Women who have sex with women (WSW) can acquire sexually transmitted infections (STIs). Sexual health risk is not exclusive to penile-vaginal intercourse, as STIs are transmitted through various forms of sexual contact involving fluids, skin, and mucous membranes. The medical term WSW describes anyone who engages in sexual activity with other women, regardless of their self-identified sexual orientation. It is important for healthcare providers and individuals in this community to recognize that sexual practices can still facilitate the transfer of bacteria, viruses, and parasites.
Transmission Routes Specific to Women Who Have Sex With Women
The primary method of STI transfer between female partners involves direct contact between mucosal surfaces and skin. This includes activities such as mouth-to-genital contact (cunnilingus) or genital-to-genital friction. Many STIs, particularly viral ones, require only skin-to-skin contact, making transmission possible even without the exchange of visible bodily fluids.
Fluid exchange also represents a clear route for transmission through vaginal fluids and menstrual blood. The transfer of these fluids can occur via shared hands or fingers that move between partners’ genital areas without being washed. This movement of fluid from one person’s vagina to another’s vagina or mouth can carry infectious organisms.
Fomite transmission refers to the transfer of infectious agents through objects. Shared sex toys, for example, can harbor bacteria or viruses if they are not properly cleaned or covered between partners. Similarly, hands and fingers used for digital penetration or stimulation must be considered a potential vehicle for transfer if hygiene practices are not maintained when moving from one partner to another.
The presence of micro-abrasions in the skin or mucous membranes, which are common during sex, creates entry points for pathogens. These small tears can be caused by friction from skin-to-skin contact, digital penetration, or the use of sex toys. Any activity that involves contact with the delicate tissues of the genitals, mouth, or anus can introduce an infectious agent.
The Most Common STIs in WSW Populations
Human Papillomavirus (HPV) is one of the most frequently transmitted infections among WSW because it spreads easily through skin-to-skin contact. Since HPV affects the genital skin and mucous membranes, direct vulvar-to-vulvar contact or even shared hands can cause transmission. HPV is the cause of nearly all cervical cancers, and high-grade cervical lesions have been detected in WSW who report no history of sexual contact with men.
Herpes Simplex Virus (HSV), both type 1 and type 2, is readily transmitted through skin-to-skin contact, especially during periods of active viral shedding, even if no visible sores are present. The common practice of oral-genital contact among WSW places them at a higher risk for acquiring genital infection with HSV-1, which is typically associated with oral cold sores.
Trichomoniasis is a parasitic infection that has been directly demonstrated to transmit between female sexual partners. This organism can survive in the vaginal environment and is easily transferred through shared vaginal fluid or contact with the vulva. While not technically an STI, Bacterial Vaginosis (BV) is highly prevalent among WSW and is strongly linked to sexual activity, with female partners often sharing similar vaginal bacterial strains.
Although the risk is lower than with penile-vaginal intercourse, some blood-borne and fluid-borne infections remain a possibility. Human Immunodeficiency Virus (HIV) transmission is rare but possible through the exchange of vaginal fluids, menstrual blood, or contact with open sores or broken skin during sexual activity. Similarly, Hepatitis A and B can be transmitted through oral-anal contact or exposure to infected bodily fluids. Syphilis, a bacterial infection that causes sores, has also been reported to transmit between female partners, typically through oral-genital contact with an infectious lesion.
Prevention and Screening Protocols
Effective prevention involves the consistent use of physical barriers to block the transfer of fluids and skin particles. Dental dams, which are thin sheets of latex or polyurethane, should be used to cover the vulva or anus during oral sex to prevent direct mucosal contact.
For digital-genital contact, the use of gloves or finger cots is a recommended way to prevent the transfer of vaginal fluids or other infectious material. If sex toys are used between partners, a new external condom should be applied, or the toy must be thoroughly washed with soap and water before being shared. These hygiene practices are paramount in preventing the transfer of bacteria and viruses from one person to another.
Screening protocols should not differ based on a patient’s sexual orientation, and WSW should receive regular health check-ups. Routine cervical cancer screening with a Pap smear is a standard of care for all women, regardless of their sexual history, due to the high prevalence of HPV transmission via skin-to-skin contact. A comprehensive discussion with a healthcare provider about specific sexual practices is necessary to determine the appropriate tests, which may include screening for chlamydia, gonorrhea, or syphilis based on individual risk factors and symptoms.
Regular testing is the most effective way to identify asymptomatic infections and prevent further transmission. WSW should discuss their sexual and behavioral risks openly with their provider, including the number of partners and the types of sexual activities they engage in. This open communication ensures that testing is targeted and that they receive the most accurate advice on barrier methods and safe sexual practices.