Lesbians, like all sexually active people, need to consider safer sex practices to protect their health and the health of their partners. While the concept of a barrier method is generally associated with preventing pregnancy, that concern is absent in exclusive female-female sexual encounters. The focus of safer sex in this context shifts entirely to the prevention of sexually transmitted infections (STIs) and other transmissible health conditions. Practicing safer sex remains a necessary consideration for all individuals engaged in sexual activity, regardless of partner gender, and involves adopting methods that minimize the exchange of bodily fluids and skin-to-skin contact.
Transmission Risks in Female-Female Sexual Contact
Sexually transmitted infections (STIs) can pass between female partners primarily through the contact of mucosal surfaces, the exchange of vaginal or other bodily fluids, and skin-to-skin contact with infected areas. The risk of transmission varies significantly depending on the specific STI and the sexual practices involved. Infections that spread easily through skin contact are of particular concern.
Human Papillomavirus (HPV), which can cause genital warts and is responsible for cervical cell changes, is readily transmitted through intimate skin-to-skin contact, even when no visible warts are present. Studies have found HPV DNA in a significant percentage of women who have sex with women (WSW). Herpes Simplex Virus (HSV), which causes genital and oral sores, is also transmitted through skin contact, especially during an active outbreak or via viral shedding.
Other infections, such as Syphilis, can be transmitted through contact with an infected sore, which may occur during oral-genital contact. Bacterial Vaginosis (BV) and Trichomoniasis are common among female-female partners, and direct transmission of Trichomoniasis has been demonstrated. Recurrent BV has been linked to having a same-sex partner and a lack of barrier use. While the transmission of Human Immunodeficiency Virus (HIV) between female partners is uncommon, it is possible if sexual activities involve exposure to blood, such as during menstruation or through open sores.
Understanding Specific Barrier Methods
Since traditional condoms do not apply to all forms of female-female sex, specialized barrier methods are used to prevent the exchange of fluids and reduce skin contact. Dental dams are thin, flexible sheets of latex or polyurethane placed over the vulva or anus during oral sex to create a physical barrier between the mouth and the genital or anal area. This prevents the transmission of STIs that pass through bodily fluids, such as Syphilis, Gonorrhea, and Chlamydia. When using a dental dam, apply a water-based lubricant to increase sensation and prevent friction, and use a new dam for each separate act of oral stimulation.
Barrier use also extends to manual and digital penetration, where nitrile or latex gloves and finger cots serve a protective function. These barriers cover the hands and fingers, preventing the transfer of bacteria and viruses, especially if there are cuts, hangnails, or long fingernails that could scratch the delicate mucosal tissues. The use of gloves also prevents the spread of infections from one body opening to another, for instance, from the anus to the vagina.
The sharing of sex toys is another common way STIs can be transmitted between partners. To prevent this, a new external or internal condom should be used on a shared toy every time it moves from one person to another or from one body opening to a different one. If a condom is not available, a dental dam can be created by carefully cutting the tip and the base off a condom, then slicing it down the side to form a rectangular sheet. Non-porous sex toys should be thoroughly washed with mild soap and warm water, or a specialized toy cleaner, after each use.
Non-Barrier Safer Sex Practices
Safer sex encompasses a broader range of practices beyond the use of physical barriers, integrating clinical and behavioral strategies for comprehensive sexual health. Regular STI screening and testing are fundamental, particularly because many STIs are asymptomatic and can go unnoticed for long periods. Women who have sex with women should follow standard guidelines for cervical cancer screening, which includes testing for high-risk HPV strains.
Open and honest communication between partners about sexual history and STI status is a proactive step in risk reduction. Partners should discuss their health status before engaging in sexual activity and agree on the safer sex methods they will use. This mutual responsibility is a foundation for a healthy sexual relationship.
Vaccination offers a preventive measure against certain infections. The HPV vaccine, for example, is recommended for individuals within the specified age ranges to protect against the most common types of HPV that cause genital warts and cancers. Avoiding sex during an active herpes outbreak or when open sores are present is a necessary behavioral adjustment to reduce the risk of transmission.