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]{{Short description|Sexual identity-neutral term}}
'''Women who have sex with women''' ('''WSW''') are ] who engage in ] with other women, whether or not they identify themselves as ], ], ], ], or dispense with ] altogether. The term ''WSW'' is often used in medical literature to describe such women as a group for clinical study, without needing to consider sexual self-identity. '''Women who have sex with women''' ('''WSW''') are ] who engage in ] with women, whether they identify as ], ], ], ], have other sexualities, or dispense with ] altogether.<ref name="Gorgos2011">{{cite journal|last=Gorgos|first=L. M.|author2=J. M. Marrazzo |year=2011|title=Sexually Transmitted Infections Among Women Who Have Sex With Women|journal=Clinical Infectious Diseases|volume=53|issue=suppl 3|pages=S84–S91|issn=1058-4838|doi=10.1093/cid/cir697|pmid=22080273|url=http://cid.oxfordjournals.org/content/53/suppl_3/S84.long|doi-access=free}}</ref> The term ''WSW'' is often used in medical literature to describe such women as a group for clinical study, without needing to consider sexual self-identity.


==Physical== ==Physical health==
===General===
In terms of medical issues with regard to ], the sexual identification of women who consult a medical professional is usually not sought nor volunteered, due to the misconceptions and assumptions about sexuality and the hesitancy of some women in disclosing their accurate sexual histories even to a physician.<ref>King, p. 219.</ref> Many women who do not participate in heterosexual activity do not go to see a physician because they do not require ], which is the initiating factor for most women to seek consultation with a ] when they become sexually active.<ref>Zimmerman, p. 359.</ref> As a result, these women are not screened regularly with ]s because they have a lower perceived risk of acquiring a ] or types of cancer. A factor which leads to lesbians neglecting to seek medical screening in the United States is a lack of health insurance offered by employers for same-sex domestic partners.<ref name="HHS">"", womenshealth.gov. ]. Retrieved January 12, 2009.</ref>
In terms of medical issues with regard to ], the sexual identification of women who consult a medical professional is usually not sought nor volunteered, due to misconceptions and assumptions about sexuality and the hesitancy of some women in disclosing their accurate sexual histories even to a physician.<ref>King, p. 219.</ref> Medical research on women's health often lacks differentiation between WSW and strictly-heterosexual women, which skews results towards the majority group.


Accessing ] is the initiating factor for most women to seek consultation with a ]. Thus, women who do not participate in ] may not see a physician upon becoming sexually active.<ref>Zimmerman, p. 359.</ref> As a result, these women are not screened regularly with ]s because they have a lower perceived risk of acquiring a ] or types of cancer. Lesbians are less likely than their heterosexual and bisexual counterparts to get screened for ], with some being refused screenings by medical professionals.<ref name=":5" />
⚫ When women do seek medical attention, medical professionals often fail to take a complete medical history. In a recent study of 2,345 lesbian and bisexual women, only 9.3% had claimed they had ever been asked their sexual orientation by a physician. A third of the respondents believed disclosing their sexual history would result in a negative reaction, and 30% had received a negative reaction from a medical professional after identifying themselves as lesbian or bisexual.<ref name="mravack">Mravack, Sally A. (July 2006)."Primary Care for Lesbians and Bisexual Women", ''American Family Physician'' '''74''' (2), pp. 279–286.</ref>


⚫ The lower rate of lesbians tested by regular pap smears makes it more difficult to detect cervical cancer at early stages in lesbians. The risk factors for developing ] rates are higher in lesbians than in heterosexual women, perhaps because lesbians are more likely to lack protective factors such contraceptive use, pregnancy, abortion, breastfeeding, and miscarriages.<ref>Vo, Christine, Carney, Michael (December 2007). "Ovarian Cancer Hormonal and Environmental Risk Effect", ''Obstetrics and Gynecology Clinics''34 (4) p. 687–700.</ref>
⚫ A patient's complete history helps medical professionals identify higher risk areas and corrects assumptions about the personal histories of women. In a similar survey of 6,935 lesbians, 77% had had sexual contact with one or more male partners, and 6% had that contact within the previous year.<ref name="mravack"/><ref group=note>Another summary of overall surveys found that women who identify as lesbian, 80-95% had previous sexual contact with men, and some report sexual behavior that is risky. (King, p. 221.)</ref>


⚫ Another factor which leads to lesbians neglecting to seek medical screening in the United States is a lack of health insurance offered by employers for same-sex domestic partners.<ref name="HHS">" {{webarchive|url=https://web.archive.org/web/20090129175054/http://www.womenshealth.gov/faq/lesbian-health.cfm |date=2009-01-29 }}", womenshealth.gov. ]. Retrieved January 12, 2009.</ref> When women do seek medical attention, medical professionals often fail to take a complete medical history. In a recent study of 2,345 lesbian and bisexual women, only 9.3% had claimed they had ever been asked their sexual orientation by a physician. A third of the respondents believed disclosing their sexual history would result in a negative reaction, and 30% had received a negative reaction from a medical professional after identifying themselves as lesbian or bisexual.<ref name="mravack">Mravack, Sally A. (July 2006)."Primary Care for Lesbians and Bisexual Women", ''American Family Physician'' '''74''' (2), pp. 279–286.</ref>
] is listed by the ] as the number one cause of death for all women. Factors that add to risk of heart disease include ] and ], both of which are more prevalent in lesbians. Studies show that lesbians have a higher ] and are generally less concerned about weight issues than heterosexual women, although they are more likely to engage in exercise regularly.<ref name="HHS"/><ref name="mravack"/>


⚫ A patient's complete history helps medical professionals identify higher risk areas and corrects assumptions about the personal histories of women. In a 2006 survey of 6,935 lesbians, 77% had had sexual contact with one or more male partners, and 6% had that contact within the previous year.<ref name="mravack"/><ref group=note>Another summary of overall surveys found that women who identify as lesbian, 80-95% had previous sexual contact with men, and some report sexual behavior that is risky. (King, p. 221.)</ref>
⚫ Lack of differentiation between lesbians and heterosexual women in medical studies that concentrate on health issues for women skews results for lesbians and non-lesbian women. Reports are inconclusive about occurrence of ] in lesbians.<ref name="mravack"/> It has been determined, however, that the lower rate of lesbians tested by regular pap smears makes it more difficult to detect ] at early stages in lesbians. The risk factors for developing ] rates are higher in lesbians than in heterosexual women, perhaps because many lesbians lack protective factors of pregnancy, abortion, contraceptives, breast feeding, and miscarriages.<ref>Vo, Christine, Carney, Michael (December 2007). "Ovarian Cancer Hormonal and Environmental Risk Effect", ''Obstetrics and Gynecology Clinics''34 (4) p. 687–700.</ref>


⚫ ===Sexually transmitted infections===
⚫ ==Mental==
]
⚫ Since medical literature began to describe homosexuality, it has often been approached from a view that sought to find an inherent psychopathology as the root cause. Much literature on mental health and lesbians centered on their ], ], and ]. Although these issues exist among lesbians, discussion about their causes shifted after homosexuality was removed from the ] in 1973. Instead, social ostracism, legal discrimination, internalization of negative stereotypes, and limited support structures indicate factors homosexuals face in Western societies that often adversely affect their mental health.<ref>Schlager, p. 152.</ref> Women who identify as lesbian report feeling significantly different and isolated during adolescence;<ref name="schlager153">Schlager, p. 153.</ref> these emotions have been cited as appearing on average at 15 years old in lesbians and 18 years old in women who identify as bisexual.<ref name="rust2">Rust, Paula, (March, 1993). "Coming out" in the Age of Social Constructionism: Sexual Identity Formation among Lesbian and Bisexual Women", ''Gender and Society'', '''7''' (1), p. 50-77.</ref> On the whole, women tend to work through developing a self-concept internally, or with other women with whom they are intimate. Women (heterosexual or otherwise) also limit who they divulge their sexual identities to and more often see being lesbian as a choice, as opposed to gay men, who work more externally and see being gay as outside their control.<ref name="schlager153"/>
⚫ Some STIs are communicable between women, including ] (HPV), ], ], ] (HIV), ] (BV), and ] (HSV). Transmission of specific sexually transmitted infections among women who have sex with women depends on the sexual practices women engage in. Any object that comes in contact with cervical secretions, vaginal mucosa, or menstrual blood, including fingers or penetrative objects may transmit sexually transmitted infections.<ref>{{cite web | title = Special Populations - 2010 STD Treatment Guidelines | publisher = CDC | url = https://www.cdc.gov/std/treatment/2010/specialpops.htm | access-date = 2015-06-23 | archive-url = https://web.archive.org/web/20150721222656/http://www.cdc.gov/std/treatment/2010/specialpops.htm | archive-date = 2015-07-21 | url-status = dead }}</ref> ] may indicate a higher risk of acquiring HSV,<ref>Frenkl, Tara Lee, Potts, Jeannette (February 2008). "Sexually Transmitted Infections", ''Urologic Clinics of North America'', '''35''' (1) p. 33–46.</ref> even among women who have had no prior sex with men.<ref>King, p. 226.</ref> HSV-2 infection in particular occurs in nearly 1 in 10 of lesbians.<ref>{{Cite journal|last1=Marrazzo|first1=Jeanne M.|last2=Stine|first2=Kathleen|last3=Wald|first3=Anna|date=2003|title=Prevalence and risk factors for infection with herpes simplex virus type-1 and -2 among lesbians|journal=Sexually Transmitted Diseases|volume=30|issue=12|pages=890–895|doi=10.1097/01.OLQ.0000091151.52656.E5|pmid=14646636|s2cid=22148830|doi-access=free}}</ref> Bacterial vaginosis occurs more often in lesbians, but it is unclear if BV is transmitted by sexual contact; it occurs in celibate as well as sexually active women. BV often occurs in both partners in a lesbian relationship;<ref>Risser, Jan M.H., Risser, William L., Risser, Amanda (December 2008). "Epidemiology of Infections in Women", ''Infectious Disease Clinics of North America'', '''22''' (4), pp. 581–599.</ref> a recent study of women with BV found that 81% had partners with BV.<ref>King, p. 229.</ref> Lesbians are not included in a category of frequency of HIV transmission, although transmission is possible through vaginal and cervical fluids and secretions; the highest rate of transmission of HIV from women to women is among those who have sexual intercourse with men, or participate in ].<ref>Zimmerman, 360.</ref><ref> Centers for Disease Control. Retrieved on January 9, 2009.</ref>

Many doctors consider sex between women to have negligible risk for transmission of STIs<ref name=":5">{{Cite book|url=https://books.google.com/books?id=Ylqqk9-5zUsC&pg=PA1012|title=Gynaecology.|date=2011|publisher=Churchill Livingstone/Elsevier|others=Shaw, Robert W. (Robert Wayne), Luesley, David., Monga, Ash K.|isbn=9780702048388|edition=4th|location=Edinburgh|oclc=787843377}}</ref> and fail to offer any information on prevention of STI transmission for sex involving two women.<ref name=":1">{{Cite journal|last=McNair|first=Ruth|author-link1=Ruth McNair|date=2005|title=Risks and prevention of sexually transmissible infections among women who have sex with women|journal=Sexual Health|volume=2|issue=4|pages=209–17|doi=10.1071/sh04046|pmid=16402667|issn=1448-5028|doi-access=free}}</ref> Although lesbians have a lower risk of contracting STIs than their heterosexual and bisexual counterparts,<ref name=":6" /> the risk still exists.<ref name=":8">{{Cite book|url=https://books.google.com/books?id=ot8UW1qzi4kC&pg=PA133|title=Lesbian, Gay, Bisexual, Trans and Queer Psychology.|last=Clarke, Victoria.|date=2010|publisher=Cambridge University Press|isbn=9780521700184|oclc=1031490912}}</ref> Additionally, most WSW have had sex with men at some point in their lifetime, which significantly increases the risk of infection.<ref>{{Cite book|url=https://books.google.com/books?id=ot8UW1qzi4kC&pg=PA133|title=Communicating Women's Health : social and cultural norms that influence health decisions|others=Madlock Gatison, Annette|isbn=978-0815386490|location=New York|oclc=1004726096|last1=Clarke|first1=Victoria|last2=Ellis|first2=Sonja J.|last3=Peel|first3=Elizabeth|last4=Riggs|first4=Damien W.|date=April 2010}}</ref> Yearly pelvic exams are encouraged for WSW to contain the complications of STIs.<ref name=":6">{{Cite book |last=Carroll |first=Janell L. |url=https://books.google.com/books?id=9A9EDwAAQBAJ&pg=PT440 |title=Sexuality now : embracing diversity |date=January 2018 |publisher=Cengage Learning |isbn=9781337404990 |oclc=1064600804}}</ref>

=== Safe sex ===
There are various ways for WSW to protect against the contraction of STIs during sex, though these methods are not well studied. ]s, ]s on ]s, gloves, and ]s are all used as protection during various forms of sex. Most WSW do not use protection during sex, due to misconceptions that a lower risk of STI transmission means that barriers are not needed.<ref>{{Cite book|url=https://books.google.com/books?id=Fbs0CwAAQBAJ&pg=PA121|title=Communicating Women's Health: Social and Cultural Norms that Influence Health Decisions|last=Gatison|first=Annette Madlock|date=2015-12-07|publisher=Routledge|isbn=9781317553892}}</ref> Engaging in oral sex without the use of a dental dam or condom is considered a high risk sexual behavior.<ref name=":6" />

The CDC recommends using a dental dam during oral sex.<ref name=":0">{{Cite web|url=https://www.cdc.gov/condomeffectiveness/Dental-dam-use.html|title=How to Use a Dental Dam {{!}} CDC|date=2019-02-22|website=www.cdc.gov|access-date=2019-10-27}}</ref> Additionally, HIV prevention organizations distribute dental dams along with condoms and other safe sex supplies.<ref>{{Cite book|title=Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS (ECHPP) for Houston-Baytown-Sugarland, Texas|publisher=Houston Department of Health and Human Services|year=2011}}</ref> The FDA has not evaluated dental dams or other barriers for their effectiveness in preventing the spread STIs.<ref name=":2">{{Cite journal|last1=Richters|first1=Juliet|last2=Clayton|first2=Stevie|date=2010|title=The practical and symbolic purpose of dental dams in lesbian safer sex promotion|journal=Sexual Health|volume=7|issue=2|pages=103–6|doi=10.1071/sh09073|pmid=20648734|issn=1448-5028|doi-access=free}}</ref> Health educators widely encourage their use during ] or ],<ref name=":2" /><ref name=":6" /> but dental dams are not widely used by WSW,<ref>{{Cite journal|last1=Richters|first1=Juliet|last2=Prestage|first2=Garrett|last3=Schneider|first3=Karen|last4=Clayton|first4=Stevie|date=2010|title=Do women use dental dams? Safer sex practices of lesbians and other women who have sex with women|journal=Sexual Health|volume=7|issue=2|pages=165–9|doi=10.1071/sh09072|pmid=20465981|issn=1448-5028|doi-access=free}}</ref><ref name=":3">{{Cite journal|last1=Stevens|first1=Patricia E.|last2=Hall|first2=Joanne M.|date=July 2001|title=Sexuality and Safer Sex: The Issues for Lesbians and Bisexual Women|journal=Journal of Obstetric, Gynecologic & Neonatal Nursing|volume=30|issue=4|pages=439–447|doi=10.1111/j.1552-6909.2001.tb01563.x|pmid=11461028|issn=0884-2175}}</ref> and are not made with STI prevention in mind.<ref name=":2" /> Dental dams are commonly found at STI clinics and on the Internet but may be difficult to find at drugstores where condoms are normally sold.<ref name=":4" /> Dental dams may also be made by cutting open a latex condom.<ref name=":0" /><ref name=":3" /> Latex condoms are known to be impermeable to pathogens which can cause STIs.<ref>{{Cite web|url=https://www.cdc.gov/condomeffectiveness/latex.html|title=Condom Fact Sheet for Public Health Personnel {{!}} CDC|date=2019-04-18|website=www.cdc.gov|access-date=2019-10-31}}</ref>

Similarly to condoms, a new dental dam is used for each instance of oral sex to reduce the risk of STI transmission. Dams are placed over the ] or ] opening before the start of any sexual activities and not be removed until activities are concluded.<ref name=":4">{{Cite book|title=The psychology of human sexuality|last=Lehmiller, Justin J.|isbn=9781119164715|edition=Second|location=Hoboken, NJ|oclc=992433913|date = 2017-12-26}}</ref> To ensure no tears or rips occur, water or silicon based lubricant can be used. Additionally, dams are not stretched out as this could lead to tears. Dental dams are stored in a cool and dry location, and never be used after their printed expiration date.<ref name=":0" />

While condoms may not be applicable to many WSW sexual encounters, they are still useful when sex toys are involved. Toys that are shared between partners can spread pathogens even when cleaned. The use of condoms in addition to thorough cleaning can help reduce the risk of transmission via sex toys.<ref name=":4" />

In the event of any open sores or wounds on the hands, latex gloves can be used to prevent infection while ] or ]. Gloves are placed over the hand before sexual activity ensues and kept on through the duration of the activity.<ref name=":4" />

Cling wrap is often posed as an alternative to dental dams, but not widely recommended. Cling wrap is used in the same way as dental dams, and much more cost effective. No studies currently exist on the permeability of cling wrap to STI causing pathogens, but it is known to be waterproof.<ref name=":2" />

⚫ ==Mental health==
⚫ Since medical literature began to describe homosexuality, it has often been approached from a view that sought to find an inherent psychopathology as the root cause. Much literature on mental health and lesbians centered on their ], ]s, and ]. Although these issues exist among lesbians, discussion about their causes shifted after homosexuality was removed from the ] in 1973. Instead, social ostracism, legal discrimination, internalization of negative stereotypes, and limited support structures indicate factors homosexuals face in Western societies that often adversely affect their mental health.<ref>Schlager, p. 152.</ref> Women who identify as lesbian report feeling significantly different and isolated during adolescence;<ref name="schlager153">Schlager, p. 153.</ref> these emotions have been cited as appearing on average at 15 years old in lesbians and 18 years old in women who identify as bisexual.<ref name="rust2">Rust, Paula, (March, 1993). "Coming out" in the Age of Social Constructionism: Sexual Identity Formation among Lesbian and Bisexual Women", ''Gender and Society'', '''7''' (1), p. 50-77.</ref>


]s and ] are the most common mental health issues for women. Depression is reported among lesbians at a rate similar to heterosexual women.<ref>Solarz, p. 69.</ref> It is a more significant problem among women who feel they must hide their sexual orientation from friends and family, experience compounded ethnic or religious discrimination, or experience relationship difficulties with no support system.<ref>Schlager, pp. 157–158.</ref> More than half the respondents to a 1994 survey of health issues in lesbians reported they had ], and 18% had attempted suicide.<ref>Solarz, p. 70.</ref> ]s and ] are the most common mental health issues for women. Depression is reported among lesbians at a rate similar to heterosexual women.<ref>Solarz, p. 69.</ref> It is a more significant problem among women who feel they must hide their sexual orientation from friends and family, experience compounded ethnic or religious discrimination, or experience relationship difficulties with no support system.<ref>Schlager, pp. 157–158.</ref> More than half the respondents to a 1994 survey of health issues in lesbians reported they had ], and 18% had attempted suicide.<ref>Solarz, p. 70.</ref>


A population-based study completed by the National Alcohol Research Center found that women who identify as lesbian or bisexual are less likely to abstain from alcohol. Lesbians and bisexual women have a higher likelihood of reporting problems with alcohol, as well as not being satisfied with treatment for substance abuse programs.<ref>Drabble, Laurie, Trocki, Karen (2005). "Alcohol Consumption, Alcohol-Related Problems, and Other Substance Use Among Lesbian and Bisexual Women", ''Journal of Lesbian Studies'', '''9''' (3), p. 19–30.</ref> Many lesbian communities are centered in bars, and drinking is an activity that correlates to community participation for lesbians and bisexual women.<ref>Solarz, p. 81.</ref> A population-based study completed by the National Alcohol Research Center found that women who identify as lesbian or bisexual are less likely to abstain from alcohol. Lesbians and bisexual women have a higher likelihood of reporting problems with alcohol, as well as not being satisfied with treatment for substance use programs.<ref>Drabble, Laurie, Trocki, Karen (2005). "Alcohol Consumption, Alcohol-Related Problems, and Other Substance Use Among Lesbian and Bisexual Women", ''Journal of Lesbian Studies'', '''9''' (3), p. 19–30.</ref> Many lesbian communities are centered in bars, and drinking is an activity that correlates to community participation for lesbians and bisexual women.<ref>Solarz, p. 81.</ref>

==Views on strap-on dildo==
There are contradicting views among ] on the use of ]s in sex. Some feminists argue that strap-on sex imitates ] structures and undermines feminist principles, asserting that fantasies should align with ethical values. They criticize feminists who engage in strap-on sex as hypocritical. However, others share these concerns but question whether politics should be brought into the bedroom, while some opposes the notion that strap-on sex is inherently linked to patriarchy.<ref>{{cite web |last1=Luxx |first1=Lisa |title=Is it "Feminist" To Wear a Strap-On? |url=https://slutever.com/feminist-strap-on/ |publisher=]|access-date=17 November 2024 |date=31 May 2019}}</ref>

== Intimate partner violence ==
] (IPV) encompasses any form of abuse, such as physical or psychological abuse, stalking, or sexual violence, perpetrated by an intimate partner.<ref name=":10">{{Cite web|url=https://www.cdc.gov/violenceprevention/pdf/cdc_nisvs_victimization_final-a.pdf|title=NISVS: An Overview of 2010 Findings on Victimization by Sexual Orientation|website=CDC}}</ref> WSW are more likely than heterosexual women to have suffered IPV of any form from their partner, with bisexual women having a higher prevalence than lesbian women.<ref name=":9">{{Cite journal|last1=Badenes-Ribera|first1=Laura|last2=Bonilla-Campos|first2=Amparo|last3=Frias-Navarro|first3=Dolores|last4=Pons-Salvador|first4=Gemma|last5=Monterde-i-Bort|first5=Hector|s2cid=206737985|date=2015-05-27|title=Intimate Partner Violence in Self-Identified Lesbians|journal=Trauma, Violence, & Abuse|volume=17|issue=3|pages=284–297|doi=10.1177/1524838015584363|pmid=26018210|issn=1524-8380|hdl=10550/97338|hdl-access=free}}</ref> Bisexual women are twice as likely as heterosexual women to experience stalking or intimate partner rape.<ref name=":10" />


== Omission from research studies ==
⚫ ==Sexually transmitted infections==
It can be difficult to draw robust and wide reaching conclusions about WSW, since many studies fail to specifically include this group.<ref name=":7">{{Cite journal|last1=Johns|first1=Michelle M.|last2=Liddon|first2=Nicole|last3=Jayne|first3=Paula E.|last4=Beltran|first4=Oscar|last5=Steiner|first5=Riley J.|last6=Morris|first6=Elana|date=January 2018|title=Systematic Mapping of Relationship-Level Protective Factors and Sexual Health Outcomes Among Sexual Minority Youth: The Role of Peers, Parents, Partners, and Providers|journal=LGBT Health|volume=5|issue=1|pages=6–32|doi=10.1089/lgbt.2017.0053|pmid=29271692|pmc=5769143|issn=2325-8292}}</ref><ref>{{Cite journal|last1=Mijas|first1=Magdalena|last2=Grabski|first2=Bartosz|last3=Blukacz|first3=Mateusz|last4=Davies|first4=Dominic|date=2021-06-01|title=Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature|url=https://www.jsm.jsexmed.org/article/S1743-6095(21)00292-7/abstract|journal=The Journal of Sexual Medicine|language=English|volume=18|issue=6|pages=1012–1023|doi=10.1016/j.jsxm.2021.02.013|issn=1743-6095|pmid=33947648|s2cid=233742279 }}</ref> Little scholarly research is done on WSW relative to other sexual minority groups.<ref name=":3" /> Research on sexual health is generally about pregnancy and heterosexual sex, with the needs of WSW largely ignored.<ref name=":8" /> Studies on intimate partner violence often fail to report the sex of the perpetrator or the sexual orientation of the victim, making it difficult to study the prevalence in WSW communities.<ref name=":9" />
⚫ In general, ] (STIs/STDs) have a lower prevalence in the WSW population than in heterosexuals. However, some STIs/STDs are communicable between women, including ] (HPV), ] (trich), ], ] (HIV), ] (BV), and ] (HSV). Transmission of specific sexually transmitted diseases among women who have sex with women depends on the sexual practices women engage in. Any object that comes in contact with cervical secretions, vaginal mucosa, or menstrual blood, including fingers or penetrative objects may transmit sexually transmitted diseases.<ref>, ], 2006 (MMWR August 4, 2006 / Vol. 55 / No. RR--11). Retrieved on January 9, 2009.</ref> ] may indicate a higher risk of acquiring HSV,<ref>Frenkl, Tara Lee, Potts, Jeannette (February 2008). "Sexually Transmitted Infections", ''Urologic Clinics of North America'', '''35''' (1) p. 33–46.</ref> even among women who have had no prior sex with men.<ref>King, p. 226.</ref> ] (BV) occurs more often in lesbians, but it is unclear if BV is transmitted by sexual contact; it occurs in celibate as well as sexually active women. BV often occurs in both partners in a lesbian relationship;<ref>Risser, Jan M.H., Risser, William L., Risser, Amanda (December 2008). "Epidemiology of Infections in Women", ''Infectious Disease Clinics of North America'', '''22''' (4), pp. 581–599.</ref> a recent study of women with BV found that 81% had partners with BV.<ref>King, p. 229.</ref> Lesbians are not included in a category of frequency of ] (HIV) transmission, although transmission is possible through vaginal and cervical secretions; the highest rate of transmission of HIV to women is among those who have sexual intercourse with men or participate in intravenous drug use.<ref>Zimmerman, 360.</ref><ref> Centers for Disease Control. Retrieved on January 9, 2009.</ref>


==See also== ==See also==
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==References== ==References==
{{Commons category|Lesbian sex}}
* Holmes, King, Sparling, P., ''et al'', eds. (2008). ''Sexually Transmitted Diseases'', McGraw-Hill Medical. ISBN 0-07-141748-6 * Holmes, King, Sparling, P., ''et al'', eds. (2008). ''Sexually Transmitted Diseases'', McGraw-Hill Medical. {{ISBN|0-07-141748-6}}
* Schlager, Neil, ed. (1998). ''Gay & Lesbian Almanac''. St. James Press. ISBN 1-55862-358-2
* Solarz, Andrea L. (ed), (1999). "Lesbian Health: Current Assessment and Directions For the Future", Committee on Lesbian Health Research Priorities, Neuroscience and Behavioral Health Program Health Sciences Policy Program, Health Sciences Section, Institute of Medicine. ISBN 0-585-04728-6 * Schlager, Neil, ed. (1998). ''Gay & Lesbian Almanac''. St. James Press. {{ISBN|1-55862-358-2}}
* Solarz, Andrea L. (ed), (1999). "Lesbian Health: Current Assessment and Directions For the Future", Committee on Lesbian Health Research Priorities, Neuroscience and Behavioral Health Program Health Sciences Policy Program, Health Sciences Section, Institute of Medicine. {{ISBN|0-585-04728-6}}
* Zimmerman, Bonnie, ed (2003). ''Lesbian Histories and Cultures: An Encyclopedia'', Garland Publishers. ISBN 0-203-48788-5 * Zimmerman, Bonnie, ed (2003). ''Lesbian Histories and Cultures: An Encyclopedia'', Garland Publishers. {{ISBN|0-203-48788-5}}
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{{DEFAULTSORT:Women Who Have Sex With Women}}
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Latest revision as of 10:54, 17 November 2024

Women who have sex with women
Sexual identity-neutral term

Women who have sex with women (WSW) are women who engage in sexual activities with women, whether they identify as straight, lesbian, bisexual, pansexual, have other sexualities, or dispense with sexual identification altogether. The term WSW is often used in medical literature to describe such women as a group for clinical study, without needing to consider sexual self-identity.

Physical health

General

In terms of medical issues with regard to sexual practices between women, the sexual identification of women who consult a medical professional is usually not sought nor volunteered, due to misconceptions and assumptions about sexuality and the hesitancy of some women in disclosing their accurate sexual histories even to a physician. Medical research on women's health often lacks differentiation between WSW and strictly-heterosexual women, which skews results towards the majority group.

Accessing birth control is the initiating factor for most women to seek consultation with a gynecologist. Thus, women who do not participate in penile-vaginal intercourse may not see a physician upon becoming sexually active. As a result, these women are not screened regularly with pap smears because they have a lower perceived risk of acquiring a sexually transmitted infection or types of cancer. Lesbians are less likely than their heterosexual and bisexual counterparts to get screened for cervical cancer, with some being refused screenings by medical professionals.

The lower rate of lesbians tested by regular pap smears makes it more difficult to detect cervical cancer at early stages in lesbians. The risk factors for developing ovarian cancer rates are higher in lesbians than in heterosexual women, perhaps because lesbians are more likely to lack protective factors such contraceptive use, pregnancy, abortion, breastfeeding, and miscarriages.

Another factor which leads to lesbians neglecting to seek medical screening in the United States is a lack of health insurance offered by employers for same-sex domestic partners. When women do seek medical attention, medical professionals often fail to take a complete medical history. In a recent study of 2,345 lesbian and bisexual women, only 9.3% had claimed they had ever been asked their sexual orientation by a physician. A third of the respondents believed disclosing their sexual history would result in a negative reaction, and 30% had received a negative reaction from a medical professional after identifying themselves as lesbian or bisexual.

A patient's complete history helps medical professionals identify higher risk areas and corrects assumptions about the personal histories of women. In a 2006 survey of 6,935 lesbians, 77% had had sexual contact with one or more male partners, and 6% had that contact within the previous year.

Sexually transmitted infections

The poster about safer sex between women

Some STIs are communicable between women, including human papillomavirus (HPV), trichomoniasis, syphilis, human immunodeficiency virus (HIV), bacterial vaginosis (BV), and herpes simplex virus (HSV). Transmission of specific sexually transmitted infections among women who have sex with women depends on the sexual practices women engage in. Any object that comes in contact with cervical secretions, vaginal mucosa, or menstrual blood, including fingers or penetrative objects may transmit sexually transmitted infections. Oral-genital contact may indicate a higher risk of acquiring HSV, even among women who have had no prior sex with men. HSV-2 infection in particular occurs in nearly 1 in 10 of lesbians. Bacterial vaginosis occurs more often in lesbians, but it is unclear if BV is transmitted by sexual contact; it occurs in celibate as well as sexually active women. BV often occurs in both partners in a lesbian relationship; a recent study of women with BV found that 81% had partners with BV. Lesbians are not included in a category of frequency of HIV transmission, although transmission is possible through vaginal and cervical fluids and secretions; the highest rate of transmission of HIV from women to women is among those who have sexual intercourse with men, or participate in intravenous drug use.

Many doctors consider sex between women to have negligible risk for transmission of STIs and fail to offer any information on prevention of STI transmission for sex involving two women. Although lesbians have a lower risk of contracting STIs than their heterosexual and bisexual counterparts, the risk still exists. Additionally, most WSW have had sex with men at some point in their lifetime, which significantly increases the risk of infection. Yearly pelvic exams are encouraged for WSW to contain the complications of STIs.

Safe sex

There are various ways for WSW to protect against the contraction of STIs during sex, though these methods are not well studied. Dental dams, condoms on sex toys, gloves, and cling wraps are all used as protection during various forms of sex. Most WSW do not use protection during sex, due to misconceptions that a lower risk of STI transmission means that barriers are not needed. Engaging in oral sex without the use of a dental dam or condom is considered a high risk sexual behavior.

The CDC recommends using a dental dam during oral sex. Additionally, HIV prevention organizations distribute dental dams along with condoms and other safe sex supplies. The FDA has not evaluated dental dams or other barriers for their effectiveness in preventing the spread STIs. Health educators widely encourage their use during cunnilingus or anilingus, but dental dams are not widely used by WSW, and are not made with STI prevention in mind. Dental dams are commonly found at STI clinics and on the Internet but may be difficult to find at drugstores where condoms are normally sold. Dental dams may also be made by cutting open a latex condom. Latex condoms are known to be impermeable to pathogens which can cause STIs.

Similarly to condoms, a new dental dam is used for each instance of oral sex to reduce the risk of STI transmission. Dams are placed over the vaginal or anal opening before the start of any sexual activities and not be removed until activities are concluded. To ensure no tears or rips occur, water or silicon based lubricant can be used. Additionally, dams are not stretched out as this could lead to tears. Dental dams are stored in a cool and dry location, and never be used after their printed expiration date.

While condoms may not be applicable to many WSW sexual encounters, they are still useful when sex toys are involved. Toys that are shared between partners can spread pathogens even when cleaned. The use of condoms in addition to thorough cleaning can help reduce the risk of transmission via sex toys.

In the event of any open sores or wounds on the hands, latex gloves can be used to prevent infection while fingering or fisting. Gloves are placed over the hand before sexual activity ensues and kept on through the duration of the activity.

Cling wrap is often posed as an alternative to dental dams, but not widely recommended. Cling wrap is used in the same way as dental dams, and much more cost effective. No studies currently exist on the permeability of cling wrap to STI causing pathogens, but it is known to be waterproof.

Mental health

Since medical literature began to describe homosexuality, it has often been approached from a view that sought to find an inherent psychopathology as the root cause. Much literature on mental health and lesbians centered on their depression, substance use disorders, and suicide. Although these issues exist among lesbians, discussion about their causes shifted after homosexuality was removed from the Diagnostic and Statistical Manual in 1973. Instead, social ostracism, legal discrimination, internalization of negative stereotypes, and limited support structures indicate factors homosexuals face in Western societies that often adversely affect their mental health. Women who identify as lesbian report feeling significantly different and isolated during adolescence; these emotions have been cited as appearing on average at 15 years old in lesbians and 18 years old in women who identify as bisexual.

Anxiety disorders and depression are the most common mental health issues for women. Depression is reported among lesbians at a rate similar to heterosexual women. It is a more significant problem among women who feel they must hide their sexual orientation from friends and family, experience compounded ethnic or religious discrimination, or experience relationship difficulties with no support system. More than half the respondents to a 1994 survey of health issues in lesbians reported they had suicidal thoughts, and 18% had attempted suicide.

A population-based study completed by the National Alcohol Research Center found that women who identify as lesbian or bisexual are less likely to abstain from alcohol. Lesbians and bisexual women have a higher likelihood of reporting problems with alcohol, as well as not being satisfied with treatment for substance use programs. Many lesbian communities are centered in bars, and drinking is an activity that correlates to community participation for lesbians and bisexual women.

Views on strap-on dildo

There are contradicting views among feminists on the use of strap-on dildos in sex. Some feminists argue that strap-on sex imitates patriarchal structures and undermines feminist principles, asserting that fantasies should align with ethical values. They criticize feminists who engage in strap-on sex as hypocritical. However, others share these concerns but question whether politics should be brought into the bedroom, while some opposes the notion that strap-on sex is inherently linked to patriarchy.

Intimate partner violence

Intimate partner violence (IPV) encompasses any form of abuse, such as physical or psychological abuse, stalking, or sexual violence, perpetrated by an intimate partner. WSW are more likely than heterosexual women to have suffered IPV of any form from their partner, with bisexual women having a higher prevalence than lesbian women. Bisexual women are twice as likely as heterosexual women to experience stalking or intimate partner rape.

Omission from research studies

It can be difficult to draw robust and wide reaching conclusions about WSW, since many studies fail to specifically include this group. Little scholarly research is done on WSW relative to other sexual minority groups. Research on sexual health is generally about pregnancy and heterosexual sex, with the needs of WSW largely ignored. Studies on intimate partner violence often fail to report the sex of the perpetrator or the sexual orientation of the victim, making it difficult to study the prevalence in WSW communities.

See also

Notes

  1. Another summary of overall surveys found that women who identify as lesbian, 80-95% had previous sexual contact with men, and some report sexual behavior that is risky. (King, p. 221.)

Citations

  1. Gorgos, L. M.; J. M. Marrazzo (2011). "Sexually Transmitted Infections Among Women Who Have Sex With Women". Clinical Infectious Diseases. 53 (suppl 3): S84–S91. doi:10.1093/cid/cir697. ISSN 1058-4838. PMID 22080273.
  2. King, p. 219.
  3. Zimmerman, p. 359.
  4. ^ Gynaecology. Shaw, Robert W. (Robert Wayne), Luesley, David., Monga, Ash K. (4th ed.). Edinburgh: Churchill Livingstone/Elsevier. 2011. ISBN 9780702048388. OCLC 787843377.{{cite book}}: CS1 maint: others (link)
  5. Vo, Christine, Carney, Michael (December 2007). "Ovarian Cancer Hormonal and Environmental Risk Effect", Obstetrics and Gynecology Clinics34 (4) p. 687–700.
  6. "Frequently Asked Questions: Lesbian Health Archived 2009-01-29 at the Wayback Machine", womenshealth.gov. U.S. Department of Health and Human Services. Retrieved January 12, 2009.
  7. ^ Mravack, Sally A. (July 2006)."Primary Care for Lesbians and Bisexual Women", American Family Physician 74 (2), pp. 279–286.
  8. "Special Populations - 2010 STD Treatment Guidelines". CDC. Archived from the original on 2015-07-21. Retrieved 2015-06-23.
  9. Frenkl, Tara Lee, Potts, Jeannette (February 2008). "Sexually Transmitted Infections", Urologic Clinics of North America, 35 (1) p. 33–46.
  10. King, p. 226.
  11. Marrazzo, Jeanne M.; Stine, Kathleen; Wald, Anna (2003). "Prevalence and risk factors for infection with herpes simplex virus type-1 and -2 among lesbians". Sexually Transmitted Diseases. 30 (12): 890–895. doi:10.1097/01.OLQ.0000091151.52656.E5. PMID 14646636. S2CID 22148830.
  12. Risser, Jan M.H., Risser, William L., Risser, Amanda (December 2008). "Epidemiology of Infections in Women", Infectious Disease Clinics of North America, 22 (4), pp. 581–599.
  13. King, p. 229.
  14. Zimmerman, 360.
  15. HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2006. Centers for Disease Control. Retrieved on January 9, 2009.
  16. McNair, Ruth (2005). "Risks and prevention of sexually transmissible infections among women who have sex with women". Sexual Health. 2 (4): 209–17. doi:10.1071/sh04046. ISSN 1448-5028. PMID 16402667.
  17. ^ Carroll, Janell L. (January 2018). Sexuality now : embracing diversity. Cengage Learning. ISBN 9781337404990. OCLC 1064600804.
  18. ^ Clarke, Victoria. (2010). Lesbian, Gay, Bisexual, Trans and Queer Psychology. Cambridge University Press. ISBN 9780521700184. OCLC 1031490912.
  19. Clarke, Victoria; Ellis, Sonja J.; Peel, Elizabeth; Riggs, Damien W. (April 2010). Communicating Women's Health : social and cultural norms that influence health decisions. Madlock Gatison, Annette. New York. ISBN 978-0815386490. OCLC 1004726096.{{cite book}}: CS1 maint: location missing publisher (link)
  20. Gatison, Annette Madlock (2015-12-07). Communicating Women's Health: Social and Cultural Norms that Influence Health Decisions. Routledge. ISBN 9781317553892.
  21. ^ "How to Use a Dental Dam | CDC". www.cdc.gov. 2019-02-22. Retrieved 2019-10-27.
  22. Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS (ECHPP) for Houston-Baytown-Sugarland, Texas. Houston Department of Health and Human Services. 2011.
  23. ^ Richters, Juliet; Clayton, Stevie (2010). "The practical and symbolic purpose of dental dams in lesbian safer sex promotion". Sexual Health. 7 (2): 103–6. doi:10.1071/sh09073. ISSN 1448-5028. PMID 20648734.
  24. Richters, Juliet; Prestage, Garrett; Schneider, Karen; Clayton, Stevie (2010). "Do women use dental dams? Safer sex practices of lesbians and other women who have sex with women". Sexual Health. 7 (2): 165–9. doi:10.1071/sh09072. ISSN 1448-5028. PMID 20465981.
  25. ^ Stevens, Patricia E.; Hall, Joanne M. (July 2001). "Sexuality and Safer Sex: The Issues for Lesbians and Bisexual Women". Journal of Obstetric, Gynecologic & Neonatal Nursing. 30 (4): 439–447. doi:10.1111/j.1552-6909.2001.tb01563.x. ISSN 0884-2175. PMID 11461028.
  26. ^ Lehmiller, Justin J. (2017-12-26). The psychology of human sexuality (Second ed.). Hoboken, NJ. ISBN 9781119164715. OCLC 992433913.{{cite book}}: CS1 maint: location missing publisher (link)
  27. "Condom Fact Sheet for Public Health Personnel | CDC". www.cdc.gov. 2019-04-18. Retrieved 2019-10-31.
  28. Schlager, p. 152.
  29. Schlager, p. 153.
  30. Rust, Paula, (March, 1993). "Coming out" in the Age of Social Constructionism: Sexual Identity Formation among Lesbian and Bisexual Women", Gender and Society, 7 (1), p. 50-77.
  31. Solarz, p. 69.
  32. Schlager, pp. 157–158.
  33. Solarz, p. 70.
  34. Drabble, Laurie, Trocki, Karen (2005). "Alcohol Consumption, Alcohol-Related Problems, and Other Substance Use Among Lesbian and Bisexual Women", Journal of Lesbian Studies, 9 (3), p. 19–30.
  35. Solarz, p. 81.
  36. Luxx, Lisa (31 May 2019). "Is it "Feminist" To Wear a Strap-On?". Slutever.com. Retrieved 17 November 2024.
  37. ^ "NISVS: An Overview of 2010 Findings on Victimization by Sexual Orientation" (PDF). CDC.
  38. ^ Badenes-Ribera, Laura; Bonilla-Campos, Amparo; Frias-Navarro, Dolores; Pons-Salvador, Gemma; Monterde-i-Bort, Hector (2015-05-27). "Intimate Partner Violence in Self-Identified Lesbians". Trauma, Violence, & Abuse. 17 (3): 284–297. doi:10.1177/1524838015584363. hdl:10550/97338. ISSN 1524-8380. PMID 26018210. S2CID 206737985.
  39. Johns, Michelle M.; Liddon, Nicole; Jayne, Paula E.; Beltran, Oscar; Steiner, Riley J.; Morris, Elana (January 2018). "Systematic Mapping of Relationship-Level Protective Factors and Sexual Health Outcomes Among Sexual Minority Youth: The Role of Peers, Parents, Partners, and Providers". LGBT Health. 5 (1): 6–32. doi:10.1089/lgbt.2017.0053. ISSN 2325-8292. PMC 5769143. PMID 29271692.
  40. Mijas, Magdalena; Grabski, Bartosz; Blukacz, Mateusz; Davies, Dominic (2021-06-01). "Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature". The Journal of Sexual Medicine. 18 (6): 1012–1023. doi:10.1016/j.jsxm.2021.02.013. ISSN 1743-6095. PMID 33947648. S2CID 233742279.

References

  • Holmes, King, Sparling, P., et al, eds. (2008). Sexually Transmitted Diseases, McGraw-Hill Medical. ISBN 0-07-141748-6
  • Schlager, Neil, ed. (1998). Gay & Lesbian Almanac. St. James Press. ISBN 1-55862-358-2
  • Solarz, Andrea L. (ed), (1999). "Lesbian Health: Current Assessment and Directions For the Future", Committee on Lesbian Health Research Priorities, Neuroscience and Behavioral Health Program Health Sciences Policy Program, Health Sciences Section, Institute of Medicine. ISBN 0-585-04728-6
  • Zimmerman, Bonnie, ed (2003). Lesbian Histories and Cultures: An Encyclopedia, Garland Publishers. ISBN 0-203-48788-5
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