Women who have sex with women: Sexual health 101

Babylon doctor Maria Cabral-Jackson has personal experience of how hard it can feel for LGBTQ+ people to talk to a clinician about sexual health. In this blog, she talks about why it’s so important to bust lesbian sexual health myths and remember that all women, independent of sexual orientation, are at risk of STIs and cervical cancer.

The World Health Organisation states that sexual and reproductive health problems are responsible for one-third of health issues for women between the ages of 15 and 44 years and that unsafe sex is a major risk factor worldwide.¹ A 2018 Stonewall LGBTQ+ in Britain Health Report revealed that one in five LGBTQ+ people aren’t out to any healthcare professionals about their sexual orientation when seeking care².

Sadly this means that 20% of lesbian, bisexual and other women who have sex with women (LBWSW) do not disclose or discuss their sexual health with a doctor, and therefore miss out on important sexual health advice as well as essential cervical screening.

Cervical cancer is the most common cancer in women aged 35 and under, and regular smears can prevent 75% of cervical cancers. We know that a majority of cervical cancers are caused by HPV. The virus is passed on through bodily fluids, may it be oral sex, transferring vaginal fluids on hands and fingers, or sharing sex toys. Therefore women who have sex with women can catch STIs such as herpes, genital warts, syphilis, HPV and HIV. HPV can also be carried without symptoms for a number of years. This means women may have it and pass it on without being aware.

Numbers show that 72% of eligible women in England attend their smear tests.³ However according to the LGBT Foundation, 51% of eligible women who have sex with women have never attended a smear test⁴ and in the USA numbers are also reduced, with between 48% and 81% of lesbians reporting recent Pap smears.⁵ Sadly this results in poor sexual health and in otherwise preventable cervical cancers. Women who do not get screened are at a higher risk of cervical cancer and also at higher risk of presenting late with advanced disease. This means that their lives are put at risk from a disease that can be prevented or cured when diagnosed early.

So why are women who have sex with women not attending their cervical smears or talking to their doctors about their sexual health?

Sexual health education starts in schools. However, the Terence Higgins Trust report on LGBT-inclusive Sex and Relationships Education in the UK showed that only 5% of young people were taught about LGBTQ+ sex, relationships and IVF.⁶

The National LGBT Partnership conducted a survey online asking women who identified under the umbrella term of lesbian, bisexual and other female-partnered women to tell them about positive or negative experiences in their healthcare encounters.⁷ The assumption of heterosexuality was the most common negative theme. It was followed by other experiences such as clinician discomfort with the patient’s sexual orientation; the patient’s coming out being ignored or being given incorrect information or treatment. The most common positive theme was that the patient felt listened to or the patient’s sexual orientation was being acknowledged.

This survey shows how important it is for clinicians to make patients feel comfortable to discuss their sexual health, to listen to their patients and know to ask the right questions. Babylon prides itself on being an LGBTQ+ inclusive practice. Check out Dr Mark Perera’s blog on what makes an LGBTQ+ inclusive practice.

It’s important to break down myths and reiterate that all women, independent of sexual orientation, are at risk of STIs and cervical cancer. It is equally important that women who have sex with women feel empowered to discuss their sexual health with a doctor.

As a lesbian doctor, I know it can be hard to talk about these issues. It can feel at times that you are endlessly coming out; that feeling of - not again. I’ve been on the other side too, whilst discussing fertility and my IVF journey. It can make you feel vulnerable to talk openly. We worry about being judged or perceived in a different light. But when it comes to your health, you shouldn’t compromise. You should be entitled to live a healthy life. So if you have any symptoms or concerns, please speak to your GP or contact a sexual health clinic. We await you with compassion and empathy.

UK - Follow the NHS link on tips for safer sex between women: https://www.nhs.uk/live-well/sexual-health/sexual-health-for-lesbian-and-bisexual-women/

US - Follow the CDC link on tips for safer sex between women: https://www.cdc.gov/lgbthealth/women.htm

References

1. Who.int. 2021. Ten top issues for women's health. [online] Available at: <https://www.who.int/news-room/...'s-health> [Accessed 14 June 2021].
2. Stonewall.org.uk. 2021. [online] Available at: <; [Accessed 14 June 2021].
3. BBC News. 2021. Cervical screening: Millions missing smear tests. [online] Available at: <; [Accessed 14 June 2021].
4. Do lesbian and bisexual women still need smear tests? Patient.co.uk (2018) Graham, S., 2021. Do lesbians still need smear tests for cervical cancer? | LGBT smear test. [online] Patient.info. Available at: <https://patient.info/news-and-...,never%20attended%20a%20smear%20test.> [Accessed 14 June 2021].
5. Waterman, L. and Voss, J., 2015. HPV, cervical cancer risks, and barriers to care for lesbian women. The Nurse Practitioner, 40(1), pp.46-53.
6. Tht.org.uk. 2021. [online] Available at: <; [Accessed 14 June 2021].
7. Assets.publishing.service.gov.uk. 2021. [online] Available at: <; [Accessed 14 June 2021].