Info for Lesbians and Bisexual Women

There are very few sexual health services specifically for lesbians or bisexual women. Partly, this has been due to the epidemiology of HIV among gay and bisexual men, but it also reflects a wider invisibility of the needs of lesbian/bisexual women in all aspects of health. Some lesbians may feel excluded by the focus of health services on family planning or contraception, or by the assumption that their sexual relationships must be with men. The fact is that lesbians and bisexual women are entitled to the same rights to appropriate and respectful services as anyone else.

While lesbians (and to a lesser extent bisexual women) are generally less likely to be subject to sexual transmitted infections (STIs) and unwanted pregnancies, it does not mean there is always no risk at all. The following section provides information on some of the sexual health issues facing lesbians and bisexual women. If you notice any symptoms you think could be due to an STI, contact your local sexual health service or get in touch with Gay Men's Health if you need advice.

Oral sex

Some STIs can be passed on through oral sex between women. There is a relatively low risk of HIV transmission, but the risk is increased if you have cuts or sores on your mouth, or the person receiving oral sex has sores on her genitals or is having her period. Using dental dams (squares of latex) to stop any vaginal fluid or menstrual blood getting into your mouth reduces the risk. Like condoms, these dams are available in different flavours.

Sex toys

Using sex toys (e.g. vibrators and dildos) plays a major part in the sex lives of many lesbian and bisexual women. Sharing these toys can transfer sexually transmitted infections if they have vaginal fluid, blood or faeces on them. Always clean them well, put condoms on them, or use a toy only on one person. Putting lubricant on sex toys can make them easier to use and result in a more pleasurable sexual experience � make sure the lubricant is water-based if you�re using condoms, Femidoms or dental dams. Lubricant and condoms are available free of charge from Gay Men's Health via our supplies by post service (Wiltshire residents only).

Pregnancy

Lesbians wanting to get pregnant need to think carefully about sperm donors. You may choose someone you know or an anonymous donor from a clinic. It is highly advisable to get thorough health checks before going ahead with any attempted insemination. With self-insemination, remember that a negative HIV test result from a sperm donor does not necessarily eliminate the risk of HIV transmission, due to the period it takes HIV antibodies to show up in a test. It is a far safer option to obtain sperm that has been screened for HIV and other sexually transmitted infections from a clinic.

Thrush

Thrush is an overgrowth of yeast causing vaginal itching and soreness, often with a white discharge. It is possibly passed on through sex between women, though oral sex is considered to be low risk. Thrush can be treated with tablets (called pessaries) inserted into the vagina and a cream.

Bacterial vaginosis (BV)

Bacterial vaginosis is very common and occurs when the bacteria that normally exist in the vagina rapidly multiply, causing a smelly discharge. It may be linked to the use of scented bath oils and soaps. Treatment is with antibiotics and a cream.

Cervical cancer

All women (lesbian, bisexual or heterosexual) between the ages of 20 and 64 need to have cervical smear tests every 3-5 years. This applies even if you have never had sex with a man, or not for a long time, as sex between women can transmit HPV, which is associated with cervical cancer. Early detection of cervical cancer through smear testing can greatly improve the likelihood of it being cured.

Breast cancer

Checking your breasts (and your partner's) regularly for changes or lumps is a good idea. Breast cancer is most common among older women, women who have never had any children and where there is a family history of breast cancer. If you discover a lump, go to your doctor immediately, but remember that 90% of lumps are not cancerous.

HIV & AIDS

HIV is present in the blood and vaginal (or seminal) fluid of someone infected with HIV, but you�re not at risk unless any of these fluids get into your bloodstream. Lesbians and bisexual women are not at high risk of being infected with HIV through woman-to-woman sex, and there are very few examples of HIV transmission between women. However, the risks may increase if you:

• Have unprotected sex with men.
• Inject drugs and share works.
• Engage in riskier sexual practices, such as sharing sex toys or activity which leads to bleeding or cuts/breaks in the lining of the vagina or anus.

See our HIV and AIDS section for more information about HIV.

Genital warts (HPV)

Genital warts are caused by HPV (Human Papilloma Virus) and are painless bumps on the vulva, in the vagina, on the cervix or around the anus. They can be passed on through contact with the wart, e.g. touching, rubbing or sharing sex toys. Visible warts can be treated with an immune-stimulating cream. Non-genital warts (e.g. on the hands) are a different species of wart and are unlikely to be transferred to the genitals.

Chlamydia

Chlamydia is relatively uncommon in lesbians, but it can 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 infection may be pain in the pelvic region. Chlamydia is easily treatable with antibiotics, but if left untreated it can lead to infertility.

Trichomonas vaginalis (TV)

TV is a tiny parasite found in the vagina and the urethra, and the infection causes a frothy, itchy discharge. It is passed on through vaginal contact or sharing sex toys. Treatment is with a course of antibiotics.

Syphilis

Syphilis is very infectious and close skin contact during sex or sharing sex toys can pass it on. Symptoms do not always appear, but may include sores in the vagina, anus or throat. You may also go on to develop a rash on the body and have flu-like symptoms. If treated early, syphilis can be completely cured with a course of antibiotics. If left untreated, syphilis can lead to mental illness, blindness, heart disease, or even death.

Hepatitis B

Hepatitis B is a viral infection which can be passed on relatively easily during sex or when sharing sex toys. It affects different people in different ways, and can be very serious. A course of vaccinations to protect against the hepatitis B virus is available from your local sexual health service.

Herpes

The herpes virus can cause painful sores on the inside of the vulva, vagina or anus (genital herpes) or on the mouth (cold sores). Herpes can be passed on through contact with a sore, e.g. touching, fondling or sharing sex toys. Oral sex when a cold sore is present can transmit the virus. Treatment with antibiotics and a cream can reduce any painful irritation and suppress further outbreaks. It is possible to have the herpes virus, be infectious, yet never have any symptoms.