Advice about sex is important for lesbians

Editor -Last month's editorial discussed an important area of health care for a group whose needs are often neglected by the medical profession.¹ But the title's reference to "women who have sex with women" is misleading. This concept is useful for considering sexual health but is irrelevant for other healthcare issues affecting lesbians and bisexual women, for whom specific sexual behaviour is not a useful way of defining health risks. Sex is just one aspect of being a lesbian or bisexual woman. A woman who considers herself a lesbian or bisexual may have never had sex, may have had sex only with men, may have had sex with both men and women, or may have had sex only with women. Regardless of her sexual activity, she could be at risk of all of the physical, mental, and social health issues identified in the editorial.

The editorial lacks practical advice for women who have sex with women about safer sex to minimise health risks. Simple advice includes:

Avoid transferring vaginal fluid from one woman to the other on fingers, etc

Avoid sharing sex toys. If sharing, ensure toys are well washed between uses or covered with a condom, which should be changed for each woman

To make oral sex safer, use a dental dam (available from many sexual health clinics or may be made from a cut-up condom or non-porous cling film) to cover the vulva

Use a lubricant on sex toys to help prevent soreness and friction

Be aware that if blood is involved through menstruation or trauma, HIV infection is a risk.

In a Glasgow clinic for lesbians, an audit showed that more than half of attendances were for reproductive and gynaecological issues.² In Glasgow, two thirds of lesbians and bisexual women either had children or hoped to have children in the future. These women have three options for conception—sex with a man, self-insemination, and insemination at a clinic. Lesbians and bisexual women in the United Kingdom may also adopt or foster. Doctors should be aware of all the options available and be prepared to offer accurate advice and appropriate referrals.

Many lesbians are not “out” to their healthcare providers. This is a problem because it may compromise care and lead to irrelevant focus on issues such as birth control and reproduction while neglecting issues that are more relevant. For instance, in one study 16% of lesbians had been pressurised by their general practitioner into accepting a form of birth control.³ Doctors should provide a non-judgmental atmosphere and avoid assumptions about heterosexuality or sexual activities.

1. Hughes C, Evans A. Health needs of women who have sex with women.studentBMJ 2003;11:395-6.(November.)
2. Carr SV, Scoular A, Elliott L, Ilett R, Meager M. A community based lesbian sexual health service: clinically justified or politically correct? Br J Fam Plann1999;25:93-5.
3. Lehmann JB, Lehmann CU, Kelly PJ. Development and health care needs of lesbians. J Womens Health1998;7:379-87.