‘Safe sex’ is any activity through which you are at no risk of becoming infected with HIV or an STD. ‘Safer sex’ refers to sex in which the risk of becoming infected with HIV or an STD is minimised. Lesbians can protect themselves from HIV and many STDs by ensuring that infected fluids, such as blood or vaginal fluids, do not enter their body during sex. Precautions that can be taken include not sharing sex toys, or if doing so, using a new condom for each partner. Certain sexual activities are also considered to be lower risk, for example hugging, touching, massage and masturbation.

However, STDs such as herpes and crabs can be passed on through skin contact alone. The only way for two women to be sure that they are not at risk during sex is if both have been fully tested, and have not had sexual contact with any other women or men since.

Lesbians, Sex and HIV

Lesbian or bisexual women are not at high risk of becoming infected with HIV through woman to woman (WSW) sex.

However, like many women:

• Some lesbians have unsafe sex with men – one British study found that 85 percent of women who have sex with women reported also having sex with men.
• Some lesbians inject drugs and share needles – research into injecting drug users has shown higher HIV prevalence among women who have sex with women, compared to heterosexual injecting drug users.
• Some lesbians wanting to get pregnant face decisions about sperm donors – legitimate sperm banks screen donor’s semen for HIV and other STDs. However, many lesbians chose to use the sperm of someone they know, rather than using a sperm bank.
• Some lesbian sexual practices are risky (see underneath for more details)
• It is argued that the widespread assumption that lesbians are a low-risk population increases some lesbians risk of HIV infection as they believe HIV is not something that they need to be concerned about.

A very effective option for communities at risk of HIV infection is PrEP, or pre-exposure prophylaxis, which is a daily pill to help keep you HIV-negative. When taken as prescribed, PrEP is highly effective. PrEP is safe and generally well tolerated. Most insurance plans (public and private) cover PrEP.

PEP, or post-exposure prophylaxis, is a combination of medications that an HIV-negative person takes for 28-30 days AFTER a possible exposure to HIV. PEP is most effective the sooner it’s started, and must be started within 72 hours of the exposure.

What are the HIV risks for lesbians?

HIV is in the blood, breast milk, vaginal fluid or semen of someone with HIV, so you are at risk if you get any of these fluids inside your body. The risks of sexually transmitting HIV between women are low. Very few women are known to have passed HIV on to other women sexually. However, some lesbian sexual practices do carry a risk of HIV transmission and precautions need to be taken to protect against infection.

• Oral sex- the risk of HIV being passed on through oral sex is low, but it is increased if a woman has cuts or sores in her mouth, or if the partner receiving oral sex has sores on her genitals or is having her period. Oral sex is safer if you use a ‘dental dam’ (a square of latex or cling film) to stop any vaginal fluid or menstrual blood getting into your mouth. A condom cut open and spread flat can also be used for this.
• Sharing sex toys - sharing sex toys (for example vibrators) can be risky if they have vaginal fluids (juice), blood or feces on them. Always clean them well and have one each. This is one area of sex where sharing is a bad idea!
• Rough sex - any sexual activity that can lead to bleeding or cuts/breaks in the lining of vagina or anus is risky, including ‘fisting’ or certain S&M (sadomasochism) activities.
• Donor insemination - if a woman is thinking about using a sperm donor to get pregnant, she needs to be aware of the potential donor’s detailed medical history and any possible risk factors – including drug use and sexual history. It is important that the donor has taken an HIV test.

What other STD risks are there for lesbians?

Although we have seen that lesbian and bisexual women are at low risk of getting HIV from sex with another woman, many other STDs – such as herpes or thrush – are just as common for lesbians as for women who have sex with men.

• Thrush is an overgrowth of yeast causing vaginal itching and soreness, often with a white discharge. It can be passed via sex between women, though oral sex is low risk.
• Bacterial vaginosis (BV) is an overgrowth of vaginal bacteria causing a smelly discharge, which lesbians often experience. There is a possible link with perfumed soaps and bath oils.
• Genital warts are painless bumps on the vulva, in the vagina, on the cervix or round the anus. They can be passed through contact with the wart, for example by touching, rubbing or sharing sex toys. It is unlikely non-genital warts, such as on hands, can be transferred to the genitals. Read more about genital warts.
• Trichomonas vaginalis (TV) gives a frothy, itchy vaginal discharge and is passed on by contact with the vagina only, for example by touching or sharing sex toys.
• Herpes can cause painful sores on the inside of the vulva/vagina or anus (these are genital herpes) or on the mouth (cold sores). Herpes can be passed on through contact with a sore, for example by touching, fondling or sharing sex toys. Oral sex when a cold sore is present can also transmit the virus. It can be possible to have the herpes virus, be infectious and yet never have had any symptoms. An American study found that the majority of women who have sex with women, who are infected with herpes, are unaware of their infection.
• Crabs/pubic lice cling to pubic and other body hair causing itching and sometimes blood spots from bites. They are spread through naked body/skin contact.
• Chlamydia and gonorrhea are rare in lesbians but if they are present may be passed on through sharing sex toys or rubbing vulvas together. Often there are no symptoms, though there may be a discharge. The first sign of both infections may be pain in the pelvic region (pelvic inflammatory disease or PID). There is a risk of infertility for women who have had untreated chlamydia. Read more about chlamydia and gonorrhea.
• Syphilis is very infectious and close skin contact during sex can pass it on. Syphilis causes painless ulcers (or chancres) to appear where the bacteria entered the body. A chancre on the vagina can be almost unnoticeable. Read more about syphilis.
• Hepatitis refers to viral infections that cause inflammation of the liver. Certain forms of hepatitis can easily be passed on in sex – for example by touching or sharing sex toys. There are often no symptoms, though it can cause jaundice (yellow skin) or nausea. Read more about hepatitis.

Treatment is available for all the STDs mentioned above, often with antibiotics, and most can be cleared up quite rapidly. It is vital you seek help as soon as you notice any symptoms and that you do not have sexual contact that could pass on any infection until it has been dealt with.

Seeing an ob/gyn isn’t just for cis-women. If you have a vagina, surgically created or otherwise, regular checkups and screening are important for your health and the health of your partner(s). It is important to be up front and honest with your provider, whether your a cisgender lesbian, a trans* questioning female bodied individual or otherwise.

If you have a cervix, regardless of how you identify, looking after yourself also means having regular cervical smears, even if you have never had sex with a man, or not for years. The reason for this is because sex between women can transmit HPV, the virus associated with cervical cancer. Smear tests can detect pre-cancerous cells and early treatment can mean cancer never develops. Despite this, clinic-based studies and surveys have shown that women who have sex with women are less likely to receive routine smears than heterosexual women of similar age.

It is just as important for a lesbian to have regular smear tests as it is for a heterosexual woman. You can talk to your doctor about having a cervical smear, or alternatively you can contact a family planning or sexual health clinic.