Safer Sex Practices
- Wet Kissing: is safe unless either of you has a cut or sore in your mouth, or bleeding gums. (After you brush or floss your teeth, wait at least 1/2 hour before kissing.) Blood, not saliva, contains disease.
- Touching your lover's breasts is safe. You can lick, suck, kiss and bite them too-as long as there's no blood or breast milk. Massage, dry kissing, masturbation (touching yourself), and body-to-body rubbing are all safe.
- Putting your fingers inside her can be risky. To be safe, wear latex gloves. If you use a lubricant, be sure it is water-based. (Oil-based lubricants like Vaseline and hand lotion will damage the latex.)
- Sores or cuts on your fingers, mouth or vagina-or hers- increase the risk. They can provide a way for the virus to get inside you. If you touch her vagina and then touch your own (or vice-versa,) you could spread the virus. Be sure to use gloves in between!
- Contact with menstrual blood is very risky.
- Oral sex on a woman is risky, especially when she has her period. Latex dams-also called "dental dams" or glyde dams - are safe to use for oral sex too. Do not use same dam twice, reverse it or use on anal area as well as vagina. Condoms can be cut to form a dam but only if they are non-lubricated.
- Sex toys are safe by themselves, but it is risky to share them. If you share dildoes or vibrators, cover them with a condom and put on a fresh one every time it is used by a different person.
- SM activities are safe if there is no blood involved. If you are piercing each other, clean the needle with bleach between users. Use different razors if you shave each other.
STIs & Vaginal Infections in Women Who Have Sex With Women
Below is a listing of STI's and vaginal infections. There is a focus primarily on woman to woman transmission (WTW) and only a general overview of the infections themselves. Due to the fact that so little study has been done on WTW its difficult to know the exact health risks.
Bacterial Vaginosis (BV): BV is basically an imbalance of the normal bacteria that live in the vagina, most specifically in association with loss of the normal protective lactobacilli that normally live there in abundance. It is not clear what precisely causes BV; some researchers think women sex partners may actually transmit some undefined factor that causes it. Research continues on this question. We do know douching is a risk factor for BV (and douching is a bad idea in general).
- Symptoms: gray to yellowish homogenous discharge, sometimes with an odor, sometimes causing vulvar &/or vaginal irritation.
- Transmission WTW: not clear. While one research article called BV a "STD among lesbians," this has yet to be proven, and research is underway to look at this more closely. Whether or not partners should be evaluated or treated is not yet known.
- Treatment: antibiotic vaginal cream or oral medication (metronidazole or clindamycin).
Chlamydia : This STI is caused by bacteria transmitted to the vagina or rectum by contact with infected genital fluids. Chlamydia can infect the cervix, rectum or urethra (the passage through which urine exits the body) in women.
- Symptoms: usually none. Sometimes slightly increased vaginal discharge, spotting, burning with urination, abnormal bleeding (especially after penetration).
- Transmission WTW: theoretically possible but not yet studied.
- Treatment: All partners should be treated.
Gonorrhea : This STI is caused by bacteria transmitted to the vagina, throat or rectum by exchanging infected genital fluids during sex.
- Symptoms: often none. Occasionally, vaginal discharge—often yellow or yellow-green—and painful urination can occur, as can abnormal bleeding, especially after penetration.
- Transmission WTW: theoretically possible but not yet studied.
- Treatment: Antibiotics. All partners should be treated.
Hepatitis : Inflammation of the liver. Many potential causes, including drugs, toxins and viruses. Hepatitis A, B, & C are the three major viruses that cause hepatitis.
- Symptoms: Often none. If symptoms do occur may include yellowing of skin & eyes, loss of appetite, nausea, stomach pain, extreme tiredness.
- WTW transmission: Hepatitis A is transmitted by fecal matter either in contaminated food or by oral-anal contact. Transmission between female partners has been reported.
Hepatitis A is transmitted by exchanging blood or body fluids. Touching an infected person's open sore or cut if you yourself have any skin breaks, or sharing a razor, toothbrush or nail clipper, can permit transmission. Even small amounts of blood or other body fluids can spread the virus if direct contact occurs. *Hepatitis A is preventable by vaccination.
Hepatitis B is not spread by food, water or casual contact. Transmission between female partners has not been studied, but has occurred. *Hepatitis B is preventable by vaccination
Hepatitis C is transmitted primarily through contact with infected blood. Sexual transmission between men and women is relatively uncommon; WTW has not been studied.
- Treatment: A complex issue.
Herpes (Genital) Infections : These infections are caused by the herpes simplex viruses (HSV-2 and HSV-1). Transmission can occur even when lesions are not present (in fact, probably most transmission actually occurs in the absence of skin ulcers or breakdown, which is why 90% of persons infected with HSV-2 don't know they're infected).
·Symptoms: small blisters on the vulva, often painful, are classic, but at least 90% of people infected with HSV-2, which causes the majority of genital herpes, do not know they are infected. Itching is a common symptom. In the initial episode of HSV, symptoms can include painful/difficult urination, fever, swollen lymph nodes, and flu-like symptoms.
- Treatment: three antiviral medications (acyclovir, famciclovir, valacyclovir) are now available & all work equally well. Antivirals are also recommended for recurrences and suppression when there are more than 6 recurrences a year. Antivirals help the symptoms of HSV and speed healing; they do not cure the virus. They also reduce the likelihood that HSV is shed in the absence of outbreaks.
- Transmission WTW: Data on specific prevalence and risks is very limited. In particular, oral-genital contact (oral sex) can transmit HSV-1 from the mouth to the genital area, especially when one partner has a cold sore.
- Precautions: because transmission can occur even when no lesions are present, any genital-genital contact should involve latex barriersall of the time; couples should abstain from sex during outbreaks, until the skin is fully healed.
HIV/AIDS : AIDS is caused by the HIV virus. It is spread through direct contact with blood, semen, vaginal fluids, or breast milk, usually during sex, birth, or sharing needles. The HIV virus slowly attacks white blood cells which constitute a major part of the body's immune system. White blood cells fight infections. When the immune system is weak, harmful germs & infections take over, and AIDS (acquired immunodeficiency syndrome) becomes evident.
- Transmission WTW: while there is little research or documentation on this topic, the medical literature does have case reports of WTW sexual transmission of HIV. The most likely sources for transmission are menstrual blood, vaginal discharge when there is vaginitis (there are more white blood cells containing HIV present then), and traumatic sex practices. However, more research is urgently needed in this area; none of these mechanisms, or their relative risk, have been directly studied yet.
- Treatment: There are numerous drug therapies to help the immune system and fight the HIV virus, though at this time there is no cure.
Human Papillomavirus (HPV)/Genital Warts: HPV is probably the most common STI (with most infected people never evidencing its two major effects: genital warts, and cervical neoplasia (pre cancerous or cancerous changes, detected as an abnormal Pap smear). It is an STI caused by skin or mucous membrane contact with an infected person. Different strains of HPV cause genital warts and cervical cancer.
- Transmission WTW: Probably occurs through direct contact of genital skin, or contamination of hands/fingers. The role of insertive sex toys is not known for sure, but it's possible that HPV could be transmitted on shared toys not thoroughly cleansed between use in one (infected) partner and the next.
- Treatment: if warts are present, the most common treatment is freezing using liquid nitrogen; more than one treatment may be required. There is no cure for the virus itself.
Pap smears can detect HPV and cervical changes ; yearly exams are essential for all sexually active women, regardless of the gender of partners. Research has shown that lesbians may be less likely to get Pap smears as frequently as they should. Get routine screening (every 1-2 years, depending on your Pap smear history) regardless of whether you have sex with men.
Pubic Lice : "Crabs" There are 3 kinds of lice that can live on humans: head lice, body lice, and pubic or crab lice. Lice move relatively slowly and cannot survive more than 24 hrs without human contact.
- WTW Transmission: Any close contact w/ an infected person or their clothes or bed linens can allow for contact, so sex partners are at very high risk. However, you might be relieved to know that lice cannot hop or fly.
- Treatment: Special shampoos, cream rinses & lotions (obtained by prescription). All partners for the last 30 days must be treated. For washable clothing and bedding use HOT cycle of washer and dryer. Dry cleaning or keeping items isolated from body for 10 days will also kill lice and eggs.
Scabies :A skin infestation by mites (tiny bugs). Mites likes to burrow in warm moist places like between fingers/toes, the wrist, armpits, breasts, skin folds, and waist. The female mite gives off a chemical as it burrows under the skin. This chemical, not bites, is what causes the itching.
- Symptoms: Itching, especially at night. The first time a person gets scabies it takes 2-6 weeks for the itching to start. The second time a person gets scabies the itching starts in 1-2 days. Scabies can mimic other skin rashes and look differently on different people. Test for scabies is a small skin scraping for microscopic examination.
- WTW Transmission: Primarily by close contact, including sex, with an infected person. Mites can live a couple of days in fabric and dust. An infected person can transmit scabies even if they have no symptoms.
- Treatment: 5% permethrin cream (not the 1% used for lice). Be sure to put some lotion under finger and toe nails. All sex partners, close contacts, and anyone else living with you within the last month should be tested and treated. You may have to be treated more than once. Itching may continue for a few days even if the mites are dead, though it should lessen. For washable clothing, bedding, towels, rugs and toys use the HOT cycle of washer & dryer or dry clean. Things that can't be washed in hot water can be placed in plastic bags and sealed for 3-4 weeks.
Syphilis :An STD caused by a spirochete that is usually detected with a blood test. Some of its most devastating effects occur when it is transmitted from a pregnant woman to her foetus.
- Transmission WTW: unknown, but theoretically possible. Contact with the sores or rash of an infected person during sex is the main mode of transmission.
- Symptoms: 10-90 days after sex a painless single sore appears in the area where contact was made. The sore "chancre" usually feels hard at the edges. It does not hurt. It can look like herpes, warts, scabies or hemorrhoids. The sore is very contagious. After 2-6 weeks the chancre goes away. If untreated, 6-8 weeks later, the second stage begins in about 30% of persons. Symptoms can last from 2 weeks to 6 months and include swollen lymph nodes, rashes, or a flu-like feeling. There may be different genital sores that look like flat grayish warts. Like other syphilis sores, these are highly infectious and can spread the disease. Symptoms start to go away in 2 weeks. Infection untreated beyond this point can eventually cause serious damage to the heart, nervous system, kidneys, eyes, and brain.
- Treatment: Penicillin injection, routine treatment of sex partners.
Trichomoniasis :"Trich", tiny protozoa, can present like BV but in contrast is definitely an STD. It lives in the moist areas of the genitals of infected people (e.g. vaginal fluid, genital glands).
- Symptoms: Often causes foamy discharge with foul odor, but symptoms may be absent. Painful urination, itching or irritation is sometimes present. If symptoms occur, they usually occur 4-20 days after infection but can begin much later.
- Transmission WTW: clearly documented, and probably underestimated. Partners should absolutely be evaluated and treated. Both partners should abstain from sexual activity until treated.
- Treatment: metronidazole in a single dose. Partners should be treated.
Urinary Tract Infections (UTIs)
Pain while urinating. Frequent need to urinate. Lower abdominal pain. Involuntary urination.
Treatment: Antibiotics.
Pelvic Inflammatory Disease (PID)
Treatment: Antibiotics, bed rest, and sexual abstinence.
Unusually long or painful periods. Vaginal discharge. Fever / nausea / chills.
Molluscum Contagiosum
Treatment: Growths removed with freezing or chemicals.
Small, pinkish-white, waxy, round, polyp-like growths in the genital area or on the thighs.
Cytomegalovirus (CMV)
Swollen glands, fatigue, fever & general weakness. Digestive problems. Loss of vision.
No cure.
Treatment: Variety of drugs to manage symptoms.
Candida (Thrush)
Thick discharge from vagina. Soreness/pain during urination.
Treatment: Pessaries
