Generally, sexual minority women (SMW) are at low risk of HIV infection, unplanned pregnancy, or becoming infected an STI. However, even with a reduced risk, transmission can still occur. Therefore, SMW need to know the risks and how to protect themselves and learn more about safer sex practices.

Prevalence: There is very little known about STI transmission among SMW due to the very few and sporadic research studies done on sexual practices and STI transmission in the SMW population. Our sex lives are also often ignored in mainstream culture and often our sex is not consiered "real sex," contributing further to the lack of information available about the pleasure or risk associated with our sexual practices and expressions. But the reality is that any sexual activity is not without risk - and your sexual health and safety has everything to do with what you do and how you do it.

Studies have proven that STI transmission is possible in SMW populations, with human papilloma virus (HPV), Herpes Simplex I & II (HSV-I, HSV-II), and syphilis being the most common STIs transmitted as they require only skin-to-skin or mucosa contact which can easily occur in the context of common sexual activity. Other STIs, including HIV and bacterial vaginosis, have been diagnosed in SMW.

Safe(r) Sex: ‘Safe sex’ is any activity through which you are at no risk of becoming infected with a sexually transmitted infection (STI); which is different from safer sex practices which provide you lowered risk for STIs by using barriers.

So, safe sex is sex that doesn’t allow any infected body fluid to enter your body – and doesn’t allow you to infect your partner, either. Activities that are safe include hugging, touch, massage, and masturbation. Safer sex is sex that involves using barriers for any other sexual activity including using sex toys, oral sex, fingering and other penetrative sexual activity.

Sex toys are fine, too – just put a condom over them, and if you switch from one person’s body to another then change the condom. You can also use dental dams for oral sex (gloves or condoms cut flat or plastic wrap can also be used), gloves for manual penetration, and condoms for sex toys or penile-vaginal intercourse. Non-latex materials are also available.

Other Sexually Transmitted Infections (STIs or STDs)

Although we have seen that lesbian and bisexual women are at low risk of getting HIV from sex with another woman, many other sexually transmitted infections - such as herpes or thrush - are just as common for lesbians as for women who have sex with men.

• Thrush is an overgrowth of yeast causing vaginal itching and soreness, often with a white discharge. It is possibly passed via sex between women, though oral sex is low risk.
• Bacterial Vaginosis/BV or Gardnerella is an overgrowth of vaginal bacteria causing a smelly discharge, which lesbians often experience. There is a possible link with perfumed soaps and bath oils.
• Genital Warts are painless bumps on the vulva, in the vagina, on the cervix or round the anus. They can be passed through contact with the wart, for example by touching, rubbing or sharing sex toys. It is unlikely non-genital warts, such as on hands, can be transferred to the genitals.
• Trichomonas vaginalis (TV) gives a frothy, itchy vaginal discharge and is passed on by contact with the vagina only, for example by touching or sharing sex toys.
• Herpes can cause painful sores on the inside of the vulva/vagina or anus (these are genital herpes) or on the mouth (cold sores). Herpes can be passed on through contact with a sore, for example by touching, fondling or sharing sex toys. Oral sex when a cold sore is present can also transmit the virus. It can be possible to have the herpes virus, be infectious and yet never have had any symptoms.
• Crabs/Pubic Lice cling to pubic and other body hair causing itching and sometimes blood spots from bites. They are spread through naked body/skin contact.
• Chlamydia and Gonorrhea are rare in lesbians but if they are present may be passed on through sharing sex toys or rubbing vulvas together. Often there are no symptoms, though there may be a discharge. The first sign of both infections may be pain in the pelvic region (pelvic inflammatory disease or PID). There is a risk of infertility for women who have had untreated chlamydia.
• Syphilis is very infectious and close skin contact during sex can pass it on.
• Hepatitis B is a viral infection that in its most infectious forms can easily be passed on in sex - for example by touching or sharing sex toys. There are often no symptoms, though it can cause jaundice (yellow skin) or nausea.

Last updated Nov 2009

References:

JM Marrazzo. Barriers to Infectious Disease Care among Lesbians. http://www.cdc.gov/ncidod/EID/vol10no11/04-0467.htm