Women who have sex with women (WSW) are women who engage in sexual activities with other 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
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.
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