The Whole Lesbian Sex Book (46 page)

Chlamydia and Gonorrhea

According to the Lesbian-Bisexual Women’s Health Study, woman-to-woman transmission of chlamydia and gonorrhea “seems to be rare,” though such transmission is possible.
¹⁵
Why don’t we know how frequently women transmit chlamydia and gonorrhea to each other? Jeanne Marrazzo thinks this is a problem of surveillance and reporting. Both chlamydia and gonorrhea infect the cervix and can be transmitted through penetrative sex. Researchers, she says, assume that lesbians don’t have penetrative sex. (Interestingly, of the 149 women in Marrazzo’s study of HPV in women who have sex with women, 147 had penetrative vaginal sex with women in the year prior to the study.)
¹⁶

In fact, Marrazzo believes that chlamydia and gonorrhea can be transmitted by dildos and hands. According to her, a shared dildo can carry chlamydia and gonorrhea from cervix to cervix, as can an unwashed hand. If you engage in fisting and then touch yourself, you could acquire chlamydia or gonorrhea.
¹⁷
Wash your hands with bacterial soap when changing partners or sexual activities—and before you touch yourself.
¹⁸
Use condoms or gloves on shared sex toys, and use gloves on your hands.

With 3 million new infections each year in the United States alone, some health educators call chlamydia the “silent epidemic” because it’s so frequently asymptomatic. In fact, most women with chlamydia have no symptoms. Others may notice a yellowish vaginal discharge, painful urination, abdominal pain, or irregular bleeding. Untreated, chlamydia can lead to pelvic inflammatory disease (PID), a cause of infertility. Chlamydia is caused by
Chlamydia trachomatis
bacteria and is treated with antibiotics.

Symptoms of gonorrhea are similar to chlamydia—vaginal discharge, irregular bleeding, and PID symptoms. As with chlamydia, it’s possible to have gonorrhea without symptoms. Gonorrhea is caused by
Neisseria gonorrheae
bacteria and is treated with antibiotics.

Hepatitis

Hepatitis is an inflammation of the liver most commonly caused by three virus strains: hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Symptoms include fatigue, depression, nausea, loss of appetite, fever, chills, stomach pain, body aches, diarrhea, weight loss, headaches, and jaundice. Some people carry the hepatitis virus without having any symptoms at all. Hepatitis is diagnosed through a blood test. For many people, hepatitis is a lifelong chronic illness. If you have hepatitis B or C, don’t share toothbrushes, razors, or piercing/cutting instruments, and don’t expose partners to your menstrual blood.

Hepatitis A (HAV).
You can transmit or acquire hepatitis A through unprotected rimming—regardless of the gender of your partners. If you engage in unprotected rimming, consider getting a vaccination for hepatitis A and use a latex barrier or plastic wrap for rimming.

Hepatitis B (HBV).
You can transmit or acquire hepatitis B through cunnilingus, especially during menstruation. Hepatitis B is more likely to be transmitted through sharing needles for IV drug use, tattooing or piercing, and accidental needle sticks. If you engage in unprotected cunnilingus with menstruating partners, or if you engage in
any
activities where blood contact is possible, consider getting a vaccination for hepatitis B. Use a latex barrier or plastic wrap for cunnilingus.

Hepatitis C (HCV).
It’s estimated that almost 4 million people in the United States are infected with hepatitis C
¹⁹
—and perhaps as many as 200 million worldwide.
²⁰
In most cases, hepatitis C is asymptomatic for years, even decades, before progressing to chronic liver disease. Many people who are infected with hepatitis C don’t know they have it. Clearly, hepatitis C is epidemic.

The risk of sexual transmission of hepatitis C hasn’t been determined, though the risk is probably higher if you engage in S/M blood play or come into contact with blood during sex. Hepatitis C
may
be transmitted through woman-to-woman sex involving cunnilingus during menstruation. Hepatitis C is most often transmitted through sharing needles for IV drug use, tattooing or piercing, and accidental needle sticks. Use dental dams or other barriers to prevent transmission during cunnilingus. There’s no vaccination for hepatitis C.

Herpes

An estimated 150 million people in the United States have been exposed to the herpes-2 virus.
²¹
And one in five adults in the U.S. has genital herpes; an estimated 90 percent don’t know they have it.
²²
Herpes is a chronic, viral STD that’s extremely contagious:

• Many believe that the virus can be spread only during an outbreak—which is not true. The herpes virus may be shedding even when there are no visible symptoms.

• Herpes can be transmitted through skin-to-skin contact, including frottage (without clothing), hand-to-vulva, and hand-to-anus contact.

• Herpes sores can break out not only
on
the genitals but in the area
surrounding
the genitals. Condoms and dental dams may not cover a large enough area to prevent transmission during outbreaks.

• Herpes can be transmitted from one mucosal membrane to another—from mouth to vulva and from vulva to mouth. As the receptive partner in cunnilingus, you can get genital herpes from a partner who has oral herpes. As the partner performing cunnilingus, you can get oral herpes from a partner who has genital herpes. Oral herpes can be transmitted from mouth to mouth.

Herpes is caused by one of two viruses:
Herpes simplex type 1
(HSV-1), which is oral herpes; or
Herpes simplex type 2
(HSV-2), which is genital herpes. Prior to a herpes outbreak, you may experience flulike symptoms or itching and tingling in the affected area. You may develop a very painful, raw herpes blister in the affected area. Outbreaks can be brought on by stress or a compromised immune system. Health-care providers diagnose genital herpes by visual inspection and by testing a tissue sample from the sore. While there’s no cure for herpes, there are medications that can help prevent or alleviate outbreaks. Use gloves on hands for finger-fucking and fisting, and plastic wrap for oral sex. Cover sex toys with a condom or glove. Change condoms and gloves between partners.

Talking about sex histories and negotiating safer sex has improved my sex life, because I feel closer to my partner—and we also talk about what turns us on.

HIV (Human Immunodeficiency Virus)

HIV is transmitted when semen, blood, vaginal fluids, or breast milk of an infected person enter the bloodstream. Small lacerations or abrasions in the mouth, anus, vagina, or skin can provide a route for transmission of the HIV virus. Sores from herpes or other STDs can also provide a way for the HIV virus to enter the bloodstream, which is why having certain STDs can increase your risk for HIV.

Since HIV is present in both blood and vaginal secretions, it’s possible to transmit HIV through unprotected cunnilingus, particularly when the receptive partner is menstruating and the other has bleeding gums or sores in her mouth. It is assumed that HIV-positive women who have sex with women acquire HIV through IV drug use, sperm donor insemination, or sex with men.

Understanding the potential for woman-to-woman transmission is complicated by the fact that models for reporting incidents of HIV infection don’t account for lesbian sex. An HIV-positive lesbian or bisexual woman with other risk behaviors (for example, unprotected anal intercourse with men, injection drug use, needle use for piercing and tattooing, or use of unscreened semen for insemination) won’t be “counted” as a case of woman-to-woman transmission.

However, now there is proof of lesbian transmission. According to
POZ
magazine, a researcher found a genetic match between the HIV virus in a newly diagnosed woman and that of her HIV-positive partner. How did transmission occur? The woman had tested negative six months prior to the positive result. For the previous two years she had had only one sexual contact—her HIV-POSITIVE partner. She had no history of IV drug use or sex with men. She had never received a transfusion. She had no piercings or tattoos. She did not share razors or toothbrushes with her partner. They did not have sex during menstruation. Her partner used protection with only her male partners, “as instructed by her physician.”
²³

Ruling out other possibilities, the researcher, Dr. Helena Kwakwa, whose study was reported in
Clinical Infectious Diseases,
determined that transmission occurred via blood on shared sex toys. Not menstrual blood—but blood from hard play. Apparently, the HIV-positive partner had not been told to use condoms with sex toys. While the risk for transmission between women is low, “it’s there.” Kwakwa reported that she saw women “who would not be coming in with HIV if they’d had the proper information and recognition of risk.”
²⁴

Most people infected with HIV have no symptoms, since the virus can lie dormant for months and can take years to produce symptoms of AIDS. Symptoms of HIV in women resemble those of a number of other STDs, such as recurrent or difficult-to-treat yeast infections or PID. Use gloves on hands for finger-fucking and fisting, and plastic wrap for oral sex. Cover sex toys with a condom or glove. Don’t share needles, razors, or piercing/cutting instruments, and don’t expose partners to your menstrual blood.

HPV (Human Papillomavirus)

HPV is the virus commonly associated with genital and anal warts and with cervical cancer. More recently, it’s been established that virtually
all
cervical cancers (99 percent) are caused by HPV, though only a few of the many strains of HPV are thought to cause cervical cancer.
²⁵

Woman-to-woman transmission of HPV seems certain, even among women who have never had sex with men.
²⁶
HPV is so prevalent in the United States as to be ubiquitous, some health educators say.
²⁷

Like herpes, HPV can be transmitted through skin-to-skin contact when the virus is shedding—which may or may not be accompanied by the appearance of warts on the genitals or anus.

I came out to my partner about being HIV+ and having HPV on our first date. That was one intense date, let me tell you! We also talked about the kind of sex we like, and we had a very hot night of sex after our long personal discussion.

HPV can be transmitted through frottage (without clothing), hand-to-vulva, and hand-to-anus contact. You can acquire HPV by touching the affected area of a partner with your hand and then touching your own genital area without washing your hands.

You might discover you’ve been infected with HPV when warts appear on your genitals or anus. More likely, HPV is discovered through a routine Pap smear. Treatment may involve removing external genital and anal warts and treating cervical abnormalities through colposcopy, biopsy, and other procedures. HPV is infectious even after the warts are removed or cervical dysplasia disappears. There’s no cure for HPV, though progression to cervical cancer can be prevented by regular gynecological screening and follow-up. Use gloves on hands for finger-fucking and fisting, and plastic wrap for oral sex. Cover sex toys with a condom or glove. Change condoms and gloves between partners.

Syphilis

Syphilis is rarely transmitted through woman-to-woman sex—though it’s been documented to occur as a result of sex between women, according to Marrazzo. She adds: “Because rates of syphilis, a previously uncommon disease, have been skyrocketing among gay men, women who are involved in sexual networks that may also involve bisexual/gay men may be at increasing risk of exposure to this disease.”
²⁸
Syphilis initially appears as a single sore or chancre. It is caused by
Treponema pallidum
bacteria and is treated with penicillin. Refrain from unprotected sex until the infection has been treated.

Trichomoniasis

This condition can be transmitted through woman-to-woman sex, via contact with vaginal secretions.
²⁹
You can acquire trichomoniasis by touching the affected area of a partner with your hand and then touching your own genital area. Partners of an infected woman should be checked for trichomoniasis. “Trich” can lie dormant for months or years. As with bacterial vaginosis, symptoms include vaginal discharge, burning, irritation, painful urination, and strong vaginal odor. Trichomoniasis is caused by
Trichomonas vaginalis
protozoa and is treated with antibiotics. Use gloves on hands for finger-fucking and fisting, and plastic wrap for oral sex. Cover sex toys with a condom or glove. Change condoms and gloves between partners.

Urinary Tract Infections (UTIs)

While not sexually transmitted,
per se
, urinary tract infections deserve mention because women often get UTIs when bacteria are forced into the urethra during vaginal penetration. Often, women who have penetrative sex after a long hiatus get UTIs—hence the nickname “honeymoon disease.” You’ll know you have a UTI when you feel a persistent, painful need to urinate—even when your bladder is empty. If you suspect you have a UTI, see a physician immediately to prevent a more serious infection. You can help prevent UTIs by drinking a minimum of eight glasses of water a day and urinating before and after penetrative sex.