Health and Life Sex and sexual health STIs Safe Sex and STIs - a guide for lesbians By Dr Emily Mandlik If you think women who have sex with women are at lower risk of acquiring STIs, you'd be wrong. Studies have suggested that the lifetime risk of STIs among lesbians is similar to that of heterosexual women Common STIs among women who have sex with women Genital Herpes Genital Herpes is caused by the Herpes Simplex Virus. Herpes is spread through skin-to-skin contact with the affected part of the body. The majority of us carry the virus but only the minority of people experience outbreaks. It's possible for your partner to pass on the virus to you without knowing they have herpes. Symptoms of herpes: Before an outbreak people often report flu-like symptoms Multiple painful blisters which develop into ulcers that crust and heal after a few days Enlarged glands near the affected area There are two subtypes of the herpes simplex virus - type 1 which commonly occurs orally as "cold sores" and type 2 which is associated with genital herpes. However the types and locations are interchangeable. It is quite common for people to get type 1 in the genital area - often due to a partner with cold sores giving them oral sex. Herpes is a lifelong condition, but the severity varies from person to person. Some may only ever have one outbreak their whole life while others may have more frequent outbreaks. Although there is no cure, there is medication that can help you manage the symptoms. Methods to reduce the risk of transmission to partners: Use protection - dental dams Avoid sexual contact during an outbreak Important note: herpes is not transmitted on towels or toilet seats! Genital warts Genital warts are caused by a strain of the Human Papilloma virus (HPV) (most commonly types 6 and 11). They tend to be fleshy "cauliflower"-looking lumps, and are generally not painful. Genital warts are not the same strain of HPV that causes cervical cancer. The virus is spread through skin-to-skin contact. There is no failsafe way to prevent the spread of warts but there are methods to reduce the risk of transmission: Use protection - dental dams Avoid sharing sex toys If you have warts avoid shaving as this can cause the number to increase There are a number of treatments for genital warts - creams, freezing, laser and surgical removal. Your body may naturally clear the virus. However a history of genital warts does not give immunity, so it is possible to be re-infected. Cervical HPV There are many strains of HPV (100+), some of which have the potential to cause mutations in cells that can lead to the development of cancers such as cervical cancer. Early pre-cancerous changes in the cells of the cervix caused by HPV can be detected by regular cervical smear testing. HPV is transmitted through skin-to-skin contact - including acts such as oral sex and fingering. WSW need the same regular cervical smear testing as heterosexual women. Thankfully the incidence of cervical cancer and genital warts is reducing since the introduction of the HPV Vaccine that all girls in the UK receive in secondary school (Year 8). It protects against HPV strains 6, 11, 16 and 18. HPV 6 and 11 commonly cause genital warts, while strains 16 and 18 are the most common cause of cervical cancer. If you missed getting the vaccination and are under 18 years old – your GP can administer it. Bacterial Vaginosis (BV) Not technically considered a sexually transmitted infection, as factors other than sexual activity can result in the development of the condition. Research has shown that rates of BV are higher in lesbians than straight women. Possible explanations for this are due to the sharing of vaginal secretions and the increased incidence of receptive oral sex. Bacterial vaginosis is caused by an overgrowth of "bad" bacteria and increased vaginal pH. This can cause a thin whitish fishy-smelling discharge although many women do not have symptoms. BV is generally not associated with symptoms such as itching and irritation. It is treated with a course of antibiotics. Methods to prevent BV: Avoid sharing toys or vaginal secretions Avoid vaginal douching Avoid bubble baths and soaps. Only use water to wash the genital area - your vagina is "self-cleaning" Use a dental dam for oral sex Stop smoking Other STIs In research WSWs have tested positive for all STIs so it is important to practice safe sex1-3. Activities that put you at higher risk of STIs are: Giving unprotected oral sex when your partner is menstruating Potential to be exposed to blood borne viruses such as HIV, Hepatitis B and C if you have any cuts or sores in your mouth or a sore throat/infection. Risk is reduced by using a dental dam. Unprotected rimming - Hepatitis A and B can be acquired from getting small amounts of poo in your mouth from an infected partner during unprotected rimming. Risk is reduced by using a dental dam. The exchange of vaginal fluids Sharing sex toys (without changing condom) Fisting without wearing gloves Injury to the vagina or rectum can mean exposure to blood, which can increase the risk of passing on blood borne viruses like HIV and Hepatitis B and C. Safe Sex = Talk + Test + Protect Communicate Be open with your partners regarding your sexual health. STI Screening Get tested regularly! Dental Dams Use a dental dam - it is a thin piece of latex used for oral sex. It is placed over your partner's vulva or anus. Wash Sex Toys Wash sex toys between partners or use a condom which is changed between partners. Ensure you clean a toy after anal play before using it vaginally. Hand Hygiene Wash your hands before sex. Ensure your nails are cut so as to not cause injury to your partner. Clean your hands after anal play. Do not switch from anal to vaginal play without washing your hands. What Next? Extra Reading Lesbian and Bisexual Women’s Health: https://www.nhs.uk/live-well/sexual-health/sexual-health-for-lesbian-and-bisexual-women/ https://www.guysandstthomas.nhs.uk/resources/patient-information/all-patients/lesbian-and-bisexual-womens-health.pdf STI information: https://sexwise.fpa.org.uk/ https://www.brook.org.uk/your-life/category/stis Finding local sexual health services: https://sxt.org.uk/ https://www.fpa.org.uk/find-a-clinic