For many adult women, health care revolves around the need for contraception. In many ways, the American medical establishment is designed around this accepted fact. Women frequently get their primary care through OB/GYNs and similar practitioners, who provide not only gynecological services but also regular health screening exams. Women who don't need contraception, either because of age, sexual orientation, or other lifestyle issues, are less likely to take advantage of recommended preventative care. In some cases, this can be life threatening. Lack of regular pap smears among lesbians and older women has been implicated in their increased risk of dying from cervical cancer.
Lesbians may also have other barriers to dealing with the mainstream medical system. Even if they do use traditional health care, they may feel uncomfortable disclosing their sexuality to doctors if they fear they will be judged. Lack of ability to discuss sexual health, however, may impact other areas of a woman's life. When you shut the door on talking about something as essential as sexuality, you also lose the opportunity to talk about many other health issues.
It can be difficult for any woman to discuss sexual health issues with her doctor. It is often easiest when they simply need to answer direct questions, but these questions may not be relevant to lesbians and other women who have sex with women (WSW). For example, a doctor might ask "How many men have you had sex with this year?" or "Do you use condoms every time you have intercourse?" and neither question would give an accurate picture of a WSW's sexual history. This, combined with a fear of prejudice that can be intensified by these heterosexist assumptions, may make lesbians reluctant to discuss their sexual history with a physician. Even, or perhaps particularly, when that sexual history occasionally includes men.
However, sleeping with a man is not the only risk factor for sexually transmitted diseases. A number of STDs can also be transmitted from woman to woman. A higher number of female partners has been associated with increased risk of bacterial vaginosis, herpes, and HPV in various studies. There is evidence that lesbian sex can transmit trichomoniasis and hepatitis. Furthermore, in 2014 the CDC found convincing evidence of the transmission of HIV within a serodiscordant lesbian couple who had engaged in high-risk sex practices with each other.
The risk of STD transmission between women is compounded by the fact that many lesbians and bisexual women consider sex between women to be a low-risk activity and so do not practice safer sex.
Lesbian safer sex is not an oxymoron. There are ways to improve the safety of most, if not all, sexual activity that takes place between women. The mechanics of many safer sex acts between women are the same as those for many other types of couples and include:
- Using barriers, such as dental dams, saran wrap, or slit open condoms, for oral-vaginal and oral-anal contact.
- Using gloves when inserting fingers into the vagina or rectum.
- Washing hands well, including under the fingernails before having sex - even if gloves are going to be used.
- Cleaning sex toys before use
- Putting condoms on insertable sex toys and changing the condom for each partner.
Note: Condoms should also be changed when moving a toy from the vagina to the rectum or vice versa.
Additionally, it is worth mentioning that many women who identify as lesbians have had sex with a man at least once in their lives. For various reasons, women who identify as lesbians are less likely to use protection during sexual encounters with men. This increases the risk of disease transmission at each encounter, as does the fact that many lesbians' male sexual partners, when they have them, tend to be at higher risk than the partners of heterosexual women.
Chan, S. et al. "Likely Female-to-Female Sexual Transmission of HIV — Texas, 2012" Morbidity and Mortality Weekly Reports. 2014, March 14; 63(10):209-212
Lindley, LL; Barnett, CL.; Brandt, HM.; Hardin, JW, and Burcin, M. "STDs among sexually active female college students: does sexual orientation make a difference?" Perspect Sex Reprod Health. 2008 Dec; 40(4):212-7.
Marrazzo, JM; Coffey, P; and Bingham, A. "Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women." Perspect Sex Reprod Health. 2005 Mar; 37(1):6-12.
McNair R. "Risks and prevention of sexually transmissible infections among women who have sex with women." Sex Health. 2005;2(4):209-17.
Muzny, CA.; Sunesara, IR; Martin, DH, and Mena, LA. "Sexually transmitted infections and risk behaviors among African American women who have sex with women: does sex with men make a difference?" Sex Transm Dis. 2011 Dec; 38(12):1118-25.
Roberts SJ. "Health care recommendations for lesbian women." J Obstet Gynecol Neonatal Nurs. 2006 Sep-Oct;35(5):583-91.