Our usual vocabulary round-up:
This episode is going to talk about queer women - but more specifically specifically on folks with vaginas having sex with other folks who have vaginas. Our subject matter is deliberately focused. Because we’re discussing sexually transmitted infections (STIs) and the things that can cause them, we have to be precise (and consistent) about what parts are being used during sex, and what’s happening to them. So in other words, we’re focusing on folks with vaginas because it allows us to be scientifically accurate about the risk of transmission and infection. But this is by no means a reflection of who is included within the community of queer women! For more on that subject, check our previous podcast episode.
Who’s STI and what’s she doing at this party? “STI” stands for “sexually transmitted infection” and is the cooler, hipper, Gen Z cousin to the millennial term “STDs” or “sexually transmitted diseases” The term “STI” has become favored within the medical community because: There’s stigma associated with the word “disease” Because things like gonorrhea and syphilis often have no symptoms. And so “infection” is a better word to reflect that fact
Why are we doing an episode on STIs for queer women with vaginas?
Queer women are often excluded or ignored within conversations/teaching about sexual health and STI risk
Why isn’t this more prominently discussed and understood? Queer women’s sex is ~varied~ (in terms of what anatomy is involved or what’s in what hole, if any). This makes it challenging to ascribe a standard amount of “risk,” since that risk could vary drastically between two queer women. The scientific literature on this subject isn’t doing us any favors, either. Papers that look at queer women’s STI risk use a variety of labels to define queer women, and it’s hard to find consistency or specificity. Lastly, there’s a widespread conception out ~in the ether~ that queer women have negligible (meaning, close to zero) risk of getting/giving STIs. So, some folks believe the subject isn’t worth spending time on.
The bottom line(s)
For folks with vaginas, the risk of STIs isn’t zero One study suggested that rates of chlamydia between queer women with vaginas are comparable to the rates in the general population Moreover, queer women with vaginas are susceptible to the same infections that other folks are at risk for, such as: Herpes Hepatitis A Trichomoniasis
Note: HIV is unlikely to spread by using fingers or toys, but queer folks with vaginas may still be at risk for HIV if they are having condomless sex with partners with penises, sharing needles, or participating in sexual or erotic blood play.
So while folks with vaginas who exclusively have sex with other folks with vaginas do have lower STI risks, there’s number of factors consider: Number of partners (since multiple partners provides more opportunities to introduce new bacteria) Whether there are penises present Whether toys or fingers are being inserted How and where folks put their mouths or tongues. Fewer things being inserted likely means lower risk of transmission, but it’s definitely not a zero-risk situation.
This is why, at the end of the day, we always recommend having an individualized conversation with your healthcare provider about your sexual practices.
BV: the STI that isn’t an STI
BV stands for “bacterial vaginosis”. It happens when the normal (read: healthy!) bacterial environment of the vagina gets thrown off balance, and can cause symptoms like changes in discharge, changes in odor, or itchiness.
It is more common in queer folks with vaginas by a factor of 2, which is thought to be related to: Whether a partner has BV already Oral sex (which can bring extra-vaginal bacteria to the vagina) Menses
What to do? None of us recommends going out of the way to prevent BV, but cleaning any toys you share with other partners is a great thing to do in general and will likely help reduce the risk of getting BV. If you know you have BV but don’t have symptoms (and aren't pregnant), Dr. Garment does not recommend treatment. If you do require treatment - either because of symptoms or because you are pregnant - then a short course of antibiotics usually solves the problem for most.
HPV - the sexually transmitted…virus?
What is HPV? HPV stands for “human papilloma virus” which is a virus that causes the overwhelming majority of cervical cancers. Mostly, HPV can be cleared by your immune system. The problem comes if (for whatever reason) your body isn't able to get rid of that infection. In these cases, HPV hangs around for too long and over years, it can start to cause changes in the cells of your cervix which, over time, can lead to cervical cancer.
What does this have to do with queer women, again? HPV can be transmitted in all sorts of ways – from a penis to vagina, from a mouth to any kind of genitals, from a mouth to a rectum. It can also be on toys, it can be on fingers. Said otherwise: queer women can get HPV from sex! In fact, when you look at HPV rates in, women who have sex with women, compared with women who identify as heterosexual, the rates are not so dissimilar in terms of the rate of HPV.
HPV prevention On a day-to-day basis, cleaning toys between use can help reduce the risk of transmission (if you're sharing your toy with more than one partner). You can check out if you're eligible for the Gardasil vaccine, which reduces the risk of getting HPV in the first place. Lastly, the cornerstone of all STI prevention is testing. In the case of HPV, it's going to be testing for the changes that it causes to your cervix via a pap smear.
Cleaning toys: a brief ode to the top rack of the dishwasher
Toys made of silicone or metal can be run through the top rack of the dishwasher.
Anything with a motor can be washed down with antibacterial soap.
Toys made of porous materials (eg, hard plastic) are difficult to clean fully. In these cases, barrier protection (eg, a condom) can limit transmission.
Dental dam…to the rescue?
Things dental dams are: Made of polyurethane Meant to be placed over par the vagina or anus while engaging in oral sex to reduce the fluids that are being transmitted between partners (and therefore reduce the number of potential STIs)
Things dental dams aren’t: Attractively named Used very often
Things dental dams may or may not be: Effective It’s hard to find data on this, TBH How protective they are (or aren’t) may be more a product of how consistently or correctly folks are using them An all-encompassing form of protection After all, queer women have many kinds of sex where barrier protection with a stretchy piece of latex won’t be helpful! At the end of the day, this is (as always) about knowing the risk of your individual sexual practice
