Let's be real for a second. The term "women who have sex with women" (WSW) sounds like something pulled straight out of a clinical textbook or a research paper from the CDC. It’s clunky. It feels detached. But doctors use it for a very specific reason: identity doesn't always equal behavior. You might identify as a lesbian, or you might be bisexual, queer, or even straight-identified but currently in a relationship with a woman.
The medical world doesn't care about your labels as much as it cares about what’s actually happening behind closed doors. For a long time, the assumption was that if you weren't having sex with men, you were "safe." No pregnancy risk? No problem. That mindset was dangerous. It led to a massive gap in healthcare where WSW were—and often still are—overlooked in discussions about sexual health, mental wellness, and preventative screenings.
Honestly, the "low risk" myth is one of the biggest hurdles we’re still jumping over. If you walk into a clinic and tell a provider you only have sex with women, sometimes they practically stop the exam right there. They skip the STI talk. They might even suggest you don't need a Pap smear. That’s just wrong.
The Myth of the "Safe" Zone
We’ve got to talk about the misconception that STIs don't happen in WSW relationships. It’s a persistent lie. Research from organizations like the Fenway Institute and studies published in the Journal of Women's Health show that while some risks (like HIV) are statistically lower than in other demographics, they aren't zero.
Bacteria and viruses don't check your orientation.
Bacterial Vaginosis (BV) is a prime example. While not strictly an STI, it’s incredibly common among women who have sex with women. It involves an imbalance of the vaginal flora. Studies have shown that WSW are significantly more likely to share vaginal microbes, meaning if one partner has BV, the other likely does too. It becomes this frustrating cycle of reinfection if both people aren't treated.
Then there’s HPV.
Human Papillomavirus is the most common STI across the board. It’s spread through skin-to-skin contact. You don't need a penis involved to transmit HPV. It can lead to cervical cancer, which is why the idea that WSW don't need regular screenings is literally life-threatening advice.
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Why the Data is Often Messy
Trying to find "perfect" data on this population is tough. Why? Because most medical forms only offer "Single, Married, Divorced" or "Male/Female." If a researcher doesn't ask specifically about the gender of your partners, you get lumped into the general female population.
Dr. Susan Dibble, a researcher who has spent years looking at lesbian health, has pointed out that this lack of specific data creates a "vicious cycle." If we don't count it, it doesn't exist. If it doesn't exist, we don't fund it. This is why many WSW feel like they have to be their own doctors half the time.
Barriers That Aren't Just Medical
It’s not just about the physical stuff. The mental load of being a woman who has sex with women in a healthcare system designed for heteronormativity is exhausting.
Think about the "coming out" process. You have to do it every single time you see a new specialist. You weigh the pros and cons. Is this orthopedist going to treat my knee differently if I mention my wife? Does my dermatologist need to know? This phenomenon is often called minority stress. It’s a term coined by Ilan Meyer to describe the chronic high levels of stress faced by members of stigmatized groups. It’s not just "in your head." It has physical manifestations. We see higher rates of smoking, alcohol use, and anxiety in the WSW community compared to their heterosexual peers. It’s a coping mechanism for navigating a world that often feels like it’s trying to erase or "fix" you.
And let’s be blunt about the "lesbian bed death" trope. It’s a sexist, outdated stereotype that suggests WSW relationships eventually lose all intimacy. It’s a narrative that ignores the complexity of how women relate to each other. Intimacy isn't a linear path. Sometimes it's about the quality of connection over the frequency of a specific act.
The Pregnancy Paradox
You’d think the one thing health providers would get right is that WSW don't usually need contraception for pregnancy prevention. But even here, there’s nuance.
Many women who have sex with women do need birth control for other reasons. Endometriosis. PCOS. Managing heavy cycles. When a doctor dismisses birth control options because "you don't need it for your lifestyle," they are ignoring the person's actual health needs.
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Furthermore, many WSW are actively trying to get pregnant. Navigating the world of ICI (Intracervical Insemination) or IVF (In Vitro Fertilization) is expensive and often bureaucratic. You’re often dealing with insurance companies that define "infertility" as "six months of unprotected sex with a man." If you don't have a male partner, you’re often forced to pay out of pocket for everything before insurance even considers helping. It’s a systemic barrier that treats WSW as an after-thought.
Breaking Down the Prevention Strategy
So, what does actual, practical health look like for women who have sex with women? It’s not about fear-mongering; it’s about being informed.
First, dental dams. Everyone laughs at them. They’re awkward. They smell like a balloon factory. But they are one of the few ways to actually reduce the risk of oral-to-genital transmission of things like herpes (HSV-1 and HSV-2) or syphilis.
Syphilis is actually making a comeback in various communities, and while the numbers are still low for WSW, it’s something to keep on the radar.
Clean your toys. Seriously. It sounds basic, but non-porous toys (like medical-grade silicone) are essential. Porous materials like cheap jelly or rubber can trap bacteria and viruses that a simple wash won't kill. If you’re sharing toys, use a new condom on the toy for each partner. It’s a simple fix that prevents a lot of grief.
The Doctor-Patient Connection
Finding a provider who gets it is life-changing.
You shouldn't have to explain what a "soft butch" is or why you’re not worried about pregnancy to your GP. Look for "LGBTQ+ friendly" tags on provider directories, but don't stop there. Ask questions.
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- "How many WSW patients do you see?"
- "What is your protocol for HPV screening in queer women?"
- "Are you comfortable discussing sexual health without making assumptions?"
If they flinch or look confused, find someone else. Your health is worth more than a polite conversation with an uneducated professional.
We also need to talk about the "all-women" spaces that are sometimes less than welcoming. Transgender women who have sex with women (WSW) often face a double-layered barrier. They deal with both transphobia and the general medical ignorance regarding WSW health. Inclusion isn't just a buzzword; it’s a medical necessity. A trans woman’s health needs are specific, and a healthcare provider needs to understand those nuances without being weird about it.
Looking Forward
The landscape is shifting. Slowly.
We’re seeing more research into the "Lez-B-Well" initiatives and more focus on the specific oncological risks for sexual minority women. For instance, there is a known "nuns' effect" (a bit of a misnomer, but stay with me) where women who haven't had children—which includes a significant portion of the WSW community—have a slightly higher statistical risk for breast and ovarian cancers. This is likely due to more lifetime menstrual cycles and the hormonal shifts that come with that.
It’s not a reason to panic. It’s a reason to stay on top of your screenings.
Basically, being a woman who has sex with women means taking charge of a narrative that the medical establishment often ignores. You have to be the loudest advocate in the room. You have to demand the tests that others try to skip. You have to prioritize your mental health in a society that still feels "kinda" uncomfortable with your existence.
Actionable Steps for Your Health
If you haven't been to a clinic in a while because it feels like a chore, here is your checklist. No fluff.
- Schedule that Pap smear. Regardless of who you are sleeping with, if you have a cervix, it needs to be checked. HPV is pervasive.
- Get a full STI panel. Ask for it specifically. Include throat and rectal swabs if that’s relevant to your sex life. Don't let them tell you "you're low risk" and send you home.
- Check your breasts. Know your "normal." Because of the slightly higher risk factors mentioned earlier, being proactive is your best defense.
- Find your community. Minority stress is real. Isolation makes it worse. Whether it’s an online group or a local center, connecting with other WSW is a legitimate health intervention.
- Audit your provider. If your doctor makes you feel like an alien, fire them. There are databases like the GLMA (Health Professionals Advancing LGBTQ+ Equality) that can help you find someone who won't blink when you mention your partner.
Your health isn't a secondary concern. It's the foundation of everything else. Stop settling for healthcare that only sees half of who you are.