*This article addresses cis- and transgender women alike, and in parts is also relevant to transgender men.
The group referred to in medicine as “women who have sex with women” (WSW) includes a broad variety of sexual minority identities and sexual practices. Research shows that women in this group tend to use less barrier protection when they have sex with other women, mostly because of the incorrect assumption that their sexual practices do not result in transmission of STIs. Indeed, the likelihood of transmission of HIV is significantly reduced, and the concern of becoming pregnant is usually non-existent. Still, there are several important things to know about diseases transmitted during sex between women.
Infections Transmitted During Sexual Contact
When women share sex toys intended for anal or vaginal contact, they expose themselves to discharge that could transmit infection. First, they expose themselves to the infectious parasite Trichomonas Vaginalis, the most common, non-viral, sexually transmitted infection. Trichomonas infections have been studied in heterosexual transmission, but research from the last decade shows that women could also transmit it to one another. Genital infection could be asymptomatic but still contagious, or could cause symptoms including genital itching in, foul smelling vaginal discharge, a burning sensation while urinating, and pain during sex. Should these symptoms present, women should see a doctor, treat the infection with antibiotics, and avoid having unprotected sex to prevent infecting their partner.
The Human Papilloma Virus (HPV)—which is linked to the development of pre-cancerous and cancerous lesions in the cervix, pharynx, and anus—can be transmitted in sexual contact between women. Research has shown that lesbian women are referred to and undergo Pap tests less often. But it is important to know that evidence of HPV has been found even in women who have never had sexual intercourse with a male partner. The virus has a high probability of transmission even in sex without penetration—although penetration does increase the probability of infection. Therefore, it is recommended that all sexually active women undergo a Pap smear for early detection of cervical cancer.
The herpes viruses (HSV-1 and HSV-2) can cause periodic flare-ups of blisters and sores on and around the mouth, noise, genitals, and anus. Infection occurs when infected skin touches a sore and scratch on uninfected skin, which allows the virus to penetrate. While HSV-1 typically causes sores around the mouth, and HSV-2 causes most infections around the genitals, both viruses can be transmitted in both areas, for instance in infection that occurs during oral sex. Research on the topic found that HSV-1 is more common among WSW, and identified a relationship between the number of sexual partners a woman has and her likelihood of carrying the virus. Many women are unaware of their infection because signs of it can go undetected. Therefore, the risk of infection can be significantly reduced by avoiding sexual contact in the presence of open sores or scratches, as well as avoiding oral sex and kissing during an active HSV flare-up.
In Bacterial vaginosis (BV), the most common infection in women, the natural balance of bacteria in the vagina is disrupted, resulting in a decrease in the normal vaginal Lactobacillus population (“good bacteria”) and an increase in the Gardnerella vaginalis population. A 2007 study found a higher prevalence of BV in WSW than in women who identified as heterosexual, findings that have since been validated. More recent studies suggest that sharing sex toys might increase the likelihood of acquiring BV. While BV does not affect male sexual partners, it might be transmitted between female partners.
And what about other “notorious” bacterial infections, like chlamydia and syphilis? Unfortunately, few studies have examined the feasibility of their transmission in sex between women. With that, the prevailing recommendation today is to include testing for chlamydia and syphilis in STI tests, even for women who have never had sex with a male partner.
I’m convinced! Now what?
First, it is important to know that women who have sex with women are not immune to STIs and need to protect themselves and their partner from infection. An HPV vaccine, for instance, is relevant for women without regard to their sexual preferences. It is recommended to wash hands and sex toys before and/or during sex and avoid direct sexual contact in the case of a suspected infection. Any vaginal discomfort, discharge, burning, or itching are all good reasons to see a doctor, and something to consider during sex.
Finally, oral sex should be avoided when there are sores or open cuts around the mouth, and lubricants should be used to prevent minor injuries due to friction that make the genitals more susceptible to infection. Barrier protection like condoms, gloves, or dams could prevent infection, if used appropriately. Want to learn more? Read additional recommendations on the Habima Clinic’s Facebook page.
Yael Harari is a medical student, and has a B.A in psychology and humanities
