Sexual health guide for LBT women and people with vaginas

In 2008, a Stonewall report found that many lesbian and bisexual women felt that sexual health services were not tailored to their needs.¹ Plus, clinicians often presumed they were heterosexual.² While LGBTQ+ acceptance and awareness has grown since then, it can still be hard to find good-quality sexual health resources for women who have sex with women (WSW).

From facts about STIs to specific guidance on contraception, we’ve covered all the need-to-know sexual health basics below for LBT women and people with vaginas.

But first, a brief note: when we use the word “woman” in this article, we’re referring to everyone who identifies as a woman. If we’re talking about something that affects people with certain bodies, for example if they have a cervix or vagina, we’ll make that clear.

How common are STIs in women who have sex with women?

In a large study of 15,000 people in the UK, roughly 8% of women aged 16-44 reported having had a sexual experience involving genital contact with another woman, and just under 5% of 25-34 year old women reported at least one female sexual partner in the past 5 years.³

This study was conducted in 2013 — the latest version of the study is still underway — and since then the proportion of the UK population identifying as lesbian, gay or bisexual has increased.⁴ So, these statistics may well underestimate the number of women who have had sex with another woman.

Bacterial vaginosis (BV) was about 1.5 times more common in WSW, and even more common among those women who only had sex with other women

WSW may think they have a lower risk of STIs.⁵ This is not the case: whilst rates of some STIs, like HIV, are less likely to be transmitted via sex between women, WSW are still at risk of STIs, even if they don’t have sex with men at all.

One 2001 study from Australia looked at rates of STIs in 1,408 WSW, and compared these to rates of STIs in 1,423 women who reported they had not ever had sex with a woman. The study found that bacterial vaginosis (BV) was about 1.5 times more common in WSW, and even more common among those women who only had sex with other women.⁶

The reasons for this are unclear, but it may be because exchange of vaginal fluid between people with vulvas passes on BV more easily than penile-vaginal sex.⁷ In the Australian study, there were no differences between these groups in rates of gonorrhoea, chlamydia or herpes, although WSW were slightly less likely to have genital warts.⁸

Plus, many of the WSW in the study reported having had sex with men in the past, so it is possible that STIs were caught from sex with a man rather than with a woman. This is in keeping with data, which shows that 85% of WSW are currently sexually active with men or have been in the past.⁹

WSW are also more likely to report some other risk factors, such as injecting drugs, which might affect the risk of STIs such as HIV.¹⁰ However, whilst possible, there are very few cases of transmission of HIV via sex between women.¹¹

How can STIs be passed between people with vaginas?

Genital-to-genital contact

Touching your genitals against someone else’s (for example, during scissoring/tribbing) can pass on some STIs, including HPV (human papillomavirus).

HPV can cause genital warts and some forms of the virus are also associated with certain cancers, like cervical and vaginal cancer. The cervical cancer vaccine (e.g. Gardasil or Cervarix) protects against some, but not all, strains of HPV. Other STIs that can be passed on through skin-to-skin contact include herpes (HSV) and pubic lice (sometimes called crabs).

Shared sex toys can spread STIs because they can be a vehicle for passing body fluids between different people

Genital-to-genital contact can also lead to the exchange of vaginal fluids (or menstrual blood), which can spread STIs such as chlamydia, gonorrhoea, and HIV. Exchange of vaginal fluids can also happen if you have touched your genitals then touch someone else’s, or vice versa.

Oral-genital contact

Touching your mouth against someone’s genitals, or vice versa, during oral sex can also pass on STIs. Herpes, aka herpes simplex virus (HSV), in particular, can be passed on this way. If you or your sexual partner have a cold sore or any vulval sores which could be HSV, avoid oral sex until the sores are fully healed.¹²

However, HSV can spread even where no symptoms are present: people who have HSV can produce viral particles that can spread to others, even during periods where they do not have any visible symptoms.

Sharing sex toys

Shared sex toys can spread STIs because they can be a vehicle for passing body fluids between different people. Sharing sex toys can also spread some vaginal infections that are not usually considered STIs, like BV and thrush.

Safe sex tips

As we’ve seen, STIs can be passed between women and people with vaginas. As with any type of sex, there are ways to minimise the risk of STIs and keep you (and your sexual partners) safe. Here are a few tips for safe sex:

• If either you or your sexual partner have any cold sores or vulval sores (which could be HSV, or another STI like syphilis), avoid kissing and oral sex. Although this does not eliminate the chance of passing on STIs (especially HSV), it is likely to reduce it
• If sharing sex toys, put a condom over them and replace it with a new condom before using the toy on another person. If the toy is small, a finger cot — a miniature condom designed to fit over a finger — might be better
• Having sex whilst you or someone else is menstruating increases the chance of exchanging body fluids. You can minimise the risk of passing on STIs by making sure you have both been tested, or by using protection such as finger cots (for fingering/genital touching) and dental dams (for oral sex/anal play)
• UK guidelines advise testing and/or treating female partners of women who have BV,¹³ so it is worth discussing with your GP if you or your female partner has BV or symptoms (like watery, fishy-smelling discharge) that could be BV
• Regardless of your gender identity or sexual orientation, you should be tested for STIs if you are sexually active, especially if you have had or expect to have new sexual partners

Do I need to use contraception?

For lesbian and bisexual women

Regardless of how you or sexual partners identify, there is a risk of pregnancy if you have a uterus/ovaries and have sex with people who have a penis.

If you do not want to become pregnant (and also want to protect against STIs), you can use either internal (“female”) condoms, which fit inside the vagina, or external (“male”) condoms, which fit over the penis.

If you have sex with men or trans women who have not had bottom surgery, there is a chance you could become pregnant

You can also use another contraceptive method like the implant, pills, IUDs, or the injection, depending on your medical history.

If you have had unprotected sex, you have the option of using emergency contraception. The emergency pill (“morning after” pill) is available from pharmacies, GPs and sexual health clinics; the copper IUD can also be used as contraception, and is available from sexual health clinics and some GPs.

For trans men and non-binary people with a uterus/ovaries

Some trans and non-binary people take medications such as testosterone or gonadotropin-releasing hormone (GnRH) analogues. However, these treatments do not prevent pregnancy.

If you have sex with men or trans women who have not had bottom surgery, there is a chance you could become pregnant. Contraception is therefore recommended for all trans men or non-binary people with a uterus/ovaries who want to avoid pregnancy. If you do become pregnant and want to continue with the pregnancy, you will likely be advised to stop taking testosterone due to the risk of problems with foetal development.¹⁴

If you have a cervix and have ever had sex, you should have regular smear tests to screen for cervical cancer

Trans men and non-binary people have several options for contraception: copper IUDs do not interfere with the hormonal treatment, and progestogen only-methods (like the progesterone-only or “mini” pill, implants, hormonal IUS or injections) are also thought to be safe. Progestogen-only methods may also reduce or stop period bleeding.¹⁵

Cervical cancer screening

If you have a cervix and have ever had sex, even if you’ve never had penetrative sex with someone who has a penis, you should have regular smear tests to screen for cervical cancer.

Unfortunately, many people — health workers included! — are sometimes misinformed about this, but cervical screening should be offered to people with a cervix regardless of their sexual orientation.

In the UK, women are invited for a smear test every 3 years between the ages of 25-49, and then every 5 years between the ages of 50-64.¹⁶ If problems are detected during smear tests (for example, if a smear is positive for HPV), you will have smear tests more regularly.

The cervical screening recall system, which keeps track of who is due a smear test and sends out invites accordingly, includes only those who have their sex coded as “female” on GP records.

If you are a trans man registered with your GP as male, you will not receive invitations to cervical screening automatically. You are still eligible for smear tests, but will need to ask your GP practice or a sexual health centre for an appointment.¹⁷ There are also specialist sexual health services like clinicQ, who offer smear tests for trans and non-binary people.
 
Featured image is of two women leaning into each other affectionately, as if about to kiss
 
Page last updated June 2023
Next update due 2026