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Safer Sex: Do Women Sleeping with Women Need It?

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absolutelyapple asks:

My girlfriend and I (I'm a chick) are both virgins. Is there any point in us using a dental dam when/if we have oral sex?

Robin Mandell replies:

Bravo to you for considering safer sex practices as part of the sexual choices you and your girlfriend make in your relationship!

Regardless of the history of the partners involved, thinking and talking about safety is really important. Unfortunately, I've seen a lot of people, including some doctors, assume that there isn't any risk around two chicks being sexual with each other.

Before I get into talking about lesbian sex and STI transmission, I want to say a few words about this idea of virginity.

Virgin is a term that means something different to everyone. It has a pretty huge and complex history, and doesn't really say much about someone's physical reality. So, you telling me that both you and your girlfriend are virgins actually leaves me with more questions than answers. Do you mean that neither of you has ever had any sexual contact with anyone of any gender? Considering that sexual contact, gender, and virginity are all caught up in complex social and historical meanings, virginity doesn't mean a whole heck of a lot, especially when it comes to non-heterosexual relationships.

To be clear, people with vulvas who have only had sex with people with vulvas who have also done the same DO (and so on, and so on...) do have smaller risks of transmitting most STIs. What we know, though, is that very few people really will only have that kind of sexual history. The idea that lesbians have lower STI risks assumes that lesbians will have been exclusive and only with other lesbians who have also been exclusive: basically, that all lesbians have only ever been sexual with cisgender women and will only ever be sexual with cisgender women. Instead, it's more typical that a person with a vulva will have also had partners with penises at one time or another. Certainly, though, this is not the case for every single lesbian.

So, assuming that neither you nor your girlfriend have had any sexual contact with anyone, ever, is there still a need to consider safer sex practices?

In a word: yes.

The thing to remember about STIs is that while all STIs can be, and most often are, transmitted sexually (that's why they're called sexually transmitted infections, after all), some of them can also be transmitted in nonsexual ways. Herpes, for example, is transmitted in many ways, encompassing social interaction and sharing of nonsexual affection. Many people contract oral herpes as children through kissing family members or sharing food and toothbrushes. Sexually, oral herpes can be transmitted to a person's genitals through oral sex if the giver has either an open or developing herpes sore on her lip. Using a dental dam can reduce, though not fully eliminate the chances of this happening. The goal with safer sex is to reduce risk; eradicating risk just isn't possible.

Herpes is transmitted primarily through skin-to-skin contact. So, were someone carrying the oral herpes virus to touch their mouth to a bare spot of someone else's vulva, they would potentially pass the virus along to their partner.

Does this mean that someone who has oral herpes should automatically not ever give a partner oral sex? Not at all. It only means that if someone gets cold sores and wishes to be the giver of oral sex, it's a sound idea to get tested, find out if it's oral herpes, then discuss with their partner so they can decide together what their comfort levels are with the potential risks.

Informed consent always rules!

It goes without saying, I think, that if someone has any open sores or cuts in, on, or around her mouth, she would want to either use added protection during oral sex, or abstain from it altogether until the wounds heal. STIs aside, open cuts and sores can aid the transfer of everyday germs and bacteria, putting both the giving and receptive partner at risk for pesky infections.

Evaluating risks is sound practice when starting a sexual relationship, and really through the entirety of a person's partnered sexual experiences. In other words, risk evaluation is an ongoing process.

Evaluating your own comfort with risks is just as important, though.

Engaging in sexual activity with another person always presents a certain amount of STI transmission risk. (There's also emotional risk inherent in being sexually involved with another person.) Building up a store of knowledge, using safer sex methods, getting tested regularly, and communicating with your partner can all reduce this risk, sometimes, depending on the STI in question, by a significant amount.

For some people, this risk, or the anxiety over possible risks, is too much, and they will choose to remain celibate. For many, many others, though, the rewards of being in a sexual relationship with another person will make partnered sexual activity worth it.

Each person in a relationship may have a different level of comfort with possible risks, and different feelings around the ways to reduce those risks. Talking about bad things that could potentially happen through having sexual contact may not seem like the most romantic way to start a relationship, but it actually shows an incredible amount of both caring and self-respect. Some of the reluctance people feel in discussing the topic of STIs is connected to the fear that talking about STIs and getting tested might actually reveal that we're infected with one. This fear stems from strong feelings of shame that society has built up around STIs, and also a deep fear of the STIs that do have serious and long-lasting health consequences.

Shedding this shame and learning more about STIs can go a long way towards helping us communicate with our partners and making healthy decisions for ourselves and our relationships.

It's also worth noting that oral sex isn't the only way that one person with a vulva can transmit an STI to another person with a vulva. Manual sex -- one partner stimulating the other partner's vulva with her hands -- can transmit STIs, too. The chances of this occurring increase if the giver has any cuts or abrasions on her hands, or if she accidentally cuts her partner's genital tissues with her nails. Cuts and abrasions can make each partner more susceptible. Manual sex can also pose transmission risks if a partner who has an STI touches her own vulva before touching her partner's vulva. Washing hands before and after sex, or using latex or nonlatex-alternative gloves, reduces these transmission risks considerably.

Sharing toys can also increase the chances of transmitting STIs and other infections, including yeast or bacterial infections. In fact, toy sharing is usually listed as the most likely reason that bacterial vaginosis> is one of the most commonly occurring infections among women who are sexual partners with women. Washing toys every time they are used, sterilizing them between partners, or (and this is often the simplest for many people) using a fresh condom on the toy each time it is used will help keep everybody healthy.

Regularly accessing sexual health care is just as important for lesbians as it is for other people. Here are some considerations for ensuring that you access appropriate and high-quality care.

The bottom line here is that talking about safer sex practices with your partner and coming up with a safer sex plan you both can agree on and enjoy is a healthy and loving act, whether it's your first relationship or your twentieth.

written 01 May 2012 . updated 20 Jan 2014

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