- • Transmission of common sexually transmitted diseases
(STDs), including trichomoniasis and human papillomavirus (HPV),
has been reported in women who have sex with women (WSW).
- • Transmission likely is mediated through exchange
of infected cervicovaginal secretions or direct contact.
- • Most WSW, including self-defined lesbians, have
had sex with men.
- • Barriers to care exist for many WSW, including
lack of provider education about relevant issues.
- • Papanicolaou (Pap) smear screening should be performed
in WSW according to routine national guidelines.
Relatively few data are available to inform estimates of the
risk of female-to-female sexual transmission of STDs. The available
data come primarily from four sources.
First, review of records from clinics that provide STD services
(STD clinics) has provided estimates of some outcomes, including
diagnosis of STD syndromes, laboratory results, and risk reporters.
Such studies have the advantages of capturing a reproducible population
of women who can be characterized relative to heterosexual women
attending the same venue and of relying on clinician-based or laboratory-defined
reports of outcomes, but are limited primarily by the relatively
small number of WSW who attend these clinics.
Second, several studies have recruited women who either self-identify
as lesbian or who report recent same-sex behavior, regardless of
stated identity. Although this type of study may capture a more
representative sample of WSW and frequently includes laboratory
diagnosis of STDs, the sample of women included is likely biased
due to self-selection for enrollment.
Third, although population-based surveys attempt to enroll a
more representative sample of women, including WSW, because these
surveys are generally expensive and complex to undertake, most do
not include laboratory-confirmed assessment of STDs but rely on
self-reported STD history.
Finally, case reports of STD transmission between women provide
the only documented evidence available for some STDs. Despite their
obvious limitations, these reports are valuable in that they can
demonstrate the potential for STD transmission between women and,
as such, help to emphasize the need for more robust, population-based
data to inform WSW patients and their providers about the true risks
associated with same-sex behavior between women.
Numerous studies have demonstrated that important barriers to
health care exist for WSW. These barriers include, but are not limited
to, lack of patient educational materials aimed at their specific risks
and circumstances, lack of knowledge among providers, low socioeconomic
status, absence of spousal benefits, and impact of negative experiences
within the health care system. Among the latter are included outright
instances of homophobia and general invisibility. For example, many office
registration materials still list options for marital status as “single” or “married”—terms that
do not apply to WSW who may be in domestic partnerships, particularly
those that are not recognized by regulatory authorities. Even providers
who are comfortable assessing STD-related risks may not be knowledgeable
about the sexual practices engaged in by many WSW, or about the
limited disease-specific information in the literature. For these ...