Sex-Related Heath Concerns for Lesbians and Bisexual Women

Lesbians and bisexual women are at risk for not getting good health care. Some of the reasons for this are:

* Being scared to tell your doctor about your sexuality or your sexual history

* Having a doctor who does not know your disease risks or the issues that affect lesbians and bisexual women

* Not having health insurance. Many lesbians and bisexuals don’t have domestic partner benefits. This means that one person does not qualify to get health insurance through the plan that the partner has

* Not knowing that lesbians are at risk for STIs and cancer

For these reasons, lesbian and bisexual women often avoid routine health exams. They sometimes even delay seeking health care when feeling sick. It is important to be proactive about your health, even if you have to try different doctors before you find the right one. Early detection – such as finding cancer early before it spreads – gives you the best chance to do something about it. That’s one example of why it’s important to find a doctor who will work with you to identify your health concerns and make a plan to address them.

Are lesbian and bisexual women a risk of getting sexually transmitted infections (STIs)?

Women who have sex with women are at risk for STIs. Lesbian and bisexual women can transmit STIs to each other through:

* Skin-to-skin contact

* Mucosa contact (e.g., mouth to vagina)

* Vaginal fluids

* Menstrual blood

Some STIs are more common among lesbians and bisexual women and may be passed easily from woman to woman. Other STIs are much less likely to be passed for woman to woman through sex. When lesbians get these less common STIs, it may be because they also have had sex with men, especially when they were younger. Bisexual women may be more likely to get infected with STIs that are lesson common for lesbians, since bisexuals have typically had sex with men in the past or are presently having sex with a man.

Common STIs that can be passed between women include:

Bacterial vaginosis. BV is more common in lesbian and bisexual women than in other women. The reason for this is unknown. BV often occurs in both members of lesbian couples. Sometimes BV causes no symptoms. But over one-half of women with BV have vaginal itching or discharge with a fishy odor. BV can be treated with antibiotics.

Chlamydia. Chlamydia is caused by bacteria. It’s spread through vaginal, oral, or anal sex. It can damage the reproductive organs, such as the uterus, ovaries, and fallopian tubes. The symptoms of chlamydia are often mild – in fact, it’s known as a “silent infection.” Because the symptoms are mild, you can pass it to someone else without even knowing you have it. Chlamydia can be treated with antibiotics. Infections that are not treated, even if there are no symptoms can lead to:

* Lower abdominal pain

* Lower back pain

* Nausea

* Fever

* Pain during sex

* Bleeding between periods

Genital herpes. /genital herpes is an STI caused by the herpes simplex viruses type 1 or type 2. It most commonly causes infections of the mouth and lips, called “fever blisters” or “cold sores.” You can spread oral herpes to the genitals through oral sex. Most people have few or no symptoms from a genital herpes infection. When symptoms do occur, they usually appear as one or more blisters on or around the genitals or rectum. The blisters break leaving tender sores that may take up to four weeks to heal. Another outbreak can appear weeks or months later. It is almost always less severe and shorter than the first outbreak. Although the infection can stay in the body forever, the outbreaks tend to become less severe and occur less often over time. You can pass genital herpes to someone else even when you have no symptoms. There is no cure for herpes. Drugs can be used to shorten and prevent outbreaks or reduce the spread of the virus to others.

Human papillomavirus. HPV can cause genital warts. If left untreated, HPV can cause abnormal changes on the cervix that can lead to cancer. Most people don’t know they’re infected with HPV because they don’t have symptoms. Usually the virus goes away on its own without causing harm, but not always. Lesbians and bisexual women can transmit HPV through direct genital skin-to-skin contact, touching, or sex toys used with other women. This is why regular Pap tests are just as important for lesbian and bisexual women as they are for heterosexual women. There is no treatment for HPV, but a healthy immune system can usually fight off HPV infection.

Trichomoniasis. Trichomoniasis is caused by a parasite that can be spread during sex. You can also get trichomoniasis from contact with damp, moist objects, such as towels or wet clothes. Trichomoniasis can be treated with antibiotics. Symptoms include:

* Yellow, green, or gray vaginal discharge with a strong odor

* Discomfort during sex and when urinating

* Irritation and itching of the genital area

* Lower abdominal pain

Gonorrhea. Gonorrhea is a common STI but it is not commonly passed during woman to woman sex. However, it could be since it does live in vaginal fluid. It is caused by a type of bacteria that can grow in warm, moist areas of the reproductive tract, like the cervix, uterus, and fallopian tubes in women. It can also grow in the mouth, throat, eyes, and anus. Even when women have symptoms, they are often mild and are sometimes thought to be from a bladder or other vaginal infection. Gonorrhea can be treated with antibiotics.

Hepatitis B. Hepatitis B is a liver disease caused by a virus. It is spread through bodily fluids, including blood and vaginal fluid. There is a vaccine that can protect you from hepatitis B. Some women have no symptoms if they get infected with the virus. Women with symptoms may have:

* Mild fever

* Headache and muscle aches

* Tiredness

* Loss of appetite

* Nausea or vomiting

* Diarrhea

* Dark-colored urine and pale bowel movements

* Stomach pain

* Yellow skin and whites of eyes

Syphilis. Syphilis is an STI caused by bacteria. It is passed through direct contact with a syphilis sore during vaginal, anal, or oral sex. Untreated syphilis can infect other parts of the body. It is easily treated with antibiotics. Syphilis is very rare among lesbians. But, you should talk to your doctor if you have any sores that don’t heal.

HIV/AIDS. The human immunodeficiency virus (HIV) is spread through body fluids, such as blood, vaginal fluid, semen, and breast milk. It is primarily spread through sex with men or by sharing needles. Women who have sex with women can spread HIV, but this is rare. Some women with HIV may have no symptoms for 10 years or more. Women with HIV symptoms may have:

* Extreme fatigue

* Rapid weight loss

* Frequent low-grade fevers and night sweats

* Frequent yeast infections (in the mouth)

* Vaginal yeast infections

* Other STIs

* Pelvic inflammatory disease in the uterus, ovaries, or fallopian tubes

* Red, brown, or purplish blotches on or under the skin or inside the mouth.

AIDS, or acquired immunodeficiency syndrome, is the final stage of HIV infection. HIV infection turns to AIDS when you have one or more opportunistic infections, certain cancers, or a very low CD4 cell count.

It is common for lesbians not to think about STIs or the consequences they can cause. If you don’t have a doctor who knows you are a lesbian and your history or who are not knowledgeable about the health concerns lesbians have, you run the risk of missing them. It is important to find a doctor who is sensitive to your needs and will help you get regular check-ups. The Gay and Lesbian Medical Association provides online health care referrals. You can access its Provider Directory or contact the Association at 202-600-8037.