Consistent, non-judgmental sexual health care for lesbian
women that supports them to make informed decisions depends on partnership and good communication with their health care providers.
Because this kind of communication is often lacking, many women who have sex with women are unaware of their individual risk factors for
contracting sexually transmitted infections (STIs).
Michele Clarke of the Sherbourne
Health Centre in Toronto says, "It's not that surprising when you consider that many women are still being told that if they're not
having sex with men, then they don't need to worry."
Risk factors for women who have sex with women
The reality is that women who have sex with women are at risk of infection. Clarke explains: "Lesbian women can pass STIs to each other
through the exchange of body fluids, skin-to-skin contact, and mucosa contact (contact between the soft tissues that line body cavities
like your mouth and your vagina). This means transmission can occur from many types of sexual behaviours including kissing, oral sex and
sharing sex toys."
The STIs lesbians are most at risk of are:
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What about HIV? Risk factors for lesbian women
Although exact statistics for the number of lesbians with HIV are unknown, there have been reported cases of HIV transmission through
woman-to-woman sexual contact.
It's important to know the sexual activities that may put lesbian
women at risk of HIV infection and choices that can reduce these risks.
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Lack of appropriate health services—a concern
Gens Hellquist, Executive Director of the Canadian
Rainbow Health Coalition says that a lack of accurate, non-judgmental sexual health information and appropriate health care is the most
important sexual health concern for women who have sex with women.
"Lesbian sexual health issues are embedded in a larger problem of finding qualified, informed, non-homophobic health care
professionals," explains Hellquist. He adds that, "What often happens is that, because they have had negative experiences with health care
professionals in the past, many lesbian women postpone interacting with the health care system until health issues become severe or chronic."
The Lesbian Health Guidelines published by the
Society of Obstetricians and Gynecologists indicate that 15% of lesbian women in Canada do not go for regular check-ups because they
believe that heterosexism will negatively affect their treatment.
Challenging assumptions about risk factors
The Guidelines state that many physicians assess sexual health risk factors for lesbians based on assumptions about their sexual
behaviors.
For instance, many health care providers assume that lesbians don't need to be screened for some STIs or don't require a Pap
test. The assumption is that a woman who identifies as a lesbian has never had sex with a man, or isn't currently having sex with men,
so certain risk factors are often not considered by physicians. However, Pap screening is recommended for all sexually active women and
women over the age of 18, regardless of whether or not they've had sex with a man.
The Guidelines advise physicians not to make assumptions about their clients' sexual behaviours based on sexual orientation. They
recommend that, "the specific sexual practices of a patient determine her risk of particular diseases and are important in developing
individual medical recommendations."
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Health care providers need to ask the right questions
It is important that health care providers help to create a comfortable environment in which a lesbian client will feel able to engage
in an open dialogue about her specific risk factors.
The Guidelines suggest that physicians use non-judgmental questions that don't assume heterosexuality, such as:
- Are you in a relationship?
- Are you sexually active?
- Do you have a partner or partners?
- Are you sexually active with men, women, or both?
These are open questions that move away from assumptions about a patient's sexual orientation. This way, a physician is better able to
understand the patient's experience, communicate to the patient how she can take care of her sexual health and ensure that she is aware of
her risk of contracting STIs.
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Health services for lesbians—raising the bar
Good health care depends on a trusting relationship between a patient and her health care provider. Because homophobia can have such
detrimental effects on the lives of lesbian women, it is important that health care providers take steps to make sure that their services
are non-judgmental and sensitive to the needs of a diversity of clients. Once an open, comfortable environment has been established, it is
important for lesbian women to communicate with their physicians to the degree that they feel safe, and it is their right to expect to
receive quality care and information that is relevant to their specific needs.
If you're a lesbian woman, what can you do to protect your sexual health?
- Protect yourself from STIs by using latex gloves and barriers when you're having sex and by not sharing sex toys—use different toys
for each partner or use condoms on your toys and change condoms between uses.
- Know your own sexual health status—this means getting tested regularly for STIs, especially before starting a new relationship, and
asking your partner to do the same.
- Watch for changes in your body and if you experience any unusual symptoms, get them checked out as early as possible.
- Go for a regular Pap test, even if your health care provider tells you it's not necessary for women who have sex with women.
- Talk to other women! Share information within your communities so that other women can become aware of their own risks.
- Be as open as possible with your health care provider about your sexual history so that you can get the information you need to make
the healthiest choices for you.
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This article was prepared by the Canadian Federation for Sexual Health, CHN’s 
