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For Lesbian and Bisexual Women

For Clinicians and Health Educators

  • Lesbian and Bisexual Womens' Health (CDC)
  • 10 Things Lesbians Should Discuss With Their Healthcare Provider (GLMA)
  • Recent studies indicate that some women who have sex with women (WSW), particularly adolescents, young women, and women with both male and female partners, might be at increased risk for sexually transmitted infections (STIs), including HIV, as a result of certain reported risk behaviors. WSW are at risk for acquiring bacterial, viral, and protozoal infections from current and prior partners, both male and female. WSW should not be presumed to be at low or no risk for STIs based on sexual orientation. Effective screening requires that providers and their female clients engage in a comprehensive and open discussion not only about sexual identify, but sexual and behavioral risks.
  • Key sexual health risks
    • Lesbians and bisexual women can get the same STIs as heterosexual women. Lesbians can give each other STIs by skin-to-skin contact, mucus membrane contact, vaginal fluids, and menstrual blood. It is important for sexually active women who have sex with women to be screened for STIs by a health care provider.
    • Human Papilloma Virus (HPV) transmission from skin to skin or skin to mucosa contact is largely preventable with HPV vaccine. HPV has been detected among 13-30% of WSW, including women who report no previous sex with men. Pap tests at the appropriate frequency for individuals with a cervix should be offered, regardless of sexual orientation or gender.
    • Bacterial vaginosis (BV) is common among women, and more so for WSW. Transmission of vaginal fluid and microbes between partners might be the cause of BV, though these may not be routinely identified as an STI. Routine screening and sexual partner treatment for BV are not recommended. Best practice is to encourage awareness of BV and promote safer sex practices that mitigate transmission of BV, such as cleaning sex toys between usage.
    • Genital infection with herpes simplex virus type 1 (HSV-1) is higher risk among WSW, due to relatively frequent practice of oral sex. Inform women about risk of HSV-1 transmission if partner has a cold sore and the importance of abstaining when a sore is present, and how to use dental dams for safer sex.
    • Chlamydia rates among WSW are largely unknown, but infection can be acquired from past or current male partners. Same sex behavior should not deter providers from screening for sexually transmitted infections.
    • Syphilis transmission between female sex partners has been reported, most likely through oral sex. Same sex behavior should not deter providers from screening for sexually transmitted infections.
  • Sexual practices and safer sex guidance
    • For oral-genital or oral-anal sex, use "dental dams"
    • For hand sex (using fingers or hands on vulva, vagina, or anus), use latex or non-latex gloves and water-based or silicone-based lubricant
    • For internal or external sex toys: If sharing between partners, use a condom for barrier protection. If using without barrier, clean after each use with warm soapy water and air dry. For stainless steel or medical grade silicone, boiling water can be used to clean. Do not use silicone lubricant with silicone toys.
    • Factsheet - Understanding Sexual Orientation and Sexual Idenity (NMCPHC)
    • Tips for Clinicians:
      • Acknowledge and overcome heteronormative bias.
      • When taking sa exual history, ask each patient “Do you have sex with men, women, or both?” Do not assume the patient is straight.
      • Provide appropriate safer sex guidance and testing based on their sexual anatomy, orientation and gender identity.

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