Sexual Practices, Risk Perception and Knowledge of Sexually Transmitted Disease Risk Among Lesbian and Bisexual Women

Abstract

CONTEXT-Sexually transmitted diseases (STDs) can be spread between female sex partners, probably through the exchange of cervicovaginal fluid and direct mucosal contact.Additionally, lesbians have a high prevalence of bacterial vaginosis, which may represent an STD in this population.However, few data on sexual practices or perceived STD risk among lesbians are available to guide development of interventions aimed at reducing the risk.METHODS-To inform the development of a safer-sex intervention for women who have sex with women, focus group discussions were conducted with 23 lesbian and bisexual women aged 18-29.Topics included sexual practices, STD transmission and prevention, and knowledge about bacterial vaginosis.RESULTS-Although six participants had had bacterial vaginosis and three an STD, women reported little use of preventive measures with female partners (washing hands, using rubber gloves and cleaning sex toys).Participants said that vaginal penetrative practices using sex toys and fingers or hands are common, and that partners frequently share sex toys during a sexual encounter, generally without condoms.Knowledge of potential for STD transmission between women, and of bacterial vaginosis, was limited.Participants viewed use of barrier methods (gloves or condoms) as acceptable, provided that there is a reason (usually STD-focused) to use them and that they are promoted in the context of sexual health and pleasure.CONCLUSIONS-Safer-sex messages aimed at lesbian and bisexual women should emphasize the plausibility of STD transmission between women, personal responsibility and care for partners'wellbeing; should target common sexual practices; and should promote healthy sexuality.In the United States, where an estimated 2.3 million women describe themselves as lesbian, 1 transmission of common sexually transmitted diseases (STDs)-including trichomoniasis, genital herpes, human papillomavirus and HIV-between female sex partners has been reported.2 In the few studies that have examined this topic, sexual practices involving digitalvaginal or digital-anal contact, particularly with shared penetrative sex toys, have been frequently reported among female sex partners; such practices present a plausible means for STD transmission, presumably by transfer of infected cervicovaginal secretions or by direct mucosal contact.3 Although messages pertaining to safer sex between women are available on the Internet and from some community organizations, none have been specifically tested for either acceptability, potential for adherence or efficacy in reducing STD transmission.Lesbians also have an unusually high prevalence of bacterial vaginosis, the most common cause of vaginal complaints among U.S. women of reproductive age. 4 Bacterial vaginosis results from a shift in the vagina's microbial ecosystem from predominance with human