Queer women aren't getting the preventative care they need for sexually transmitted infections (STIs). Despite studies showing that cisgender lesbian and bisexual women are at risk and, in some cases, have a higher risk, these risks are rarely talked about in schools or even clinical settings. According to Bethany G. Everett, Ph.D., an assistant professor of obstetrics and gynecology at the University of Utah, "LGBQ women often don't perceive themselves to be at risk for STIs and are not given accurate medical information on how to have safe and healthy same-sex sexual relationships."
Because of this lack of clinical attention, there isn't as much data available about the level of risk queer women face compared to straight women or men -- or how to mitigate that risk.
"There's really this huge gap in evidence," says Carmen Logie, Ph.D., M.S.W., an associate professor of social work at the University of Toronto who studies the stigma surrounding queer women in the medical field. She says that gap in evidence is even bigger for trans women and nonbinary people. "Many trans women also identify as lesbian, bisexual, or queer," says Logie. "The diversity of women's sexuality is really overlooked. And more than overlooked, I think. Oppressed."
But what we do know tells us that LGBTQ women and assigned female at birth (AFAB) nonbinary and genderqueer people need better access to sexual health services. Lesbians specifically are less likely to get routine gynecologic examinations, and they were less than one-third as likely as straight women and one-quarter as likely as bisexual women to get the human papillomavirus (HPV) vaccine, which helps prevent cervical cancer.
And while HIV transmission between cisgender women is extremely rare, it is possible for women to transmit chlamydia, gonorrhea, herpes, and bacterial vaginosis to one another through oral sex and fluid exchange by sharing sex toys, for example. What's more, there are some STIs that may be more prevalent in lesbian and bisexual women than heterosexual women. Studies have shown that bisexual women are more likely to have cervical cancer-- caused by sexually transmitted HPV -- than heterosexual women, and that both lesbian and bisexual women are more likely to contract chlamydia than heterosexual women.
Both diseases can lead to further complications if they're not caught and treated in time. Untreated chlamydia can lead to infertility and pelvic inflammatory disease. And in recent years, certain strains of chlamydia and gonorrhea have been found to resist medical treatment. Deaths due to cervical cancer have decreased dramatically since the introduction of Pap smears to screen for HPV, as well as a vaccine to prevent certain strains. Still, if patients aren't screened and the cancer goes undetected, it can be deadly.
Getting tested and treated for STIs is a great way to keep from transmitting them to other people, and this should be something that queer women are able to do as easily as anyone else. However, even this can be a challenge, because health care workers are sometimes misinformed about testing needs. According to Everett, "Even if [LGBQ women] are proactive about their sexual health, medical providers sometimes give inaccurate advice, telling LGBQ women they do not need to be screened for STIs, such as HPV, and/or do not offer the full range of sexual health services to these women." The BBC reported in 2017 that health workers in the United Kingdom were specifically telling lesbian women that they did not need to be screened for STIs. To receive proper care, these women would have had to understand their risks and needs better than the health care providers serving them.
Everett recommends going to an LGBTQ-friendly clinic, like Planned Parenthood, for testing. Sex educator and writer Cameron Glover adds that other resources exist to help queer women advocate for their own sexual health -- including finding a doctor who is either LGBTQ-identified or an LGBTQ ally. But it's not a level playing field, says Glover -- queer people with less access and privilege, as well as those who live far from a big city, will have more trouble finding inclusive providers. Even remote access can be a problem, says Glover, because of shadow banning and censorship on social media platforms. "But there are sex educators sharing valuable, evidence-backed information that really helps with this," she says, including writer and sex educator Jaime J. Leclaire, speaker Goody Howard, trans sex blogger June Pilote, YouTuber Stevie Boebi, and YouTuber Eva, the host of the series What's My Body Doing.
STI prevention for queer women has not been thoroughly studied, according to Logie. "You know, there's a lot of focus on biomedical prevention in the area of PrEP [pre-exposure prophylaxis for HIV], which is great. But that doesn't really address [other] STIs." None of the barrier methods queer women can use were designed specifically for them; the dental dam is a classic example of a dental tool adapted to be used for safer sex.
However, at this point, barrier methods and good hygiene for bodies and for sex toys are the best known prevention methods for queer women trying to avoid STIs like herpes, gonorrhea, chlamydia, and HPV. Glover says that she recommends a variety of materials for safer sex, including external and internal condoms, latex or nitrile gloves, and finger cots. "All of these things can be adapted for different acts," she says. "For example, external condoms are great for insertable sex toys or folks with penises (they can add additional friction if you purchase ribbed options, but they also minimize transferring of any fluids between partners or acts), and can also be cut into dental dams for oral sex or analingus." She says AFAB trans, nonbinary, and others who are taking testosterone and experiencing bottom growth -- the growth of the clitoris into a larger phallus -- can also use finger cots, also known as a "finger condom," as a barrier method.
Finger cots can also work for smaller, bullet-style vibrators. "You want to change barriers frequently, even if you're using the same object for play," says Glover. "This is especially important if folks are engaging in play involving more than one person." Everett adds that important, safe, same-sex sex strategies include dental dams, washing your hands, and cleaning sex toys. And, for those queer women who have partners with penises, condoms would be appropriate in that setting, as well.
It's possible for queer women to have safer sex and for us to advocate for ourselves to better understand what's happening in our own bodies. But, unfortunately for us, and especially for trans queer women and nonbinary people, it's a bigger uphill battle because much of the medical establishment fails to understand us or take us seriously. The good news is that there are more resources than ever, especially queer sex educators, to help us understand how to have safer sex.