Sexual Health for LGBTQ+ women
Women, non-binary people and trans men can pass on or get STIs through sex with other women, non-binary people and trans men.
Lesbians and bisexual women, non-binary individuals and trans men and women are not immune to sexually transmitted infections (STIs). It's important not to be complacent about getting tested for them.
Sometimes, lesbian and bisexual women, female-assigned non-binary individuals and trans men are told they don't need to be tested for STIs. This is not the case.
A survey of lesbian and bisexual women by Stonewall revealed half of those who have been screened had an STI. And of those women who had an STI, one in four had only had sex with women in the previous five years.
"Women can catch STIs such as herpes, genital warts and chlamydia when exchanging bodily fluids," says Ruth Hunt of Stonewall.
"Any one-on-one contact, such as oral sex or using the same hand when touching yourself and then your partner, can put you at risk. Two women that are both menstruating are at a higher risk, too.”
Tips for safer sex between women, non-binary individuals and trans men.
- If you're using sex toys, use a new condom or internal condom for each partner. Use different condoms/I condom when changing from vaginal to anal penetration. Sex toys should be washed with soap and water between sessions. Find out more about cleaning sex toys.
- Avoid oral sex, or use a dental dam/condoms if either of you has any cuts or sores in the mouth or on the lips. A dental dam is a latex or polyurethane (very thin, soft plastic) square, of about 15cm by 15cm, which you can use to cover the anus or genitals during oral sex. It acts as a barrier to help prevent sexually transmitted infections passing from one person to another.
- Some infections can be transmitted by hands, fingers and mutual vulval rubbing. Wash your hands before and after sex and consider wearing gloves.
- Wear latex gloves and use plenty of water-based lubricant for vaginal and anal fisting.
Tips for safer sex
If you have vaginal or anal penetrative sex, use a condom/Internal Condom. When used correctly, condoms protect against unintended pregnancy and STIs. In addition to using condoms/Internal Condoms, find out about the form of contraception that suits you best.
Trans men may believe that they are unable to get pregnant if they are taking testosterone (“T”). This is not true. If you are a trans man having penetrative vaginal sex, for instance with another man, it is important to use a condom unless you are trying to get pregnant. If you are trying to get pregnant you and your partner should both have full screening for STI’s before having unprotected sex. Remember, some infections have window periods, where they can take time to develop before the tests are conclusive, if you let your healthcare provider know your sexual history, they will be able to advise you when to test for your results to be conclusive. If you are already having unprotected sex, you and your partner can still go for testing.
If you think you may be at risk of unintended pregnancy, emergency contraception (the "morning after" pill or an IUD) is available from pharmacies, your GP, hospital, family planning clinics and some sexual health clinics.
Vaginal health
If your vagina has been surgically constructed, it is not self-cleansing and will need maintenance. There are methods for dilating and maintaining your vaginal health. See Terrence Higgins Trust for advice on safe sex as a trans woman.
If you have a vagina that has not been surgically constructed, it is self-cleansing, so there's no need to wash inside it (douching). Vaginal soreness and vulval irritation can be caused by overuse of perfumed soaps, bubble baths and shower gels.
After going to the toilet, always wipe from front to back (from vagina to anus).
Symptoms of STIs in women, non-binary individuals and trans men
Thrush
Thrush is caused by an overgrowth of yeast called candida. Symptoms may include vulval and vaginal itching, pain and soreness on penetration, burning when passing urine, and a thick, white discharge.
It's possible to transmit thrush during sex through touching and sharing sex toys. Thrush can be treated with medicated cream, pessaries and tablets, which can be bought from a chemist. Go to your GP if your symptoms persist. Read more about thrush.
Genital herpes
This is caused by a virus, which can spread if you have vaginal, anal or oral sex, or share sex toys. It can also cause cold sores on the mouth and nose.
Symptoms include painful blisters and ulcers around the genital area, although some women may have no symptoms.
Antiviral tablets can help the healing process and shorten the length of the episode. Read more about genital herpes.
Genital warts
These are fleshy growths in the vulval and anal region. They may be itchy, but are usually painless.
They are caused by certain strains of the human papilloma virus (HPV), which are usually sexually acquired through skin contact, such as rubbing vulvas together.
If you have genital warts you do not need more regular smear tests than those without them. There are a variety of treatment options, including freezing and medicated creams. Read more about genital warts.
Trichomoniasis
Trichomoniasis can be passed on during any sexual activity that involves the exchange of vaginal fluid.
Symptoms include a frothy discharge, discomfort when passing urine, vulval soreness, and sometimes an unpleasant vaginal odour. Some people don't have any symptoms. It is treated with antibiotics.
Read more about trichomoniasis.
Chlamydia and gonorrhoea
These STIs are caused by bacteria, which can infect the cervix, rectum, throat and urethra. There may be a discharge, but usually there are no symptoms.
If the conditions are not treated, the bacteria may lead to an infection in the fallopian tubes and infertility.
Chlamydia and gonorrhoea can be passed on through shared sex toys, hands, and by rubbing vulvas together. Treatment is with antibiotics.
Read more about chlamydia and gonorrhoea.
Syphilis
Syphilis is a bacterial infection that causes a painless ulcer, usually in the genital area. It will disappear on its own, but other symptoms may appear. These can include a rash on the body and swollen glands.
If it is not treated, syphilis can cause serious nerve and body organ damage later in life, resulting in disability and death. Syphilis is also very serious to people who are pregnant.
In its early stages, syphilis is extremely infectious and can be passed on by close skin contact during sex. Treatment is with antibiotic injections or tablets.
Read more about syphilis.
Shigella
This is a bacterial infection of the intestine that causes severe diarrhoea and stomach cramps. It is often mistaken for food poisoning. It can be caught during sexual activity, including anal-oral sex ("rimming") and giving oral sex after anal sex. It is spread very easily – all it takes is a tiny amount of infected poo (faeces) getting into your mouth.
A person with shigella can be infectious for up to a month. It can be treated with antibiotics. If you suspect you have shigella, you should visit your GP or sexual health clinic to get tested.
You can avoid getting shigella by washing hands after sex (buttocks, groin and genitals too, if you can by taking a shower), and changing condoms between anal and oral sex. Using latex/vinyl gloves for fingering or fisting offers protection. And don't share sex toys or douching equipment.
You'll find more information on shigella in this leaflet (PDF, 2.13Mb).
Get tested
Not all sexually transmitted infections have symptoms. If you are sexually active, have any of the symptoms above or are worried you may have an STI you should be tested regularly. Getting tested regularly is a good idea to ensure you have a healthy sex life. NHS services are free.
Find your local sexual health service.
Read more about STIs.