The questions below were generated during the LGBT workshop’s session on health experiences during Pride Week 2010. All of the lesbians present shared that they never ask any questions relating to their sexual health when they go to see a doctor. They only go to see a doctor for the usual sicknesses of fever etc. They never consult a doctor relating to sexual health. They feel too afraid and too ashamed.
So, we asked the lesbians if they could ask a doctor some questions, what would they want to ask? Here are their questions and our answers:
1 Can lesbians be affected by sexually transmitted infections or diseases?
The basic answer is yes. In fact the message for lesbians isn’t that much different to the general population, as STI risk relates to sexual practice rather than sexual orientation. With women having sex with women rates of contracting STIs are generally much lower, but not zero.
Herpes, HPV (the genital wart virus that can lead to cervical cancer), and bacterial vaginosis are transmitted fairly easily between women during sex as they are transmitted by skin-to-skin, genital-to-genital, or mouth-to-genital contact. Herpes and HPV are viruses and are not curable and stay in the body, a woman could acquire herpes or HPV from a male partner and later pass it on to a female partner. HIV, hepatitis B, gonorrhea, and chlamydia are much less likely to be transmitted – the risk is low but it is still possible.
The most common route of transmission seems to be oral sex or the sharing of sex toys. It is not known if STDs or STIs can be transmitted through menstrual blood but it is possible. A large number of lesbian and bisexual women have, or have had, sex with men, and all STDs are easily transmitted from men to women during intercourse. Often STDs do not have symptoms, so it is possible for a woman to have become infected years ago and to still harbor the infection.
There are two conditions that are very common amongst lesbians:
Trichomoniasis is a very common infection among sexually active women and is caused by a microscopic parasite that lives, most commonly, in the vagina.
Some women have signs or symptoms of infection which include a frothy, yellow-green vaginal discharge with a strong odor. The infection also may cause discomfort during intercourse and urination, as well as irritation and itching of the female genital area. In rare cases, lower abdominal pain can occur. Symptoms usually appear in women within 5 to 28 days of exposure.
For diagnosis a health care provider must perform a physical examination and laboratory test to diagnose trichomoniasis.
Trichomoniasis can usually be cured with prescription drugs, either metronidazole or tinidazole, given by mouth in a single dose. Both partners should be treated at the same time to eliminate the parasite. Persons being treated for trichomoniasis should avoid sex until they and their sex partners complete treatment and have no symptoms. Metronidazole can be used by pregnant women.
Having trichomoniasis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.
The surest way to avoid transmission is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.
As this is not always possible, any genital symptom such as discharge or burning during urination or an unusual sore or rash should be a signal to stop having sex and to consult a health care provider immediately. A person diagnosed with trichomoniasis (or any other STD) should receive treatment and should notify all recent sex partners so that they can see one of the healthcare providers listed on the Connections pages of this website and be treated.
Bacterial vaginosis (BV)
BV is caused by an imbalance in the bacteria normally found in the vagina, and only affects women. It is not strictly speaking a sexually transmitted infection as it is possible to have it even if you have never had sex but it can be transmitted during sex and BV rates are higher in women having sex with women. It causes a bad ‘fishy’ smelling discharge and, whilst it is not dangerous, it can cause disturbing symptoms.
Any woman with an unusual discharge should be evaluated so that more serious infections can be excluded. Symptoms may be similar to those found in yeast infections of the vagina and trichomoniasis and these conditions must also be excluded in women with vaginal symptoms. BV is a common condition and is nothing to be ashamed of. Studies have shown that approximately 29% of women in the US are affected. The cause of BV is not known but certain factors have been identified that increase the chances of developing it. These include multiple or new sexual partners, intrauterine devices for contraception, recent antibiotic use, vaginal douching, and cigarette smoking.
To diagnose BV the doctor will perform a pelvic exam where they note the appearance of the vaginal lining and cervix. The doctor will also perform a manual exam of the ovaries and uterus. The cervix is examined for tenderness, which might indicate a more serious infection. The doctor may collect samples to check for other infections.
The doctor will probably examine the vaginal discharge under the microscope and in the laboratory.
Treatment for bacterial vaginosis consists of antibiotics. Metronidazole (Flagyl) taken by either oral (pill) form or by vaginal metronidazole gel (Metrogel) is an effective cure. The oral metronidazole can cause some minor but unpleasant side effects, but is believed to be the most effective treatment.
Tinidazole (Tindamax) is an antibiotic that appears to have fewer side effects than metronidazole and is also effective in treating bacterial vaginosis.
Recurrence of bacterial vaginosis is possible even after successful treatment. More than half of those treated experience recurrent symptoms within 12 months. It is unclear why so many recurrent infections develop. With recurrent symptoms, a second course of antibiotics is generally prescribed.
2 If we have a lot of sexual intercourse does it affect our health or not?
Scientists show that sex is extremely beneficial for our health, while the lack of an active sex life might have negative effects. Some medical studies have even shown that people who have a regularly and healthy sex life live longer than those that don’t. Here are some of the reasons why:
Our mental and emotional health is clearly influenced by sex. It is a medical fact that, after having sex the brain releases endorphins that decrease stress and inducing a state of relaxation and well-being.
Sex can also be a beauty treatment! While having sex, a woman’s body doubles the estrogen level, and this makes her hair shine and the skin becomes softer and clearer.
Sex is good exercise which helps to keep our lungs, circulation and heart healthy and helps to lose weight. The estrogen hormone released while you have sex further helps to protect your heart.
Sex is also a pain reliever. Immediately before orgasm, levels of the hormone Oxytocin rise by five times, determining a huge release of endorphins, the chemicals that help to reduce pain.
Kissing stimulates salivation, which cleanses the mouth and lowers the acidity in the mouth, reducing tooth decay.
Sex strengthens the pelvis muscles which can lead to improved bladder control – this is especially useful to women who have been pregnant or delivered babies.
Sex can improve sleep quality. Following an orgasm, the body becomes completely relaxed and sleep inducing hormones are released.
Be careful when opening the condom package to avoid damaging the condom.
Put the condom against the end of the erect penis, leaving about 1cm of space at the end by gently squeezing the end of the condom to remove air from the tip.
3 Why is sexual intercourse between woman and woman sometimes painful?
Having sex does not, and should not, usually hurt. The first time you have sex may be a bit uncomfortable as your hymen (a thin layer of skin that partially covers the entrance to the vagina) may be stretched or torn and this may cause a little bleeding, but it does not usually last long and many women don’t even notice it. After the first time, sex should totally painless. The vagina is very stretchy but you may experience pain when having sexual intercourse if your vagina does not produce enough natural lubrication.
Extra vaginal fluids are usually produced when a woman becomes sexually excited. If you are tense or rushing then your vagina may not become moist enough for penetration to occur smoothly. Stress can also cause the muscles in the vagina to involuntarily tense up, making penetration difficult and painful. The best way to ensure pain free sex is for both partners to relax and take things very slowly. Extra water-based lubrication (like KY Jelly) might also help, and can be bought from many pharmacies.
4 If someone has many sexual partners do they get diseases, infections, STIs? What kind of diseases etc. can someone get?
See the answer to question 1 above and have a read through the “How to have sex – SAFELY” page in the Health section of this website. There is a definite link between multiple sexual partners and an increased risk of contracting an STI. Make sure you read and follow the advice on this website and you should be able to have as much safe, risk-free sex as you want. Just bear in mind though that often the quality of sex is better with a partner that you know and trust!
5. How can we prevent catching STIs? What is the treatment for STIs?
See the answer to question 1 above and have a read through the “How to have sex – SAFELY” page in the Health section of this website. In addition:
Wash your hands before getting intimate with your partner.
Don’t share sex toys and if you do, use a condom, or properly clean them with soap and water before switching to a new user.
And finally, one of the best things that you and your partner can do to protect yourselves and one another, is to communicate! Talk about your sexual history, whether you’ve had sex with men in the past, if you’ve been tested before and if you haven’t been tested recently GET TESTED! Check out the Connections page of this website for help on where to get tested.
6. Why do some women/partners not have vaginal juice during sexual activity? If they don’t, is something wrong?
Vaginal moisture is mainly produced by the cervix (neck of the womb) at the top of the vagina and eventually oozes out of the vagina as healthy vaginal discharge. This means that there is a very slow flow of moisture through the vagina, and this keeps it clean, as it moves dead cells and the remains of the menstrual period to the outside.
When you are sexually excited, two special glands at the entrance of the vagina produce extra secretions. The moisture from these glands is more slimy than the moisture from the cervix, because its purpose is to provide good lubrication during intercourse. Its musky signals that the woman is ready for sex.
The most common reason for a woman not having enough natural vaginal lubrication during sex is that she is either not sexually aroused or relaxed enough. This problem is simple to solve with a little extra time and attention from her partner.
The menopause (the time when a women stops menstruating), diabetes and breast feeding can all cause extra dryness. If you and your partner are happy and comfortable together and take the time to create mutual arousal before penetrative sex but one of you still doesn’t seem to get wet enough for satisfying and pain free sex then you may want to consider if any of the things listed above is applicable to you. If you are confident that it is one of these problems that are causing the dryness then all you need to do is use some additional water-based lubrication (such as OK Plus) that you can buy from a pharmacy.
7. Can we get any disease for French kissing?
As long as you are both healthy, kissing (including the deep or French variety) is highly unlikely to transmit any disease, including HIV, the virus that causes AIDS, and other STIs.
So, can you get diseases from kissing alone? Well, there’s always the common cold and flu, and even mono, all of which can be passed on from an infected kisser to his or her kissee. The herpes virus that causes cold sores on the lips or inside of the mouth can be spread through kissing, too. Hepatitis B and some forms of bacterial meningitis could also be transmitted through kissing alone, but this is much less common than getting a cold or flu from swapping saliva or hand-to-hand contact with an infected person. So generally kissing is considered safe.
8. Can having oral lesbian sex cause any disease?
See the answer to question 1 above and have a read through the “How to have sex – SAFELY” page in the Health section of this website to explain clearly about the risks of oral sex. Generally the risk of HIV or other STIs 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.