Jun 272016

Welcome back to Open Minded Health Promotion! This week is all about how cisgender women who have sex with women, including lesbian and bisexual women, can maximize their health. As a reminder — these are all in addition to health promotion activities that apply to most people, like colon cancer screening at age 50.

Woman-and-woman-icon.svgAll cisgender women who have sex with women should consider…

  • Talk with their physician about their physical and mental health
  • Practice safer sex where possible to prevent pregnancy and sexually transmitted infections. Some sexually transmitted infections can be passed between women. If sexual toys are shared, consider using barriers or cleaning them between uses.
  • If under the age of 26, get the HPV vaccine. This will reduce the chance for cervical, vaginal, anal, and oral cancers.
  • Avoid tobacco, limit alcohol, and limit/avoid other drugs. If you choose to use substances and are unwilling to stop, consider using them in the safest ways possible. For example, consider vaporizing marijuana instead of smoking, or participate in a clean needle program.
  • Maintain a healthy weight. Women who have sex with women are more likely to be overweight than their heterosexual peers. Being overweight is associated with heart disease and a lower quality of life.
  • Exercise regularly. Weight bearing exercise, like walking and running, is best for bone health. But anything that gets your heart rate up and gets you moving is good for your body and mind!
  • Seek help if you’re struggling with self injury, anorexia, or bulimia. These issues are much more common in women than in men, and can be particularly challenging to deal with.
  • Consider taking folic acid supplements if pregnancy is a possibility. Folic acid prevents some birth defects.
  • Discuss their family’s cancer history with their physician.

Your physician may wish to do other tests, including…

  • Cervical cancer screening/Pap smear. All women with a cervix, starting at age 21, should get a pap smear every 3-5 years at minimum. Human papilloma virus (HPV) testing may also be included. More frequent pap smears may be recommended if one comes back positive or abnormal.
  • Pregnancy testing, even if you have not had contact with semen. Emergency situations are where testing is most likely to be urged. Physicians are, to some extent, trained to assume a cisgender woman is pregnant until proven otherwise. If you feel strongly that you do not want to get tested, please discuss this with your physician.
  • BRCA screening to determine your breast cancer risk, if breast cancer runs in your family. They may wish to perform other genetic testing as well, and may refer you to a geneticist.
  • If you’re between the ages of 50 and 74, mammography every other year is recommended. Mammography is a screening test for breast cancer. Breast self exams are no longer recommended.

One note on sexually transmitted infections… some lesbian and bisexual women may feel that they are not at risk for sexually transmitted infections because they don’t have contact with men. This is simply not true. The specific STIs are different, but there are still serious infections that can be spread from cis woman to cis woman. Infections that cis lesbians and bisexual women are at risk for include: chlamydia, herpes, HPV, pubic lice, trichomoniasis, and bacterial vaginosis (Source). Other infections such as gonorrhea, HIV, and syphilis are less likely but could still be spread. Please play safe and seek treatment if you are exposed or having symptoms.

Want more information? You can read more from the CDC, Gay and Lesbian Medical Association, and the United States Preventative Services Task Force.

Oct 192015

206px-Polytat.svgIf you were to ask 10 strangers the #1 way to prevent a sexually transmitted infection, what do you think they might answer? Very likely one of their answers will be “monogamy.” And they wouldn’t, strictly speaking, be wrong. The fewer numbers of people you have sexual contact with, the less likely it is you’ll have been exposed to a sexually transmitted disease. This concept gets drilled into high schoolers lucky enough to have a sexual education class: Be abstinent. If you’re not abstinent, at least be monogamous.

But monogamy isn’t for everyone. Some chafe at the practice, strongly preferring to share their love and sexuality with more than one individual. Monogamy is not for them. Instead of relying on monogamy to protect them from disease, they use barriers such as condoms and test themselves and their partners for disease. And they communicate.

Here’s a question though: Does the use of barriers protect as well as monogamy does? I’ve felt it probably does, but haven’t seen any data to say one way or another.

And then this study was published!

This week’s study polled monogamous and (consensual) non-monogamous people and asked them about their sex life, their use of barriers, their STI testing, and so on. They recruited around 550 participants, 70% female, 63% monogamous, 77% heterosexual.

What did they find?

Among the nonmonogamous participants, 72% had sex with a partner other than their primary partner. 37% reported that their primary did not know about this sexual encounter.

Among the monogamous participants, 24% had sex with a partner other than their primary partner. 75% reported that their primary did not know about this sexual encounter.

In other words: both monogamous and nonmonogamous participants, as groups, had sexual encounters with people other than their primary partner. Nonmonogamous people were more likely to have that sex and to tell their partners about it. When monogamous people had sex outside their partnership they were far less likely to tell their partner.

And what about safe sex? Both monogamous and nonmonogamous participants were equally likely to use barriers with their primary partner. However, nonmonogamous participants used barriers with others more often than monogamous participants.

When it came to STIs, there was no difference in actual diagnoses of STIs. But nonmonogamous people were more likely to get tested.

Now — let’s translate all that.

What this ultimately means is that people who practice consensual nonmonogamy are no more likely to get a sexually transmitted infection than are monogamous people. This is very likely because nonmonogamous people use barriers/condoms with other partners and get tested more often.

As the paper stated: “Persons who have made monogamy agreements often break them, and when they do, they are less likely to take safety precautions, get tested for STIs, and disclose those extradyadic encounters to their partners than persons who agree to some form of negotiated nonmonogamy.” Absolutely.

Monogamy is one way to try to prevent the spread of STIs…and it is equally as effective as clear communication and relationship negotiation with the use of barriers and STI testing in non-monogamous relationships.

The study was published in the Journal of Sexual Medicine, and its abstract is publicly available.

Mar 072011

A report recently came out looking at trends in the medical literature regarding LGBT people. This is a meta-analysis (i.e., it is an article summarizing the original research of others – it is a secondary source) that looked at articles from 1950-2007.

Findings include:

  • Estimations of percentage of the population that is LGBT ranges from 2 to 10%, depending on the survey. In the United States, this should be between 6 and 30.4 million people.
  • Lesbians have a higher risk for breast and gynecological cancers. Gay men are at higher risk for anal cancer. We don’t know if these are because of genetics (homosexuality may have a genetic root), sexual practices, or culture.
  • You can continue reading to understand the biggest barrier to health care for LGBT patients is stigmatization by health care providers, because of poor education and training: “Providers as a whole need to better understand the distinct difference between LGBT status and persons with ‘high risk’ sexual behaviors.” (pg 166)
  • There is an overemphasis in the literature on sexual behavior-related topics. About 1/3rd of all papers published about LGBT people are about HIV, AIDS, STIs, and other related illnesses. This is by far the biggest group of papers. About 13% of papers are about mental health issues, and another 12% are stigmatizing articles about the causes and treatment of homosexuality. All other topics are covered by less than 9% of papers. For example, only 3.28% of papers deal with patient-health care provider interactions, and 2.66% deal with transsexual issues. This overemphasis means that we don’t have enough information about other illnesses that affect LGBT people.
  • Some research specifically excludes LGBT people with no clear explanation or reasoning behind it. This is actually against NIH research policy – populations canNOT be excluded without reason.


Snyder, J. E. (2011). Trend Analysis of Medical Publications About LGBT Persons: 1950-2007. Journal of Homosexuality, 58: 164-188.