Sexual practices, risk perception and knowledge of sexually transmitted disease risk among lesbian and bisexual women.

Context: Sexually transmitted diseases (STDs) can be spread between female sex partners, probably through the exchange of cervicovaginal fluid and direct mucosal contact. Additionally, lesbians have a high prevalence of bacterial vaginosis, which may represent an STD in this population. However, few data on sexual practices or perceived STD risk among lesbians are available to guide development of interventions aimed at reducing the risk.

Methods: To inform the development of a safer-sex intervention for women who have sex with women, focus group discussions were conducted with 23 lesbian and bisexual women aged 18-29. Topics included sexual practices, STD transmission and prevention, and knowledge about bacterial vaginosis.

Results: Although six participants had had bacterial vaginosis and three an STD, women reported little use of preventive measures with female partners (washing hands, using rubber gloves and cleaning sex toys). Participants said that vaginal penetrative practices using sex toys and fingers or hands are common, and that partners frequently share sex toys during a sexual encounter, generally without condoms. Knowledge of potential for STD transmission between women, and of bacterial vaginosis, was limited. Participants viewed use of barrier methods (gloves or condoms) as acceptable, provided that there is a reason (usually STD-focused) to use them and that they are promoted in the context of sexual health and pleasure.

Conclusions: Safer-sex messages aimed at lesbian and bisexual women should emphasize the plausibility of STD transmission between women, personal responsibility and care for partners' well-being; should target common sexual practices; and should promote healthy sexuality.