporary OB/GYN, she states that “most lesbian patients hesitate to reveal their sexual orientation, even though [the healthcare provider] need[s] that information to deliver targeted health care.”
The U.S. 10-year public health plan, released in 2000, agreed, saying that “differences in health status for non-heterosexual women result from negative attitudes and experiences within society and the healthcare system, which in turn influence patterns of health-seeking behavior, health-risk factors and specific health issues.” It specifically recognized sexual orientation as a social determinant of health.
Aside from fear of disclosure, however, many lesbians are also deterred by the high cost of healthcare—and the limited amount of partner benefits available. Staying healthy isn’t as easy as it should be.
“A two-woman household, they just don’t have the income [often, for good healthcare]— and there’s no partner recognition,” Dispenza says. “Households with men usually have a higher income. Two lesbians are at a disadvantage because they’re often being paid less and they’re not able to share healthcare if one of them has it, so that can hinder their ability to get healthcare.”
But even if you don’t have health insurance, there are free, low-cost and sliding scale testing centers. Look for LGBTQ health centers in your city. In New York City, visit the The Lesbian, Gay, Bisexual & Transgender Community Center . San Francisco offers the SF LGBT Community Center , and in Chicago you’ll find the Howard Brown Health Center.
If you’re located outside of a major metropolitan center in, say, Iowa, know that Planned Parenthood is focused on improving their LGBT healthcare options. Use the Planned Parenthood website to find a health center near you.
Another example of rural-focused healthcare exists in upstate New York: In 2006, The Bridge, a rural-focused community center, opened their doors to all LGBT communities and interested citizens.
If you’re looking for an LGBTQ-friendly doctor, check out the Gay and Lesbian Medical Association online.
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