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Safer Sex and Sexually Transmitted Disease - STD Prevention for Women who have Sex with Women - WSW

There is a belief among some women and providers that women who have sex with women (WSW) are not at risk for STDs. Nevertheless, many lesbian women experience them. Female to female transmission is possible with some STDs. STDs are more common in lesbian and bi women with a history of heterosexual activity. It is estimated that 8% to 20% of lesbians have or have had same-sex partners exclusively. Sensitive providers inquire about a woman's sexual behavior to determine appropriate STD screenings.

Safer sex and STD prevention are important practices for anyone who is sexually active. Safer sex means learning and practicing behaviors that decrease the chance of contracting or transmitting a disease. Safer sex is negotiated and planned honestly between partners. Those who know and discuss their limitations and expectations are likely to have better, safer sexual experiences. Prevention is possible only if one understands STDs and how they are spread. An understanding of STDs and how they can be prevented leads to safer, healthier sex and general health awareness.

Lesbian Sexual Behavior

STDs Transmission Between Women
The following STDs can be transmitted during sex between women:

  • Anogenital warts (human papillomavirus, HPV; occuring on the anus and vagina; linked with cervical, uterine, anal, and vulvar cancer)
  • Bacterial vaginosis (causes inflammation of vagina, fishy smell)
  • Candida vaginitis (yeast infection; causes irritation and inflammation)
  • Chlamydia (genital bacterial infection; causes discharge and labial irritation; can cause pelvic inflammatory disease (PID) and fertility problems)
  • Genital herpes (viral infection; causes vaginal sores, inflammation, pain, and itching; closely related to herpes infection that can cause oral lesions so may obtain via oral-genital, genital-genital, or genital-anal contact)
  • Hepatitis B and C (viral infection; causes inflammation of the liver)
  • HIV
  • Trichomoniasis (parasite; causes burning, itching, redness, and discharge)
STDs like genital herpes, genital warts, and chlamydia, may be noticeable on the vagina. Others, like candida or trichomoniasis are often not visible but are contagious.

Safer Sex
It is important for partners to discuss their sexual and STD history before having sex. The best means for avoiding STDs is a barrier. Latex gloves and condoms can be used for genital and anal stimulation with the fingers or with sex toys (dildos, vibrators, etc.). Whether or not a glove or condom is used, it is best to start with the vagina and move to the anus, instead of anus to vagina. If anal sex occurs first, it is best to change gloves or condoms or to wash the hands before stimulating the vagina. This will keep the bacteria of the lower intestine away from the vagina. A dental dam (flat, latex barrier), nonmicrowavable plastic wrap, or a condom cut lengthwise and placed over the vagina is advisable for oral-genital sex.

It is advisable to avoid sex when genital herpes or genital warts are active until all lesions have cleared up.

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