Expert Answers Factual Answers to Your Sexual Health Questions

anonymous on August 29, 2011

What STDs should women who have sex with women worry about?

I was wondering what kind of sexual diseases women can give to each other?

answered by
Annette Fuglsang Owens, MD, PhD on August 29, 2011

I’m glad that you asked this important question. Because pregnancy isn’t a concern among same sex couples, many women who have sex with women (WSW) wrongly assume that they don’t need to use protection when they have sex. But the fact is that WSW are at risk for all of the most common sexually transmitted diseases (STDs)…and the Centers for Disease Control and Prevention recommend annual STD testing for all sexually active women, regardless of sexual orientation.

WSW may or may not identify as lesbian, and they might have sex with women and men, or just with women. Although researchers are still learning about rates of STD infection for WSW, they do know that women can transmit STDs to one another if one partner is infected. In fact, some research shows that women who have sex exclusively with other women may actually be at higher risk for some STDs – like chlamydia and a certain type of genital herpes infection – than women who have sex exclusively with men.

Why are WSW at a higher risk for one type of genital herpes? Most genital herpes infections are caused by herpes simplex virus type 2 (HSV-2) and most oral herpes infections (cold sores or fever blisters) are caused by herpes simplex virus type 1 (HSV-1). However, it is possible to transmit an oral HSV-1 infection to the genitals.

Although WSW are somewhat less likely than other populations to have genital HSV-2 infection, they’re more likely to have genital HSV-1 infection. Indeed, a2003 article in the journal Sexually Transmitted Diseases found that self-reported lesbian women may be more likely to get genital herpes from orally transmitted HSV-1 than heterosexual women. That’s because when one partner has oral herpes (cold sores) and gives her partner oral sex (cunnilingus), it’s possible for the giver to pass HSV-1 to the genitals of her partner.

Some research also shows that WSW are at a higher risk for chlamydia andbacterial vaginosis infections, as well. According to a 2011 study in the American Journal of Public Health, rates of chlamydia in women who have sex with women were 7.1%, while the rate of chlamydia in women who exclusively have sex with men was 5.3%. Higher rates of bacterial vaginosis have also been reported in women who have sex with women. According toone research study, that may be because female couples end up sharing specific bacterial strains that can cause bacterial vaginosis.

What are some ways that women spread STDs to each other? Any number of activities – from oral sex and shared penetrative sex toys, to fingers-to-vagina contact and skin-to-skin genital contact – can transmit STDs between female partners. For example:
  • Skin-to-skin genital contact or mouth-to-genital contact can transmit genital herpes and human papillomavirus (HPV) from an infected partner. (Some types of HPV can cause genital warts while other types can cause cervical cancer.)
  • Oral sex, particularly if the giving partner has any open cuts or sores in the mouth, and/or if the receiver has menstrual blood present, increases the odds of transmitting HIV, hepatitis B or hepatitis C. Transmission of syphilis between women (probably via oral sex) has also been reported, as well as chlamydia and gonorrhea.
  • Shared penetrative sex toys are one way that women can pass infected vaginal secretions which can carry STDs like HIV, trichomoniasis and bacterial vaginosis, as well as chlamydia and gonorrhea.
  • And all women – regardless of whom they’re sexually active with – are at risk for STDs if they use intravenous drugs and share needles.

For more information about the risks, symptoms, complications and treatment of these STDs, see our Expert Guide to STD Basics.

What can WSW do to have safer sex and reduce the risk of spreading STDs? One step women can take is to get tested for STDs. If it turns out that you or your partner test positive for an STD, you can get treated, if necessary, and reduce the risk of spread.

Additionally, women can practice safer sex by using condoms over sex toys, and changing the condom if sharing the toy between partners. Also, dental dams provide barrier protection for oral sex, and the CDC recommends that all women who are sexually active get regular Pap tests to screen for cervical cancer. I would encourage you to speak with your doctor about these screenings and other steps you can take to stay healthy. To learn more about safer sex practices, you may also want to browse our Prevention + Safer Sex Overview.

Thanks again for your question, and I wish you the best of health.

Annette Fuglsang Owens, MD, PhD

Dr. Owens is an AASECT-certified sexuality counselor. Her areas of expertise include the medical aspects of human sexuality and sexual problems, as well as the impact of STDs ⎼ and other diseases, illnesses and disabilities ⎼ on sexuality. Dr. Owens was educated at the University of Copenhagen in Denmark.

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