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Safer sex education must be based on sexual behaviour and not on sexual orientation. It is important to take a full sexual history on all patients, regardless of sexual orientation, and to determine which sexual behaviours patients are engaging in.
There is little information about safe sex for lesbians[1]. Women who have sex with women have been largely ignored by HIV/AIDS prevention and safer sex education campaigns[2]. Because there are few public health campaigns directed at women who have sex with women health care providers need to fill this void and be knowledgeable about safer sex practices and comfortable discussing them with patients[2]. In one Canadian study of lesbian and bisexual women in the Atlantic provinces[2], the interview participants articulated concerns that the medical profession still enforces heterosexual norms by asking questions about sexual health that assume a woman is having sex with men. This heterosexism left participants feeling unable to get the required information and responsible for educating their providers on safe sex for women who have sex with women.
Safer Sex | ||
Activity | Increasing Risk | Safer Sex |
Dry Kissing | Considered a safe act | |
French Kissing (Insertion of the tongue while kissing) | Sores in the mouth | Avoid brushing teeth or flossing before kissing |
Masturbation (either self or mutual masturbation with NO exchange of body fluids) | Considered a safe act | |
Tribadism/Dry Humping/Frottage | Tears or abrasions | Avoid if one partner has a contagious skin infection |
Digital Stimulation/Fingering (Finger stimulation of the vagina or rectum) | Tears or abrasions | Use of latex gloves or individual finger cots |
Cunnilingus/Going Down On/Eating Out (Oral sex on a woman) | Menstruation, open sores or lesions | Use of dental dams |
Fellation/Giving Head/Giving a Blow Job (Oral sex on a man) | Ejaculation, open sores or lesions | Use of condoms |
Sex Toys | Presence of blood or other body fluids on the toys | Use of condoms and changing condoms between partners or between orifices; cleaning toys using bleach between partners |
Penile-Vaginal Intercourse | Tears or abrasions | Use of condoms or female condoms, use a new condom when using a new orifice |
Penile-Anal Intercourse | Tears or abrasions | Use of condoms or female condoms |
Analingus/Rimming (Oral-anal stimulation) | Tears or abrasions | Use of dental dams |
Water Sports (Urinating, expelling a douche or an enema on one’s partner) | Tears or abrasions | Use of disposable nozzles, latex gloves, personal bags |
Fisting (Insertion of the fist into the vagina or anus) | Tears or abrasions | Use of latex gloves |
Sadomasochism/S&M/Bondage/ Whipping/Paddling/Not "Vanilla Sex" | Must have a safe word; physician should ensure that any wounds were obtained voluntarily | |
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1. Solarz, AL Ed. Lesbian Health: Current Assessment and Directions for the Future. Washington DC. National Academy Press; 1999.
2. Bailey N, Gurevich M, Mathieson C. Voix Feminstes / Feminist Voices No. 10. Invoking community : rethinking the health of lesbian and bisexual women. Ottawa, ON. CRIAW = ICREF; 2000.
